Introduction to types of pregnancy loss before 20 weeks
Pregnancy loss before 20 weeks can happen in different ways. Doctors, nurses, and midwives often use medical terms to explain what’s happening in your body. These words aren’t meant to upset or blame you — but they can feel clinical or hard to hear during an emotional time.
In this section, we explain the different types of pregnancy loss you might hear about. You may recognise your own experience, or you might still be waiting for answers. Most people are given one clear diagnosis, but early signs like bleeding can lead to different outcomes, and it may take time to understand what’s happening.
This section starts with a table showing the main types of pregnancy loss and common medical terms used to describe these. Then we explain each one in more detail — what it means, how it’s confirmed, and what care might be offered. This step-by-step approach is designed to help you find the right information when you need it, without feeling overwhelmed.
You may come across terms like miscarriage, ectopic pregnancy, molar pregnancy, or pregnancy of unknown location. These describe different ways a pregnancy can develop, sometimes outside the usual pattern.
When a pregnancy doesn’t continue, each type of loss is unique — and so is the care and support that may be needed.
We hope this section helps you feel more informed — whether you’re learning about your own experience or supporting someone close to you.
A note on the words we use
People describe pregnancy loss in different ways. Some think of what is passed as their baby. Others may call it pregnancy tissue. There’s no right or wrong way to feel or speak about your experience.
In this section, we use the term pregnancy tissue to describe what may be passed during a loss. This can include the baby, the placenta, and other tissue connected to the pregnancy. What is passed can look and feel different depending on how far along the pregnancy was. We understand this kind of loss is deeply personal. We use this term gently and with respect for the many ways people experience and describe their loss. Please use the words that feel right for you.
| Terms used to describe pregnancy loss | What it means |
|---|---|
Threatened miscarriage | Bleeding in early pregnancy, but the baby may still be okay, and the cervix is closed. |
Miscarriage | The pregnancy ends before 20 weeks, often in the first 12 weeks. |
Incomplete miscarriage | Some pregnancy tissue has passed, but some is still in the uterus. |
Complete miscarriage | All pregnancy tissue has passed from the uterus. |
Missed miscarriage | The baby has stopped growing and has no heartbeat, but there are no signs like pain or bleeding. Usually found on an ultrasound. |
Inevitable miscarriage | Bleeding has started and the cervix is opening. A miscarriage is likely to happen soon. |
Septic miscarriage | A miscarriage with an infection in the uterus. This needs urgent medical care. |
Late miscarriage | A pregnancy loss between 14 and 20 weeks. Also called second trimester miscarriage. |
Recurrent miscarriage | Two or more pregnancy losses before 20 weeks, even if they don’t happen one after another. |
Caesarean scar pregnancy | A rare pregnancy where the baby starts growing in or near the scar from a past caesarean birth. |
Pregnancy of unknown location (PUL) | A positive pregnancy test, but the pregnancy can’t be seen yet on an ultrasound. |
Anembryonic pregnancy | A pregnancy sac grows, but no baby develops inside. Also called a “blighted ovum.” |
Molar pregnancy | A rare condition where abnormal cells grow in the uterus instead of a baby. |
Single death in a multiple pregnancy | One baby dies during a multiple pregnancy (such as a twin pregnancy), while the other continues to grow. |
Termination of pregnancy | When a pregnancy is ended due to medical or other reasons. |
Types of pregnancy loss before 20 weeks
A threatened miscarriage means there is vaginal bleeding in early pregnancy, but the cervix is still closed, and the pregnancy may still continue. It can be a very uncertain and emotional time.
Why it happens
Bleeding in early pregnancy is common and can happen for many reasons. It might be caused by implantation, hormone changes, or changes in the cervix.
Having experienced miscarriage before or other pregnancy complications can slightly increase your risk — but many people who experience bleeding in early pregnancy go on to have a healthy pregnancy.
