Around 20% of all pregnancies end in pregnancy loss, and a small number of these happen during the second trimester.
Pregnancy loss during the second trimester was once referred to as “miscarriage,” though many may find the term to be insensitive.
It is a loss between weeks 14 and 20, and it is sometimes called late pregnancy loss.
Below, we describe the symptoms, including when to seek emergency attention. We also explore the medical approaches and aftercare.
- First trimester: 1–13 weeks
- Second trimester: 14–24 weeks
- Third trimester: week 25 onward
If a loss happens between weeks 14 and 20, a doctor may refer to it as “late.” Or, they may describe it as a second-trimester or mid-trimester loss.
About 2–3% of pregnancy losses occur in the second trimester. Losses that occur after 20 weeks are called stillbirths.
Most pregnancy losses occur because the development of the fetus is atypical.
There may be no signs of any problem, and the loss may only become apparent when an ultrasound scan shows no fetal heartbeat. In this case, people may refer to it as a “silent” or “missed” loss.
Other people may experience changes, including:
Lack of fetal movement
During the second trimester, the fetus begins to move in a way that the person can feel. If the movement decreases or stops, it can indicate a problem.
Light bleeding or spotting is fairly common during pregnancy.
However, heavier bleeding can indicate that the cervix is opening without labor contractions. This issue is called cervical insufficiency, and it can lead to problems during pregnancy, premature birth, or pregnancy loss.
Other signs of cervical insufficiency are a feeling of pelvic pressure, a new backache, cramps, and a change in vaginal discharge.
Regular bouts of cramping, similar to menstrual cramps or gas pains, can be a sign that labor is beginning.
Passing of tissue or mucus
Sometimes, when a pregnancy loss has occurred, tissue, blood, or mucus passes from the vagina.
If possible, collect some of this in a clean container, as it can be helpful for a doctor to examine.
Feeling exhausted or lightheaded
A pregnancy loss that happens between weeks 14 and 20 is not necessarily a medical emergency. However, see a doctor as soon as possible if any of the above changes occur.
Other signs that medical intervention is necessary include:
- very heavy vaginal bleeding, such as bleeding that soaks a large pad every hour for 1–2 hours
- severe nausea
- severe pain
- a fever
- vaginal discharge that smells unpleasant
After a loss, the fetus may remain in the uterus, and this can cause dangerous changes in the body. It increases the risk of significant bleeding.
For this reason, it is important for anyone who has experienced pregnancy loss to contact a doctor, who can determine the need for medical attention.
A doctor can identify a late miscarriage when an ultrasound scan shows no fetal heartbeat.
They might also suggest blood tests to measure levels of hormones associated with pregnancy.
Once the doctor has confirmed a late pregnancy loss, a person may have several options, including:
This is a procedure to empty the uterus. It is also called dilation and evacuation or dilation and curettage. Some people use the shorthand “D&E” and “D&C.”
Beforehand, the cervix needs to dilate. Achieving this may involve oral or vaginal medication. Or, a doctor may recommend placing stick-like tools called osmotic dilators into the cervix before the procedure.
Surgical evacuation involves inserting a tube with a suction device through the cervix to gently empty the contents of the uterus.
The healthcare provider performing the procedure can remove any remaining tissue with a loop-shaped metal tool called a curette.
This involves starting labor with medication. Delivery proceeds as usual, and the person decides whether to take pain relief medication, such as an epidural, gas and air, or intravenous options.
During this time and afterward, the delivery team should provide extensive support, including emotional support.
Recovery from pregnancy loss is different for everyone.
Some factors that can influence a person’s experience include their age, any ongoing health issues, the type and amount of ongoing support, and the duration of the pregnancy.
Below, we describe some physical effects of medical intervention after pregnancy loss and how to help the body recover.
Cramping, exhaustion, and bleeding
Each of these issues can continue after a late pregnancy loss.
People who have had surgical evacuation may experience lighter bleeding than people who have undergone induced labor.
It is best to avoid intercourse, douching, and using tampons for at least a week after surgical evacuation or induced labor.
After a late pregnancy loss, some people start producing breast milk. This is temporary, but in the meantime, breast pads can help prevent leaks.
A doctor may recommend ways of reducing any associated pain or discomfort, and they may prescribe medication to reduce milk production.
The emotional aspect of recovery can be challenging. Some people experience intense grief and anger, as well as guilt or depression. A person may also feel envious of others who are pregnant or have babies.
Talking these feelings through with a trained counselor, a healthcare provider, and people in support groups who have had similar experiences can help.
Most pregnancy losses happen in the first trimester, and about 2–3% happen during the second.
Many people may not have any symptoms of pregnancy loss. Others may experience bleeding or cramping or notice a lack of fetal movement.
If the body does not empty the uterus on its own, a doctor may recommend a procedure to this effect or recommend induced labor.
The doctor may also suggest exploring the cause of the loss, especially if they suspect that a medical issue may pose a risk to any future pregnancies. However, it may not be possible to find the cause.
Anyone who is experiencing emotional distress after a pregnancy loss should tell their doctor know. A range of support is available.
Also, anyone who suspects that they might be experiencing pregnancy loss should receive medical attention.