Bleeding 3 months after miscarriage

What Happens After a Miscarriage? An Ob-Gyn Discusses the Options.

Miscarriage, the loss of a pregnancy that’s in the uterus, is common. It happens in about 1 in 10 women who know they’re pregnant. But many people don’t know what to expect afterward.

The vast majority of miscarriages happen in the first trimester, before 13 weeks of pregnancy. Most occur before 10 weeks. In this article, I’ll discuss the treatment options for first-trimester miscarriage, also called early pregnancy loss. Second-trimester miscarriage usually requires different treatments.

Here’s what to know about care and recovery.

There are three main treatments for early pregnancy loss. The goal for all three is to remove any pregnancy tissue left in the uterus. There are two nonsurgical treatments: expectant management (letting the tissue pass on its own) and medication. The third treatment is a surgical procedure called dilation and curettage (also known as D&C or suction curettage).

In many cases, patients can choose the option they prefer.

Expectant management is giving your body time to pass the tissue on its own. This doesn’t involve medication or surgery. Some women choose this because it’s the most natural option, but it is more unpredictable than other treatments.

Most women pass the tissue within 2 weeks of a miscarriage diagnosis, but it can take longer. If it takes too long, your ob-gyn may recommend medication to start the process. (Once the process starts and cramping and bleeding begin, most of the tissue passes within a few hours. More on that below.)

Sometimes, the body doesn’t pass all the tissue. When this happens, another treatment is recommended, usually a D&C. Expectant management is most likely to work when you already have some bleeding and cramping. This means your body has begun the process of passing the tissue.

Medication works faster and is more predictable. Some women choose medication that helps their body remove any leftover tissue. These drugs are absorbed through the cheek in the mouth or through the vagina. Cramping or bleeding usually starts within a few hours. Most women pass the tissue within 48 hours and don’t need any other treatment. (Some women may still not pass all the tissue and may need a surgical procedure.)

Medication gives you more control over the timing of the tissue passing. And it’s often quicker than waiting for the tissue to pass on its own.

Some women like to take the medication in the morning, so the process doesn’t start overnight. And some women like to have a support person, such as a friend or family member, with them when they take the medication.

You’ll have a similar experience whether the tissue passes on its own or you take medication. You’ll have bleeding and cramping that are heavier than your normal period. The pregnancy tissue may look like large blood clots, or it may look white or gray. It does not look like a baby. The process can be painful, and ob-gyns may prescribe medication to help with this discomfort. Your ob-gyn may also suggest over-the-counter pain medication. Talk with your ob-gyn about pain relief options.

Most of the tissue passes within 2 to 4 hours after the cramping and bleeding start. Cramping usually stops within a day. Light bleeding or spotting can go on for 4 to 6 weeks. Two weeks after the tissue passes, your ob-gyn may do an ultrasound exam or other tests to make sure all the tissue has passed.

A D&C is the most predictable treatment. During a D&C, your ob-gyn passes a small tool through the cervix and into the uterus to remove the tissue. Some women choose this option because they want a faster, more certain treatment. And if you’re already bleeding heavily, it’s the safest option.

Some ob-gyns do D&Cs in an operating room using general anesthesia, which means you’ll be asleep. Some offer a form of pain relief called sedation, where you will be awake but comfortable. Others do the procedure in a normal exam room, with an injection of drugs that block pain in a specific area. Women often have some bleeding and intense cramping during a D&C. They usually have little discomfort afterward.

Light spotting or bleeding can last up to a month. An antibiotic is prescribed to prevent infection. Other complications are rare, and most women don’t need any follow-up appointments.

Whichever option you choose, call your ob-gyn if you have very heavy bleeding, a fever, or feel unwell. Dangerous bleeding and infection are a risk of all treatments, but these problems are rare. Call your ob-gyn right away if you have any of these symptoms:

Your bleeding soaks through more than two large pads in an hour for 2 hours or more. This much bleeding is dangerous and needs immediate care.
You have a temperature higher than 100 °F.
You have chills, severe pain, or any other symptoms that concern you.

Physical recovery is usually quick. Most women resume their regular activities a day or two after they pass the tissue or have a D&C. For some, nausea and other pregnancy symptoms stop before their ob-gyn diagnoses a miscarriage. For others, these symptoms go away a few days after the tissue passes.