How it’s confirmed
Your care provider will look at your symptoms and may do some tests to understand what is happening and how the pregnancy is progressing.
These may include:
- Ultrasound scan — to check whether the pregnancy is inside the uterus (not ectopic), confirm a heartbeat if visible, and estimate how far along the pregnancy is.
- Blood tests (pregnancy hormone, hCG levels) — these may be done if the ultrasound is too early to confirm a pregnancy inside the uterus. Measuring hCG levels over time can help show whether the pregnancy is developing. Once an ultrasound confirms a pregnancy in the uterus, hCG levels are usually not needed.
- Pelvic examination — to check whether the cervix is open or closed.
Sometimes, your care provider may not be able to give a clear answer straight away. You might be asked to come back for a repeat scan after a few days or weeks. This waiting can be emotionally hard, and support is available if you need it.
What care might be offered
Your care provider may:
- Recommend another ultrasound, especially if it’s too early to see a heartbeat or check how the pregnancy is going.
- Suggest more blood tests to check pregnancy hormone levels (hCG), but only if it’s not clear whether the pregnancy is in the uterus. If a healthy pregnancy in the uterus is confirmed, more blood tests are usually not needed.
- Talk with you about rest and activity. There’s no strong evidence that bed rest prevent miscarriage, but it’s still important to listen to your body. If you feel tired or unwell, take it easy. You can ask your care provider what kind of activities are okay or you.
In some areas, you may be referred to an Early Pregnancy Assessment Unit (EPAU) for extra support and checks. If there isn’t one nearby, your GP, midwife, or local hospital can still help and arrange any tests you need.
What to expect next
A threatened miscarriage can be scary and confusing. It’s normal to feel worried while waiting for answers.
- You might still have pregnancy symptoms like nausea or breast tenderness, even if there are concerns. These symptoms are common but don’t always show us what’s going on.
- If bleeding stops and the ultrasound results are reassuring, the pregnancy will most likely continue.
- If symptoms change or get worse — like heavier bleeding, stronger pain, or a sudden stop in pregnancy symptoms — talk to a healthcare professional. It doesn’t always mean something is wrong, but it’s best to check.
Sometimes, the outcome is clear right away. Other times, more tests and waiting are needed. Waiting can be hard. It’s okay to ask questions, talk to someone you trust, and take things one day at a time.
A miscarriage (sometimes called a spontaneous miscarriage) is the most common type of early pregnancy. It affects about 1 in 4 known pregnancies. Most miscarriages happen in the first 12 weeks of pregnancy (the first trimester), though some can happen later, between 14 and 20 weeks. Later miscarriage is explained in the next section.
In most cases, once a miscarriage begins, sadly there is no treatment that can stop it. This doesn’t mean your concerns aren’t important — it just means that your care team may not be able to change what’s happening. They are still here to support you and help you understand what to expect.
A miscarriage can start suddenly, with bleeding or cramping. But sometimes there are no signs. Very early pregnancy loss, which happens before 5–6 weeks (sometimes called a chemical pregnancy), may only be detected by a rise and fall in the pregnancy hormone (hCG) in your blood or urine. It’s often not visible on ultrasound and may feel like a normal or slightly heavier period.
Some losses may only be found during a check-up or ultrasound. This is called a missed miscarriage, where the pregnancy has stopped developing, but the body hasn’t recognised this yet.
You might hear terms like incomplete miscarriage, inevitable miscarriage, or complete miscarriage. These describe what’s happening in the body and help guide your care. Even though the names are different, the care offered is often similar.
Why it happens
Most miscarriages happen because of differences in the baby’s chromosomes. Chromosomes carry instructions for how the body grows and develops. These differences usually happen by chance and are not caused by anything you did or didn’t do.
Other things that might increase the risk include:
- Age — egg quality changes with age, especially after age 35.
- Health conditions — like thyroid problems or diabetes.
- Uterus differences — in the shape or lining.
