Being told a pregnancy has ended is a shock, and there is a lot to take in at once. One question shapes what you can do next: is the pregnancy still in your womb? If it is, some genetic tests may still be possible before it passes or before treatment, so it helps to think about testing early.
Unless you are bleeding heavily or feel unwell, there is usually time to decide. If you are bleeding heavily, in severe pain or feel faint, call 999 — see when to get help straight away.
Question one
This matters because the two main kinds of genetic test work at different times. While pregnancy tissue is in the womb, the placenta releases tiny fragments of its DNA into your blood, which a blood-based test can analyse. Once the tissue has gone, that DNA fades within hours to days, and testing then depends on whether tissue was kept.
This is usual after a missed miscarriage, when the pregnancy has stopped developing but has not come away. A blood-based genetic test may be possible now, ideally before any tablets or procedure, and you can plan for the tissue to be tested once it passes or is removed. See testing before treatment.
If pregnancy tissue was collected and kept fresh, without any preservative, a laboratory may be able to test its chromosomes. Contact your early pregnancy unit or a genetics service promptly, because samples should reach the laboratory quickly. See pregnancy tissue testing.
A blood-based test becomes less reliable once the tissue has gone: in a large Danish study, more than 1 in 4 samples taken 12 to 24 hours after the tissue passed gave no result. Testing this pregnancy is often no longer practical. After recurrent miscarriage, checking both parents' chromosomes is sometimes offered when no tissue result is available. A genetic counsellor can help you plan ahead.
Question two
Miscarriage is usually diagnosed with an internal (transvaginal) ultrasound scan. NICE, which writes guidance for the NHS in England, says one scan cannot be guaranteed to be 100% accurate, particularly very early in pregnancy, so it sets size limits below which a single scan is never enough, and even above them it asks for a second opinion, a repeat scan or both. CRL (crown–rump length) is the length of the embryo.
| What the scan shows | What NICE recommends before confirming a miscarriage |
|---|---|
| Embryo (CRL) under 7 mm, no heartbeat | A repeat scan at least 7 days later; sometimes more than one |
| Embryo (CRL) 7 mm or more, no heartbeat | A second opinion from another specialist, a repeat scan at least 7 days later, or both |
| Pregnancy sac under 25 mm, no embryo seen | A repeat scan at least 7 days later; sometimes more than one |
| Pregnancy sac 25 mm or more, no embryo seen | A second opinion, a repeat scan at least 7 days later, or both |
| Abdominal scan only, no internal scan | The size is recorded and the scan repeated at least 14 days later |
NICE adds that the date of your last period alone should not decide whether a heartbeat ought to be visible, and that waiting for a repeat scan does not harm the pregnancy. Your early pregnancy unit arranges repeat scans free of charge.
If you were told the miscarriage is already complete but no earlier scan had shown the pregnancy in the womb, NICE advises follow-up, such as hCG blood tests or further scans, until a definite diagnosis is made, because an ectopic pregnancy has not yet been ruled out.
For an independent look, our second-opinion scan is with Dr Fred Ushakov, a specialist in first-trimester and fetal anomaly scanning. Please call us first so we can check it suits your stage of pregnancy.
Your options
Before 14 weeks, your early pregnancy unit offers three ways to manage a missed miscarriage on the NHS; from 14 weeks, your care team will talk you through different options. Unless there is a reason to act sooner, such as a higher risk of heavy bleeding or signs of infection, NICE recommends waiting for 7 to 14 days as the first option, although you can ask about tablets or surgery instead. If genetic testing matters to you, say so before choosing, because each option affects how a sample can be collected.
Expectant management
You wait at home for the pregnancy to pass, with advice on pain relief and a 24-hour number to call. Other options are suggested if you have a higher risk of heavy bleeding, a previous traumatic pregnancy experience or signs of infection. If nothing has happened after 7 to 14 days, you are offered a repeat scan. Tommy's notes that tablets or surgery may work better than waiting, especially after a missed miscarriage. Tissue can pass unexpectedly, so ask for a collection pot early if you want testing.
Medical management
NICE recommends 200 mg of mifepristone by mouth, then 800 micrograms of misoprostol 48 hours later. Contact your unit if bleeding has not started within 48 hours of the misoprostol. You may go home after the medicine or be looked after in hospital. A blood-based genetic test, if you want one, is best taken before the first tablet.
Surgical management
Gentle suction removes the pregnancy, either by manual vacuum aspiration under local anaesthetic in a clinic or in theatre under general anaesthetic, and you may be able to go home the same day. Tissue is collected at the time, which makes a sample easier to plan; Tommy's notes that NHS tissue testing is, in practice, often limited to people who have had surgery. Tell the team beforehand if you want testing.
From two UK studies of missed miscarriage. They describe groups of people, not what will happen to you.
Call 999 or go to A&E if you are bleeding heavily (soaking a pad soon after putting it on), have severe tummy pain or pain in your shoulder, or feel sick, faint or dizzy. Tommy's also advises urgent care if you soak through 2 pads an hour for 2 to 3 hours, pass more than one clot the size of your palm, cannot control the pain with painkillers, or have a high temperature. For anything else that worries you, use your early pregnancy unit's 24-hour number or call NHS 111. A private appointment is never a substitute for emergency care.
Genetic testing
About half of early miscarriages happen because the pregnancy had the wrong number or arrangement of chromosomes, usually by chance. Testing can sometimes show this, and many people find that knowing helps them understand what happened. It is optional, it cannot always give an answer, and it does not change the treatment options above.