To keep your infection risk low, don’t put anything into your vagina for a week—no douching (which is never a good idea at any time), vaginal sex, tampons, or menstrual cups. You can use pads to absorb the bleeding. Most women have their first period about 2 weeks after any spotting or light bleeding ends, which is usually about 2 to 3 months after you pass the tissue or have a D&C.

People have different emotional reactions. Some women feel sadness or grief. Others may feel relief. Some may feel a mixture of emotions. All these feelings are normal, and it’s important to allow yourself time to process them.

Talking about these feelings with friends, family, your ob-gyn, or a mental health professional can help. If you feel depressed or are thinking of hurting yourself, tell your ob-gyn or another doctor right away. Support groups and resources, such as Share Pregnancy & Infant Loss Support, may be helpful too.

Miscarriage isn’t your fault. Women often worry that they somehow caused their miscarriage. This is not the case. Physical activity, stress, and sex don’t cause miscarriages. Most happen because the pregnancy wasn’t developing normally. Often, the egg or sperm develops with more or fewer chromosomes than normal, which can lead to miscarriage. This is a random event that you cannot control.

Most women can have a healthy pregnancy after a miscarriage. Talk with your ob-gyn if you have concerns. Your ob-gyn can help ease your fears, answer any questions, and talk about preparing for your next pregnancy.

Published: June 2022

Last reviewed: June 2022

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Incomplete miscarriage | Tommy's

An incomplete miscarriage is when a miscarriage begins, but the pregnancy doesn’t completely come away from the womb.

What is an incomplete miscarriage?

Sometimes not all of the pregnancy comes away after a miscarriage. An incomplete miscarriage is when a miscarriage begins, but some pregnancy tissue stays in the womb.

Signs of an incomplete miscarriage

All women have some bleeding or pain during and after a miscarriage. But if you have an incomplete miscarriage, you may have these symptoms:

heavy bleeding – get medical help if you’re soaking through a pad in an hour
bleeding that carries on and doesn’t settle down
passing blood clots
increasing tummy pain, which may feel like cramps or contractions
a raised temperature (fever) and flu-like symptoms.

Get medical help straightaway if you experience any of these warning signs.

Treatment for an incomplete miscarriage

If you have an incomplete miscarriage, you’ll need to have treatment. There are 3 options available:

waiting for the miscarriage to happen by itself naturally (expectant management)
taking medicine to help things along (medical management)
having surgery to remove the pregnancy (surgical management).

Your doctor should talk with you about what may be the best option for you. You should be given some time for the diagnosis to sink in and to think about what you want to do.

“It's OK to take your time over making a decision. You may have a gut feeling about how to manage the miscarriage, you may not. Talk through your options with the medical professionals. I know they are incredibly busy, but we needed and wanted answers. I phoned the number we were given after our second missed miscarriage and asked all the questions I had. This helped us make a decision.”
Catherine

How you are treated is your choice. However, you may be advised to have surgery immediately if there are any problems, such as infections.

Find out more about how your miscarriage will be managed.

Your emotional health

Miscarriage can be devastating. You may be struggling with grief, anxiety and shock, but you do not need to go through this alone. There are lots of organisations that can provide advice and support.

If you’re worried that you or your partner are struggling to cope after losing a baby, please talk to your GP. They will be able to help you get the support you need.

You can also talk to a Tommy’s midwife for free. You can call them Monday-Friday, 9am-5pm on 0800 0147 800 or you can email them at [email protected]. Our midwives are trained in bereavement support so will be able to talk to you about what you’re going through.

Find out more about support after a miscarriage.

Miscarriage. What to do after a miscarriage?

When a woman finds out about her pregnancy, she changes her rhythm of life, especially if the pregnancy is desired. However, depending on many circumstances, miscarriage , that is, a natural termination of pregnancy, may occur. Statistics say that up to 20 percent of pregnancies end in pathological abortions. Often a woman may not know that she was pregnant, as a miscarriage sometimes occurs at a very early stage and seems to be just a normal delay in menstruation followed by heavy discharge. nine0005

If a woman finds out that she is pregnant and wants to become a mother, she should be very attentive to her condition. The threat of miscarriage often occurs in the early stages of pregnancy and therefore it is necessary to know what symptoms and signs precede a sudden miscarriage.