- Lifestyle factors — like smoking or having too much caffeine. More than 200 milligrams of caffeine a day (about 2–3 cups of coffee) may slightly increase the risk of miscarriage. Caffeine is also in tea, cola, energy drinks, and chocolate.
Many of these things are out of your control. Miscarriage usually happens without a clear reason. It doesn’t mean something is wrong with your body, and many people go on to have healthy pregnancies afterward.
How it’s confirmed
Your care team will ask about your symptoms and may do tests to understand what’s happening.
These may include:
- Ultrasound — the main way to check the pregnancy and confirm a miscarriage.
- Physical examination — if you have pain or bleeding, they may check your abdomen or do a vaginal exam.
- Blood tests — sometimes used if it’s too early to confirm the pregnancy with an ultrasound.
Sometimes the results aren’t clear right away. You may need more than one ultrasound, usually over 1–2 weeks. Waiting can be hard, but these tests help your care team give you the right support.
What care might be offered
If a miscarriage is confirmed, your care team will talk with you about your options.
These may include:
- Expectant management — waiting for the pregnancy tissue to pass through the vagina.
- Medical management — taking a medication called misoprostol to help you deliver the pregnancy tissue through the vagina.
- Surgical management — an operation to remove the pregnancy tissue from your uterus.
Each option has its own risks and benefits. Your team will help you choose what feels right for your body and your situation. You can also talk about what will help you feel more comfortable — like where you’ll be, who can support you, and what to expect.
You can read more about these options in the next section: “Understanding your care after a pregnancy loss.”
A septic miscarriage happens when pregnancy tissue stays in the uterus after a miscarriage and becomes infected. This is rare, but it can cause serious illness if not treated quickly.
You might notice:
- Fever or chills
- Pain in the lower belly
- Unusual or smelly vaginal discharge
- Feeling weak or unwell
If you have any of these symptoms, seek medical help right away. Fast treatment can help prevent serious problems.
Why it happens
Septic miscarriage is caused by bacteria getting into the uterus and causing an infection. This can happen:
- If some pregnancy tissue stays in the uterus after a miscarriage.
- If a miscarriage lasts a long time without medical care.
- (Rarely) after a procedure to remove pregnancy tissue.
This is not your fault. Infection after miscarriage is uncommon, but it can be serious. Knowing the signs and getting help quickly can lower the risk.
How it’s confirmed
If your care provider thinks you might have a septic miscarriage, they may do:
- Blood tests to check for infection.
- An ultrasound to look for any remaining pregnancy tissue.
- A physical examination to look at symptoms like fever or pain.
These tests help confirm the infection and guide your treatment.
What care might be offered
Septic miscarriage needs quick medical care. You may need:
- Antibiotics — often given through a drip in hospital.
- Close monitoring — of vital signs, temperature, and response to treatment.
- Medical management — taking a medication called misoprostol to help you deliver the pregnancy tissue through the vagina.
- Surgical management — an operation to remove the pregnancy tissue from your uterus.
Your care team will check to make sure the infection is getting better. Most people recover well with the right care.
You can read more about surgery, hospital care, and recovery in the next section: Understanding your care options after a pregnancy loss.
A late miscarriage is when a pregnancy ends between 14 and 20 weeks. It’s also called a second trimester miscarriage.
Because the pregnancy is further along, the experience likely includes labour and birth. This means you experience contractions, and the birth process can take several hours or sometimes longer. You’ll likely be cared for in a maternity ward in a hospital, where your care team will support you both physically and emotionally. The physical experience can be intense and exhausting, the medical team can discuss pain relief options with you and ensure you’re as comfortable as possible throughout the process.
Sometimes, the baby may have died days or weeks earlier before the loss is found. This can affect how the birth is managed and what care is offered. Your care team will explain what to expect and help you make decisions that feel right for you.
Why it happens
Late miscarriage can happen for many reasons. Sometimes a cause is found, but often it isn’t. It’s rarely caused by anything you did.