On the NHS, chromosome testing of pregnancy tissue is usually offered from the third miscarriage, after any miscarriage from 14 weeks, or sooner in some situations, such as when a scan has shown features that suggest a chromosome condition. After a first or second early miscarriage it is not routinely offered, although it is always worth asking your unit.
A blood-based test reads placental DNA in your blood, so it is best taken while the tissue is still in the womb, after a scan has checked that it is there. In a 2026 Danish study of 1,463 women, levels fell significantly more than 12 hours after the tissue passed, and more tests failed to give a result.
These blood tests are not part of standard NHS care, and the result is closer to screening than a final answer. Across eight studies they picked up about 78 in 100 of the chromosome changes that tissue testing found; some 'abnormal' results did not match the tissue, and some samples gave no result. Triploidy (a whole extra set of chromosomes) is usually missed.
Tissue testing examines the pregnancy tissue itself, usually with a rapid test for the commonest chromosome changes plus a chromosomal microarray, and it needs fresh tissue. Our guide to blood or tissue testing compares the two, and our genetic counsellors can talk through your options in a 30-minute video appointment.
Practical steps
Ask early, ideally before any treatment begins.
Tell your early pregnancy unit that you would like the tissue tested, and ask whether NHS testing is available to you.
If it is not, ask whether a fresh sample can be set aside for a private test, and who will arrange it.
Ask for the genetics sample not to go into formalin or any other preservative. Formalin is used for routine pathology and usually stops genetic testing from working.
If you are waiting at home or taking tablets, ask in advance for a sterile container, and for advice on storing the tissue and getting it to the laboratory.
The laboratory may also ask for a sample of your blood, to check that the result comes from the pregnancy rather than from your own cells.
If you are considering a blood-based test, speak to a genetic counsellor before any tablets or procedure.
Keep copies of your scan reports and results for any future tests or pregnancy.
Your appointment
NICE says you should be given a 24-hour number to call. If you need more time to talk things through, you can ask for another appointment. Writing your questions down, or bringing someone with you, can help.
If your blood group is rhesus (RhD) negative, the NHS may offer you an anti-D injection if you were 12 weeks pregnant or more.
Looking after yourself
Shock, sadness, numbness and anger are all common, and they can shift from hour to hour. Partners grieve too, sometimes in different ways. A missed miscarriage can be especially hard when there were no warning signs and you still felt pregnant.
Most early miscarriages happen because of a chance problem in the way the pregnancy developed, often involving its chromosomes, rather than anything you did or did not do. Our guide Why did I miscarry? looks at the worries people most often carry.
You do not have to manage this alone. Your GP or early pregnancy unit can tell you about counselling. Miscarriage UK runs a helpline on 0303 003 6464, and Tommy's midwives can be reached free on 0800 0147 800. In England you can also apply for an optional baby loss certificate.
You do not need to work while you are miscarrying; Tommy's notes that you are entitled to sick leave if you are not well enough. And most people who have a miscarriage go on to have a successful pregnancy in the future.
How we can help
Your NHS early pregnancy unit provides diagnosis, repeat scans and treatment free of charge, and it should be your first port of call. Alongside that, we offer genetic counselling by video, an independent second-opinion scan at our City of London (Spitalfields) clinic, and a post-miscarriage recovery scan at our City and West London (Chelsea) clinics.
Online, 30 minutes
A video appointment with a registered genetic counsellor to talk through whether a blood-based test or tissue testing is possible for you, and what a result could and could not tell you.
Independent review
A fresh, independent scan with Dr Fred Ushakov at our City clinic if you would like more certainty about a finding. Call us first so we can check it suits your stage of pregnancy.
After your first period
A recovery scan and review to check the womb has returned to normal and look for any remaining tissue. It is not a scan for diagnosing a miscarriage.
Usually not. Unless you have a higher risk of heavy bleeding, signs of infection or another reason to act sooner, NICE recommends waiting 7 to 14 days as the first option, so many people take a few days to think, and you can ask for another appointment. The exception is a blood-based genetic test, which works best while the tissue is still in the womb, so it is worth deciding about that early.
NICE accepts that one scan cannot be guaranteed to be 100% accurate, which is why it asks for a repeat scan, a second opinion or both before a miscarriage is confirmed. If doubts remain, ask how the diagnosis was reached, or consider a second-opinion scan.
Not necessarily. After a missed miscarriage, pregnancy hormones can stay high for some time, so pregnancy symptoms and a positive test can carry on even though the pregnancy has stopped developing. The scan, repeated where NICE advises, is what confirms the diagnosis.
The evidence suggests not: Tommy's notes that the chance of getting pregnant again is the same whichever type of management you have. Our guide to pregnancy after miscarriage covers what can help next time.
We do not analyse tissue at the clinic, and tissue testing cannot be booked online. It is carried out by accredited genetics laboratories, and how a sample is collected and handled makes a difference. To explore it, book a genetic counselling appointment or call us on 020 3687 2939, ideally before treatment so collection can be planned.
This is a personal choice, and there is no right or wrong answer. Depending on how the miscarriage happens, some people bring the remains to the hospital for burial, some bury them at home and some flush them away, and some are offered testing. Your unit can explain the arrangements available locally.
This page gives general information about the days after a miscarriage diagnosis. It is not a substitute for advice from the clinicians caring for you, who know your circumstances. If you have heavy bleeding, severe pain, a fever or feel faint, contact your early pregnancy unit or NHS 111 straight away, and call 999 in an emergency.
Contact
The figures and clinical statements on this page are drawn from the sources below. Guidance evolves — always discuss your individual circumstances with a clinician.
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