Signs

The main sign of a suspected miscarriage is bleeding from the uterus. They happen not abundant, pale scarlet or gray-brown. The discharge most often gradually increases and is characterized by sudden spasms or pulling pains in the lower abdomen. These symptoms may last for some time. nine0005

The pains are often so mild that the woman simply does not pay attention to them. They are able to be interrupted, and the woman simply forgets about them, especially if the discharge also stopped, and before that they were insignificant. Meanwhile, the very first symptoms should alert you and you should urgently go to the gynecologist for examination and consultation. Even if the process has stopped, after a few days you can feel a sharp deterioration in health, and then you can no longer save the life of the unborn child. Be sure to pay attention to what exactly comes out with the discharge, if there are tissue fragments, it means that miscarriage has already occurred. Therefore, one should not hesitate to go to the doctor, the fetus may come out, in whole or in parts, there may be white particles or a round gray bubble. When the body is completely cleansed, the pain will subside, but before that it may continue for some time.

Terms of miscarriages

A miscarriage is classified as early if it occurred before twelve weeks from the onset of pregnancy. Starting from the 22nd week, if a spontaneous miscarriage has occurred, it is considered late. If the termination of pregnancy occurred before thirty-seven weeks, then this is already called premature birth. All subsequent fetal rejections are called term births and are generally considered normal, since during this period, mostly able-to-survive children are born. In modern medicine, children born after 22 weeks are nursed and subsequently do not differ from those born at term with normal weight. nine0005

Types of miscarriages

Specialists have identified several types of miscarriages.

Complete or inevitable - characterized by pain in the lower back and dilatation of the cervix, hemorrhages from it. The fetal membrane necessarily bursts, and the pregnancy is terminated. The fetus comes out of the uterus, and all discomfort in the form of pain and bleeding stops.
Miscarriage is different in that the fetus died, but remained in the mother's body. This can be detected by a doctor when examining a woman and when listening to the fetal heartbeat. nine0050
Repeated miscarriage is rare, it occurs only some time after the first and can occur up to three times in a row in the early stages.

Causes of spontaneous abortion

The vast majority of women, having learned about their pregnancy, want to give birth to a healthy baby. And if there is a spontaneous miscarriage , then for a failed mother this is a real tragedy. Many, having experienced an abortion, try to conceive a child faster again, but first you need to know the reasons for what happened in order to save the fetus in the future. According to statistics, the largest number of miscarriages occurs precisely in the early stages. nine0005

There are several reasons for this:

Violations in genetics.

This is the most common cause of miscarriage. This is not due to heredity, it is a consequence of the mutation of parent germ cells, which accidentally ended up in unfavorable conditions. This is also the influence of radiation, poisoning, viruses, that is, temporary situations that affected the quality of germ cells. The body thus gets rid of a weak non-viable fetus. It is impossible and unnecessary to prevent such spontaneous abortion. It is only necessary, having decided to become pregnant, to try to cleanse your body of possible harmful influences. nine0005

Hormonal disorders

The cause of miscarriage at a very early stage also lies in the lack of the hormone progesterone, or in the fact that a woman has an excess of male sex hormones that suppress the production of estrogen and progesterone in her body. In this case, the fetus can be saved medically by administering the necessary medicines to the woman. The work of the adrenal glands, as well as the thyroid gland, affects the production of hormones, so a lot depends on the work of these glands throughout the pregnancy process. nine0005

Immunological causes .

In this case, the vitality of the fetus is directly affected by the Rh conflict. The embryo will inherit the positive Rh of the man, and if the partner has a negative Rh, then her body simply rejects cells that are foreign to him. A similar situation can be prevented by injecting the expectant mother with a variety of progesterone, a process called immunomodulation.