Possible causes include:
- Infections during pregnancy.
- Cervical insufficiency (when the cervix opens too soon) — there is a chance that your baby might be born with signs of life, which will change the plans for care after birth in regard to registration of birth and death. Your care provider will guide you through this process and explain what options and requirements apply in your situation.
- Complications in the baby such chromosomal or genetic conditions, structural anomalies or developmental problems.
- Problems with the placenta (like early separation or slow growth).
- Health conditions (like high blood pressure or diabetes).
Even with testing, a clear reason isn’t always found. Your care team will support you, whatever the results.
How it’s confirmed
To understand what’s happening, your care team may suggest:
- Ultrasound scans — to check for the baby’s heartbeat, position, and how the placenta is working.
- Physical examination — to check for signs of early labour or infection.
If a miscarriage is confirmed, you may be offered further tests to look for a cause such as:
- Blood tests — to check for infections or health conditions.
- Tests on the baby or placenta — if you agree, this might help understand the cause and help guide future care.
What care might be offered
Your team will talk with you about your options and provide:
- Clear information about what’s happening.
- Emotional support before, during, and after the birth.
- Time and space to make decisions with your partner or family.
If you’re unsure, ask questions. Your care team is there to help. Depending on your situation, you may be offered:
- Expectant management — waiting for the baby and placenta to pass through the vagina.
- Medical management — taking a medication called misoprostol to help you deliver your baby and placenta through the vagina.
- Surgical management — an operation to remove the baby and placenta from your uterus. For pregnancies beyond 14 weeks, surgical management may not be possible due to the baby’s size, so medical management is usually recommended.
Your care team will explain each option, offer pain relief, and provide emotional support. You can read more about these options in the section: ‘Understanding your care after a pregnancy loss’.
Recurrent miscarriage means having two or more pregnancy losses before 20 weeks, even if they don’t happen one after another. It affects about 1 to 4 in every 100 women.
Going through this more than once can be very hard. People often feel a mix of emotions — grief, sadness, fear, or guilt. Everyone experiences it differently. Support is available, and you’ll find more information about counselling, peer support, and specialist care later in this guide.
Why it happens
There are many possible reasons for recurrent miscarriage. These may include:
- Genetic differences in the embryo.
- Differences in the shape or lining of the uterus.
- Hormone problems, like thyroid issues or low progesterone.
- Blood clotting conditions, such as antiphospholipid syndrome.
- Immune system problems.
- Being over 35 years of age can also increase the risk.
Sometimes, no clear cause is found — even after testing. This can be hard and leave people feeling frustrated or without answers. It can also raise worries about infertility or what the future holds, adding to the emotional toll of repeated loss.
How it’s confirmed
If you’ve had two or more miscarriages, your care provider may suggest:
- Genetic testing for you and your partner.
- Blood tests to check your hormones, immune system, and blood clotting.
- Ultrasound scans to look at your uterus and nearby structures.
These tests can help find any causes and guide your care in future pregnancies.
What happens next
If a cause is found, your doctor may suggest:
- Medicine or treatment for any health conditions.
- Extra care and monitoring early in your next pregnancy.
- A referral to a specialist clinic that supports people with recurrent loss.
Even if no cause is found, having more care and support in your next pregnancy can still help. Many people go on to have a healthy pregnancy with the right care.
If you need emotional support after multiple losses, you can access support through Pink Elephants’ Bereavement Support Program, which offers connection and counselling for those navigating recurrent miscarriage, as well as Red Nose and other support services.
An ectopic pregnancy happens when a fertilised egg attaches outside the uterus — most often in a fallopian tube. In rare cases, it may grow in the cervix, ovary, caesarean scar, or abdomen.
It affects about 1 in 80 pregnancies. While ectopic pregnancies are uncommon, finding them early is important to avoid serious complications.
