Go to the emergency department if you are soaking through more than two menstrual pads per hour for two or more hours in a row, if you develop a fever above 100.4°F, if you feel faint or lightheaded, or if you have severe pain that isn’t relieved by over-the-counter pain medication. Many miscarriages can be managed safely at home or with a follow-up visit to your provider, but certain symptoms signal complications that need immediate attention.
Heavy Bleeding That Needs Emergency Care
Some bleeding during a miscarriage is expected and normal. The key threshold is volume and speed: soaking through at least two full-sized menstrual pads in a single hour, and continuing at that rate for two hours or more. That level of blood loss can lead to dangerous drops in blood volume. If you’re changing pads constantly and they’re fully soaked each time, don’t wait to see if it slows down.
Signs that blood loss is becoming serious include a racing heartbeat, feeling dizzy or lightheaded when you stand, cold or clammy skin, and passing out. These are signs your body is struggling to compensate for the volume of blood you’ve lost, and they require emergency treatment. Even if your bleeding is heavy but below that two-pads-per-hour mark, call your provider’s office to be seen the same day.
Fever and Signs of Infection
A miscarriage can sometimes lead to infection, known as a septic miscarriage. This happens when bacteria enter the uterus, often in connection with tissue that hasn’t fully passed. The warning signs are specific:
- Fever above 100.4°F that occurs more than once
- Chills
- Foul-smelling vaginal discharge
- Worsening lower abdominal pain
A septic miscarriage is a medical emergency. Untreated infection can spread to the bloodstream quickly. If you notice any combination of fever, chills, and unusual discharge, go to the hospital rather than waiting for a callback from your provider’s office.
Pain: What’s Normal and What’s Not
Cramping during a miscarriage can be significantly more painful than a typical period, especially if you don’t usually get bad menstrual cramps. The uterus is contracting to pass tissue, and that process hurts. Heat packs, hot baths, and over-the-counter pain relievers like ibuprofen can help manage this.
Pain that warrants a trip to the ER is pain that doesn’t respond to these measures at all, pain that is sudden and severe on one side of your abdomen, or pain that comes with dizziness and feeling like you might faint. One-sided pain in particular can signal an ectopic pregnancy, where the embryo has implanted outside the uterus, typically in a fallopian tube. A ruptured ectopic pregnancy causes internal bleeding and is life-threatening. One unusual but telling symptom is sharp shoulder pain, especially when lying flat. This happens because internal bleeding irritates the diaphragm, and the brain interprets that irritation as shoulder pain.
When a Miscarriage Doesn’t Complete on Its Own
Most miscarriages will pass on their own within one to two weeks after symptoms begin. You may continue to have lighter vaginal bleeding for up to three weeks afterward. But sometimes the process stalls, and tissue remains in the uterus. This is called an incomplete miscarriage, and it increases the risk of heavy bleeding and infection.
Signs that a miscarriage may not have completed include bleeding that continues to get heavier rather than tapering off, persistent cramping that doesn’t ease over several days, nausea and vomiting, or a return of fever. If your bleeding and cramping haven’t started within 7 to 14 days of a diagnosed miscarriage, or if symptoms are getting worse rather than better, you need another evaluation. Your provider can perform an ultrasound to check whether tissue remains and discuss options, which may include medication to help the uterus empty or a brief procedure to remove the remaining tissue.
What Happens at the Hospital
If you do go to the emergency department, the evaluation typically starts with a physical exam to check for active bleeding and to see whether the cervix is open or closed. Blood tests will measure your pregnancy hormone levels, check your blood count to assess how much blood you’ve lost, and determine your blood type. Your blood type matters because if you are Rh-negative (your provider may have mentioned this during prenatal care), you may need an injection to prevent your immune system from developing antibodies that could affect future pregnancies.
An ultrasound, usually transvaginal, is the main tool for determining what’s happening. It can show whether the pregnancy is still in the uterus, whether tissue remains, or whether the miscarriage has completed. If you’re hemodynamically stable (meaning your blood pressure and heart rate are in a safe range), the ER team will often consult with a gynecologist to decide on next steps. If your bleeding is under control and the miscarriage appears to be progressing, you may be sent home with instructions on what to watch for. If tissue remains and bleeding is heavy or persistent, a procedure to remove the tissue may be recommended.
Situations That Can Wait for Your Provider
Not every miscarriage requires a trip to the emergency room. If your bleeding is similar to or somewhat heavier than a period, your pain is manageable with heat and pain medication, you have no fever, and you’re not feeling faint, it is generally safe to call your provider’s office and ask to be seen soon rather than going to the ER. Many clinics can arrange same-day or next-day appointments for suspected miscarriage and can perform ultrasounds and blood work in the office.
The distinction comes down to speed and severity. Gradual bleeding with manageable cramps is the body working through the process. Rapid soaking of pads, uncontrollable pain, fever, fainting, or one-sided sharp pain are signals that something beyond a straightforward miscarriage is happening, and those need emergency evaluation.