Sexually transmitted infections such as toxoplasmosis, syphilis, trichomoniasis, chlamydia and others are of great danger. External infection: bacteria and viruses infect the fetal membranes, and the body will inevitably reject the embryo. Therefore, before becoming pregnant, you should be examined to know for sure that there are no infections, and if the result is positive, undergo treatment. nine0005

In addition, all inflammatory processes, various diseases of the internal organs, which are accompanied by a persistent high temperature, can also lead to unexpected rejection of the fetus. Rubella is especially dangerous, and viral hepatitis is common. But even a sore throat, mild pneumonia, appendicitis sometimes play a key role and lead to a miscarriage, so the expectant mother must undergo a thorough examination even before the child is conceived, and then beware of all kinds of infections and weakening of the body. nine0005

Medical abortion.

If a woman had an abortion in a hospital and then became pregnant and decided to give birth, there is a danger that she will have a miscarriage. Abortion is a stress factor for the body, ovarian dysfunction is often observed, inflammatory processes in the female genital organs can begin, and all this will lead, at best, to miscarriage and subsequent repeated miscarriages, and at worst, to infertility. Therefore, you need to think very seriously before going for an abortion. nine0005

Medicines and certain herbs.

It is advisable for a pregnant woman not to take any medication at all, especially during the first three calendar months. Medicines and herbs can cause various defects in the fetus, which in turn will lead to its rejection. Analgesics and uncontrolled hormonal contraceptives are especially dangerous. Parsley and nettle should be eaten with caution - they cause a high tone of the uterus, which in turn can reject the fetus. nine0005

Stress.

It is no coincidence that in ancient times, pregnant women were protected from unrest, they were created comfortable conditions, and they tried to give as many positive emotions as possible. Now the direct dependence of the health of the unborn baby on the mental state during pregnancy has already been proven. Any stress, fear and overstrain can cause an unexpected termination of pregnancy. If you have a problem (death of a loved one, divorce, etc.), you need to find sedatives with the help of a doctor, they will help you cope with this period. nine0005

Unhealthy lifestyle.

Of course, the intake of alcoholic beverages, an unhealthy lifestyle, smoking, even coffee consumption in large quantities, improper diet - all this can lead to a transient miscarriage. Therefore, the expectant mother should prioritize and change her rhythm of life in advance in order to give birth to a healthy child.

Sexual intercourse, falling, heavy lifting.

All of these factors can affect the fetus, so you should protect yourself and your baby by avoiding these activities.

What to do after a miscarriage?

Having experienced the tragedy of losing a child, parents often intend to immediately conceive a new baby, but they are afraid that everything will happen again. In this case, you do not need to make independent decisions, but consult a doctor. And first of all, it is necessary to identify the cause that led to the miscarriage. For this, the expectant mother needs to undergo as thorough an examination as possible. nine0005

If no obvious cause is found, the fetus most likely has a chromosomal abnormality. In this case, you should not worry, since the next conception will occur with a different set of chromosomes, which means that there will be no repeated miscarriage. If the miscarriage was repeated, it is necessary to contact a geneticist and conduct a study of the set of chromosomes of both parents. If it turns out that the cause was an infection, then it is necessary to fully recover. If we are talking about sexual infections, then both parents need to undergo therapy. It is necessary to take tests for hormonal studies, hemostasis systems and determine the immune status. nine0005

After a miscarriage, should be treated, if necessary, and pause between conceptions. During pregnancy, you should not take medications to prevent re-spontaneous pathological termination of pregnancy. Therefore, you can become pregnant only after the end of the course of treatment. If the cause was hormonal abnormalities, then the expectant mother should take special drugs to stabilize the background, and at this time she should never become pregnant. During the pause, you need to choose contraceptives with the help of a doctor. You can go to a specialized clinic where you will be prescribed a full course of rehabilitation. nine0005

The first week after a miscarriage women often experience pain in the lower abdomen, heavy bleeding, so you should refrain from sexual intercourse with a man. If there is severe bleeding, acute pain in the lower abdomen, convulsions, high fever, palpitations, nausea, vomiting, then you should immediately consult a doctor to identify the cause of this condition. It is necessary to plan a subsequent pregnancy not earlier than three months after this situation, but preferably six months later. Until that time, it is worth reconsidering your outlook on life, giving up hard work, eating right and wisely, taking vitamins, exercising, losing weight if you are overweight, stop smoking, drinking alcohol, think over your daily routine. nine0005