A pregnancy cannot grow safely outside the uterus. As it gets bigger, it can cause pain, internal bleeding, or damage to nearby organs. An ectopic pregnancy is not safe and needs treatment to protect your health.
Why it happens
Ectopic pregnancy can happen to anyone. Often, the cause is not known. Some things that may increase the risk include:
- A previous ectopic pregnancy.
- Past pelvic infections (like chlamydia or pelvic inflammatory disease).
- Surgery on the fallopian tubes or pelvis.
- Fertility treatments.
- Smoking.
Problems with the shape or function of the fallopian tubes may also play a role.
How it’s confirmed
Your care provider may suspect an ectopic pregnancy if:
- You have pain or bleeding.
- Nothing is seen in the uterus during an early scan.
- You have symptoms like shoulder tip pain, dizziness, or feeling faint—these may suggest internal bleeding and need urgent care.
You may be offered:
- An ultrasound to look for the pregnancy.
- Blood tests to check pregnancy hormone levels (hCG) over time.
- A physical examination, especially if you have symptoms.
Sometimes, it takes more than one visit to confirm an ectopic pregnancy.
What care might be offered
If an ectopic pregnancy is confirmed, your care team will talk with you about the safest option. This may include:
- Expectant management — in some early cases of ectopic pregnancy your doctor may recommend watching and waiting. This is only an option when the pregnancy is not growing and pregnancy hormone levels (hCG) are dropping. You’ll be closely monitored with regular blood tests and check-ups.
- Medical management — taking a medication called methotrexate to stop the pregnancy from growing. It’s used when the pregnancy is small, and you meet certain safety criteria.
- Surgical management — an operation to remove the pregnancy tissue. This may be needed if the pregnancy is growing, if you have pain, or if there is a risk of internal bleeding.
Your care team will explain each option and help you choose what’s best for your body and situation. You can read more about these treatments in the next section: Understanding your care after a pregnancy loss.
A caesarean scar pregnancy happens when a pregnancy starts in or near the scar from a past caesarean birth. Instead of growing in the usual part of the uterus, the pregnancy grows into the scar tissue. Doctors or your medical notes may refer to this as a ‘CSP’.
Caesarean scar pregnancies are rare, but they are being seen more often because:
- More people are having caesarean births.
- Scans are better at picking up these types of pregnancies earlier.
- Health professionals now know more about what signs to look for.
Why it happens
A caesarean scar pregnancy happens when the scar from a previous caesarean creates a weak spot in the uterus, where a pregnancy may begin to grow. You may be at higher risk if you:
- become pregnant less than 18 months after a caesarean birth.
- have had more than one caesarean birth.
How it’s confirmed
Some people have no symptoms. When symptoms do happen, they may include:
- Light vaginal bleeding.
- Mild cramping or pain in the lower abdomen.
- Usual early pregnancy symptoms, like nausea.
A caesarean scar pregnancy is usually found during an early ultrasound scan. Sometimes, a small probe may be gently placed in the vagina for a clearer scan. This is called a transvaginal ultrasound and is often used early in pregnancy.
The best time to diagnose a caesarean scar pregnancy is between 5 and 7 weeks of pregnancy. The scan checks:
- Where the pregnancy sac is.
- How thick the muscle wall is around the scar.
- Whether a heartbeat is present.
Sometimes, diagnosis takes time. You may need to return for another scan or blood test. Waiting can be hard, but your care team is there to support you.
What care might be offered
Your care will depend on whether a heartbeat is seen.
If there is no heartbeat
The pregnancy will not continue. Treatment options may include:
- Expectant management — this can be referred to as “wait and watch”. In some cases, the body may pass the pregnancy on its own. But because caesarean scar pregnancies are in scar tissue, there is a higher risk of bleeding.
Your doctor may still recommend other treatment options including:
- Medical management — taking a medication like methotrexate to stop the pregnancy from growing.
- Surgical management — an operation to safely remove the pregnancy, especially if there is bleeding or if the scar is very thin.
