The type of treatment you need will depend on how far along your pregnancy was, whether you can pass all the pregnancy tissue and whether you have any complications.
Complete miscarriage
If the miscarriage is complete and all pregnancy tissue has been cleared naturally by your body, no further treatment is needed.
The earlier you are in your pregnancy, the more likely it is that your body will clear all the pregnancy tissue from your uterus by itself and you won’t need further treatment.
Incomplete or missed miscarriage
Treatment options for incomplete or missed miscarriage can be conservative, medical or surgical. All of the options have advantages and disadvantages. Unless you're bleeding heavily, there's no rush to make a decision. Talk to your healthcare provider about which treatment is best and safest for you.
Conservative management (also known as expectant management)
This is a where you wait for nature to take its course and clear the pregnancy tissue from your body naturally. This could take days or weeks and you may need follow up for monitoring of your pregnancy hormone levels. If your womb doesn’t empty completely you may need further treatment.
Advantages:
- It's a natural process, allowing nature to take its course.
- No drugs, anaesthesia or operation are required.
Disadvantages:
- It's not possible to predict how long it will take for the miscarriage to be completed – it can take days or weeks to occur and the course of pain and bleeding is unpredictable.
- There is a chance that your womb won't empty completely and you may need to have medical or surgical management.
Medical management
Medical management involves the use of medicines (mifepristone and misoprostol) to speed up the natural process of miscarriage. Mifepristone prepares your uterus for the effects of misoprostol and the misoprostol stimulates your womb to contract and empty itself. You may not need mifepristone.
Most people experience moderate abdominal pain and heavy vaginal bleeding when they take misoprostol. Sometimes bleeding begins straight away, but it can take 2 to 3 days or longer. You’ll be given the medicine in hospital then you can go home, as long as you have an adult support person with you. You may need to take another dose of the medicine the next day and have a blood test 2 weeks later to check your pregnancy hormone levels.
Advantages:
- No surgery or anaesthetic required.
- You don’t need to stay in hospital.
- It can be started the same day as your appointment.
Disadvantages:
- You usually need to be seen in hospital for an appointment.
- Medical management isn't always successful and you may still need to have further doses of misoprostol or surgical management.
- These medications may not be suitable for you, eg, if you have some heart conditions.
- Side effects are uncommon but include nausea (feeling sick), vomiting (being sick) and diarrhoea (runny poo).
What can I expect with conservative or medical management?
- When the miscarriage is about to happen, you can expect very heavy bleeding for at least a couple of hours and you’ll pass some pregnancy tissue and clots. Within a few hours the bleeding will become similar to the heaviest day of your menstrual period, and after that you’ll have light bleeding which should settle over several days. The amount of time before the bleeding stops varies from person to person.
- The process of emptying your uterus can be painful – you can take pain relief such as paracetamol or ibuprofen to help with this. The pain should only last a few hours. You can also use wheat bags or a hot water bottle to help with the pain.
- Sometimes you may see the fetus in the pregnancy tissue that’s passed. This can be upsetting, but you may find it helpful to see what’s happened. You’ll be given a small container for the pregnancy tissue so that you can bring it into the hospital so that it can be sent to the laboratory (if you wish) to confirm that it is pregnancy tissue.
- You should see your healthcare provider within 2 weeks so that they can check whether you still have symptoms, such as bleeding, pain or discharge. This is also a time when you can discuss how you’re feeling – you may want to consider counselling to help you through this experience. You can also talk about contraception or plans for a future pregnancy.
- You should do a pregnancy test after 3 weeks to confirm that the all the pregnancy tissue has been removed. Contact your healthcare provider if the pregnancy test is still positive at this stage.
Go to the hospital emergency department if you have:
- heavy bleeding that isn’t settling down (if you’ve soaked a pad every half hour for the past 2 to 3 hours)
- pain that’s not relieved by regular pain relief
- hot and cold ‘flu-like symptoms
- a fever (high temperature).
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