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If a miscarriage is suspected, a physician will obtain a medical history and ask questions regarding the symptoms a woman may be experiencing, followed by a thorough pelvic examination.

The pelvic exam is performed to check the size of the uterus and determine whether the cervix is open or closed. If a miscarriage is in progress, the cervix is usually open and the pregnancy will not continue. If a miscarriage has already occurred, the cervix can be either open or closed, depending on whether all the pregnancy tissue has passed out of the mother’s uterus.

In addition, a physician may order an ultrasound to establish if a miscarriage has occurred or to help determine if the pregnancy is capable of progressing to term. With this imaging test, a physician can check for the presence of an embryo that has a heartbeat and determine if it is growing according to schedule and whether it is the appropriate size in relation to the placenta.

There also are several blood tests that measure pregnancy hormone titers. Titer levels should increase at a particular rate during a normal, healthy pregnancy. Theses tests can be used along with ultrasound to monitor the course of early pregnancies that are complicated by bleeding.

Physicians usually do not perform any tests following a first miscarriage that occurs in the first trimester (the first 12 weeks of pregnancy). The cause of these early losses is often unknown, even though chromosomal abnormalities are usually suspected.

However, if a woman has a miscarriage during the second trimester or experiences recurrent miscarriage, physicians will recommend various tests to determine the cause, such as:

• Blood tests. Laboratory analysis of blood samples of both parents to check for chromosome abnormalities, as well as certain hormonal problems and immune system disorders (e.g., lupus) in the mother (e.g., karyotype test).
  
  
• Transvaginal ultrasound. A procedure that uses a probe inserted into the vagina that emits sound waves to produce a picture of the body tissue. It is useful in finding abnormalities in the vagina, uterus, fallopian tubes, ovaries, bladder and other nearby structures.
  
  
• Hysterosalpingography (HSG). X-ray of the uterus and fallopian tubes that is used to look for blockages and other problems.
  
  
• Hysteroscopy. A test that allows a physician to view the uterus through a special scope inserted through the cervix. It is usually prescribed if results from the HSG are abnormal.
  
  
• Sonohysterography. A technique that involves injecting saline solution into the uterus via the cervix in order to observe the image of these structures through an ultrasound. This type of test is very accurate in determining uterine and/or cervical abnormalities that may cause recurrent miscarriages.
  
  
• Magnetic resonance imaging (MRI). A safe and noninvasive or minimally invasive test that uses powerful magnets to produce images on a computer screen and film. It is useful in confirming uterine abnormalities after a transvaginal ultrasound or HSG.
  
  
• Endometrial biopsy. The removal and analysis of a sample of endometrial tissue to determine if the tissue that lines the uterus (uterine lining) is sufficiently hospitable to allow the embryo to implant and grow.
  
  
• Analysis of tissue samples. Testing for chromosomal abnormalities in tissue from the miscarriage (if available).