Your care team will talk with you about which option is the safest and best option for you and support you throughout.
If a heartbeat is seen
The pregnancy is still growing, and decisions can be more complex. Your care team may talk with you about two options:
Ending the pregnancy
- Often recommended to reduce serious health risks.
- Early treatment can prevent complications like heavy bleeding or damage to the uterus.
- Helps protect your overall health and future ability to have children.
Continuing the pregnancy
- Some people choose to continue, with very close monitoring medical care.
- Some babies are born safely, but most are born early.
- There can be serious problems with the placenta and uterus that may put your life at risk.
- In many cases, surgery to remove the uterus (hysterectomy) is needed. This means you wouldn’t be able to carry another pregnancy.
Your care team will explain all the risks, answer your questions and help you make the decision that’s right for you.
Seek help straight away if you have:
- Heavy bleeding (soaking one pad every hour for two hours and/or passing large clots).
- Severe belly or pelvic pain.
- Dizziness or fainting.
- Shoulder pain (which can be a sign of internal bleeding).
A pregnancy of unknown location happens when your pregnancy test is positive, but nothing can yet be seen on an ultrasound — either inside or outside the uterus. Doctors or your medical notes may refer to this as a ‘PUL’.
Why it happens
A pregnancy of unknown location can happen when:
- the pregnancy is too early to be seen on a scan.
- a miscarriage has already happened before the pregnancy could be seen.
- the pregnancy is ectopic (growing outside the uterus), but it’s too early to detect.
Most pregnancies of unknown location turn out to be early miscarriages or normal pregnancies that are just too early to see. But sometimes, it may be an ectopic pregnancy, which needs urgent care.
How it’s confirmed
Your care provider may recommend:
- Blood tests over several days to track pregnancy hormone levels (hCG).
- Repeat ultrasounds to see if the pregnancy becomes visible.
These tests help show whether the pregnancy is developing normally, is ectopic, or has ended in a miscarriage.
What care might be offered
You’ll be closely monitored until your care team can confirm where the pregnancy is, or until your hormone levels return to normal.
- If it turns out to be a healthy pregnancy, care will continue as usual.
- If it is a miscarriage or an ectopic pregnancy, your care team will talk to you about next steps.
This process can take time and may feel stressful. More information about treatment and care options is included later in this guide.
An anembryonic pregnancy, also called a blighted ovum, is a type of early pregnancy loss. It happens when a fertilised egg attaches to the uterus, but the baby doesn’t start to grow.
Even though a pregnancy sac forms, it stays empty. Your body may still make pregnancy hormones for a while, and you might feel early symptoms of pregnancy. This type of loss is often not found until a routine scan. It can be confusing — especially if there are no warning signs.
Why it happens
Anembryonic pregnancy usually happens because of chromosome problems in the fertilised egg. These problems stop the baby from developing, even though your body still supports the pregnancy for a time.
This is not caused by anything you did or didn’t do. Risk factors may include being older or having had a pregnancy loss before. But in many cases, no clear cause is found.
How it’s confirmed
Your care provider will usually use an ultrasound scan to check the pregnancy. This scan looks at the size and shape of the pregnancy sac and whether anything is developing inside it.
Sometimes, if the scan is done very early or the results aren’t clear, you may be asked to:
- Come back for another scan in a week or two.
- Have blood tests to check your pregnancy hormone levels (hCG).
These follow-up tests help your care team be sure before making a diagnosis. Waiting for answers can be hard, but your care team is there to support you and answer any questions.
What care might be offered
If an anembryonic pregnancy is confirmed, there are a few ways it can be managed:
- Expectant management — waiting for the pregnancy tissue to pass through the vagina.
- Medical management — taking a medication called misoprostol to help you deliver the pregnancy tissue through the vagina.
- Surgical management — an operation to remove the pregnancy tissue from your uterus.
Your care provider will talk with you about what feels right for your body, your health, and your situation.