It is very important during this recovery period to have a positive attitude and confidence that the next attempt will be successful. This is harder to do than to say, because after a miscarriage the woman is in a depressed state and is afraid of a repetition of the situation. You can’t get hung up on your problem, during this period it’s better to do some favorite thing, relax, change the situation, travel, visit the city more often. The modern ecological situation in cities has a bad effect on women's health, so private trips to nature, a trip to the sea, to friends in another city can distract from painful thoughts. An important role in this case is played by the woman's relatives and, above all, the husband, who can surround her with care and attention, creating peace of mind. nine0005

You may need to contact a counseling psychologist or psychotherapist. Yoga classes, self-education, visiting theaters, exhibitions and temples have a very beneficial effect on the psyche of a woman and help to distract from her problems. Helping others who have a difficult life situation, caring for the sick can also have a beneficial psychological effect and help you look at your problems from the outside.

Remember, the human body is a self-healing system, it just needs a little help. nine0005

Spontaneous abortion (miscarriage)

If the pregnancy is terminated naturally before the fetus reaches gestational age, this is called a spontaneous abortion or miscarriage. More than half of miscarriages occur no later than 12 weeks of gestation due to fetal abnormalities. The rest falls on the period up to 20 weeks and is associated with pathologies of pregnancy. If the pregnancy is terminated in the second half, it is called preterm labor.

Spontaneous abortion, otherwise known as miscarriage, is one of the most common complications during pregnancy, accounting for 10-20% of diagnosed pregnancies, and is the rejection of a fetus weighing no more than 500 grams. and less than 22 weeks. Unfortunately, with such indicators, the fetus is not viable. Usually 80% of the total number of spontaneous abortions occurs before the 12th week of pregnancy. nine0005

Types of spontaneous abortion

1. Threat of miscarriage - characterized by mild uterine cramps, pulling pain in the lower abdomen and sometimes mild bloody discharge from the vagina.

2. A miscarriage that has begun - is characterized by more severe pain and profuse bleeding. At the same time, the tone of the uterus is slightly increased, and the internal os is closed.

3. Inevitable miscarriage - accompanied by dilatation of the cervix - a fetal egg can be distinguished - with profuse bleeding and severe cramps in the lower abdomen. nine0005

4. Incomplete miscarriage - part of the fetus comes out. The bleeding is so profuse that it can lead to the death of a woman.

5. Completed miscarriage - the fetal egg and the fetus itself are completely out. After that, the bleeding and spasms stop.

The etiology of miscarriage is due to many factors. Among them:

- genetic disorders;

- previous induced abortions;

- too little time has passed since the previous pregnancy; nine0005

- inflammatory infections in the mother, endocrine disorders;

- blood conflict between mother and fetus;

- taking hormonal contraceptives and certain medications;

- smoking during pregnancy and drinking alcohol;

- unknown causes.

To prevent miscarriage, it is necessary to give up bad habits, not to have abortions and to be regularly examined by a doctor.

Spontaneous abortion begins with the appearance of cramping, pulling pains, similar to pain during menstruation. Then bleeding from the uterus begins. At first, the discharge is slight or moderate, and then, after detachment of the fetal egg, abundant discharge with bloody clots begins. The appearance of these symptoms requires urgent hospitalization. nine0005

After examining a woman in a hospital, having determined the degree of detachment of the embryo, one of the following diagnoses will be made:

- a threat of pregnancy - detachment is only outlined or is completely insignificant. In this case, the pregnancy can be saved;

- a miscarriage that has begun - detachment is already quite decent with a pronounced pain syndrome. And in this case, the fetus can be saved;

- abortion in progress - detachment with displacement progresses, labor-like contractions begin. Pregnancy cannot be saved, cleaning is required; nine0005

- incomplete miscarriage - independent exit of a part of the fetus and membranes, curettage is necessary for the final curettage of the uterus;

- late abortion - premature delivery of an unviable baby.

After a spontaneous abortion, it is recommended to take a short break in planning and take preventive measures to avoid recurrence.

In case of repeated miscarriage, a thorough comprehensive examination is necessary to determine the causes of miscarriage and eliminate them. nine0005

A miscarriage is a severe psychological trauma, especially during the first pregnancy. But do not give up, with a competent approach to planning and bearing, the next pregnancy will certainly end with the appearance of a long-awaited baby.