You can read more about these options in the next section: Understanding your care after a pregnancy loss.
A molar pregnancy is a rare type of early pregnancy loss. It happens in about 1 in every 1000 pregnancies. Instead of growing into a healthy baby and placenta, the pregnancy cells grow in an abnormal way.
There are two types:
- Complete molar pregnancy — no baby forms. Only abnormal tissue grows in the uterus.
- Partial molar pregnancy — a baby may start to form but cannot grow normally and will not survive.
Why it happens
Molar pregnancy is caused by a chromosome problem during fertilisation. This stops the pregnancy from developing properly.
You may be at slightly higher risk if you:
- Are a teenager or over 40 years of age.
- Have had a molar pregnancy before.
In most cases, there is no known cause, and it is not anything you did or didn’t do. These pregnancies happen by chance and can’t be predicted or prevented.
How it’s confirmed
Your care provider may suspect a molar pregnancy if:
- You have strong pregnancy symptoms, like severe nausea or vomiting.
- Your uterus feels larger than expected.
- Your pregnancy hormone (hCG) levels are higher than normal.
- An ultrasound shows an unusual pattern.
Most molar pregnancies are first seen on an ultrasound, but are only confirmed after the pregnancy tissue is tested by in a lab. This is called histology.
What care might be offered
If a molar pregnancy is confirmed, your care team will usually recommend an operation to remove the pregnancy tissue. Medicine is not usually used to treat a molar pregnancy.
You’ll need follow-up care to make sure all the molar tissue is gone and that your body is recovering. This usually includes:
- Regular blood tests to check your pregnancy hormone levels (hCG) return to normal (this may take weeks or months).
- Waiting until your hCG levels return to normal and stay stable for several months before trying for another pregnancy. During this time, using reliable contraception is important to avoid a new pregnancy, so your doctor can clearly track your recovery without confusion.
- This waiting time can feel hard and uncertain. But it’s an important for your safety and to avoid complications. If you’re finding it difficult, your care team or a support organisation, like Pink Elephants, can help.
Rare complications
In rare cases, some molar tissue keeps growing. This is called Gestational Trophoblastic Neoplasia (GTN). It is treatable, and your care team will continue to monitor you closely if this happens.
If you’re expecting twins or more, and one of your babies dies, it can bring mixed emotions. You may feel grief and sadness for the baby you lost, while also trying to stay hopeful for the baby who is still growing.
There is no way to save the baby who has died, but your care team will focus on keeping you and the surviving baby safe. You may have more scans and check-ups. Your care plan will depend on how far along you are and whether the babies share a placenta.
In most cases, the surviving baby can keep growing and be born safely with the right medical care.
Why it happens
This is called a single fetal death in a multiple pregnancy. It can happen at any stage.
In early pregnancy (before 12 weeks), it’s often called vanishing twin syndrome. One baby stops developing, usually because of how they implanted or formed.
In later pregnancy, causes may include:
- problems with the placenta.
- growth issues.
- twin-to-twin transfusion syndrome (in identical twins).
- other medical concerns.
This is not your fault. Often, no clear cause is found.
How it’s confirmed
The loss is usually found during an ultrasound. You may not have any symptoms.
- In early pregnancy, one baby may stop developing and disappear from the scan.
- In later pregnancy, the scan may show that one baby no longer has a heartbeat.
You may need extra scans to check the health of the surviving baby.
What care might be offered
Your care will depend on how far along you are, and how you and the surviving baby are doing. Your care team may:
- Monitor your pregnancy more closely.
- Explain what to expect for the rest of your pregnancy and birth.
- Support you emotionally and practically.
What to expect
If the loss happens before 12 weeks, the baby who died is usually absorbed into the body. Many people don’t know it has happened until an ultrasound shows it.
If the loss happens after 12 weeks, the baby who died will stay in the uterus until birth. When your surviving baby is born at term, the baby who died will also be delivered. Their body may look different when born (they may be more flattened and drier). Your care team will gently explain what to expect and offer support.
Understanding grief in a multiple pregnancy
If your baby’s death occurred early in the pregnancy, you may still be processing this loss as your pregnancy with your surviving baby continues. It can be especially challenging to grieve one baby while caring for a surviving twin or triplet.
You may feel joy and grief side by side. You might also feel pressure to focus on the surviving baby during pregnancy or to move on before you feel ready. Be gentle with yourself, and allow space for both your love and your loss.
Speak to your healthcare team about what support options are available locally, and what might feel right for your family as you navigate pregnancy after the loss of one of your babies.
It may be helpful to think about ways to honour your baby, while still pregnant. This might be through creating a memory box of ultrasound images and mementos from your pregnancy. See the next section on memory making and honouring your baby. Later chapters in this guide also offer gentle support for coping, grieving, and honouring your baby. You can also speak with your care team or contact groups like Red Nose or the Pink Elephants Support Network. You may also find the booklet, ‘Guiding Conversations’ helpful during this time — carearoundloss.stillbirthcre.org.au
Registration and acknowledgement of your babies
The loss of one baby in a multiple pregnancy can be complicated because recognition of this loss varies — medically, legally, and socially. Each state and territory has different requirements and options for registration and acknowledgement.
Depending on your location and circumstances, you may have options to formally recognise your baby who has died. This might include registering a birth and death, or other forms of acknowledgement. Your healthcare provider can explain what options are available in your area and help you understand the requirements.
This is entirely a personal decision. Some parents find comfort in official recognition, while others prefer to honour their baby privately. There is no right or wrong choice. See the next section on memory-making for more information.
Pregnancy may be ended for many reasons. Some people face heartbreaking medical news, while others make personal decisions based on emotional, social, or other reasons.
Termination for medical reasons (TFMR)
TFMR is when a pregnancy is ended due to serious health risks to the baby or mother. This may happen after unexpected news — like finding out the baby has a life-limiting condition, or when continuing the pregnancy could be dangerous for the mother’s health.
TFMR can happen at any stage of pregnancy, but often takes place after 12 weeks, when more detailed scans and tests are available. This experience is deeply personal and can bring many emotions.
Why it happens
TFMR is usually considered when doctors find a condition that may:
- Greatly affect the baby’s chance of survival or quality of life such as chromosomal abnormalities or genetic conditions.
- Cause serious suffering due to problems that can’t be treated.
- Put the mother’s life or health at serious risk due to pregnancy complications.
- Develop suddenly during pregnancy, like a severe infection.
Your care team will explain your situation and what it means. This may involve:
- Ultrasounds — to check the baby’s development.
- Blood tests or genetic testing — to look for specific conditions.
- Specialist consultations — with maternal-fetal medicine or genetics teams.
You should be given clear, balanced information and time to ask questions. You may also be offered counselling or emotional support to help you make the decision that feels right for you and your family.
These decisions are never easy. They often involve many tests and conversations with healthcare professionals. Every situation is different.
What care might be offered
If you decide to end the pregnancy, your care team will talk with you about the next steps. These may include:
- Medical management — taking a medication called misoprostol to help you deliver the pregnancy tissue through the vagina.
- Surgical management — an operation to remove the pregnancy tissue from your uterus.
Where you receive care will depend on your needs both clinically and emotionally, this might be in your home with help from family or friends, or in the hospital setting with medical support.
For loss between 14–20 weeks gestation
The type of care depends on how far along your pregnancy is and the size of your baby. You will likely be in hospital for medical management to deliver the baby and placenta. Your care team will support you to decide on the best approach for your specific situation. There may be other procedures that are important depending on your situation and preferences. This is something that your health care team will talk through carefully with you — discussing the likelihood of your baby being born alive and explaining how this might affect your care options. This will also include information on where your care will happen, who can be with you, and how to create memories and spend time with your baby if you would like to.
