Options for miscarriage

Miscarriage - What happens - NHS

If there's no pregnancy tissue left in your womb, no treatment is required.

However, if there's still some pregnancy tissue in your womb, your options are:

expectant management – wait for the tissue to pass out of your womb naturally
medical management – take medicine that causes the tissue to pass out of your womb
surgical management – have the tissue surgically removed

The risk of complications is very small for all these options. It's important to discuss them all with the doctor in charge of your care.

Expectant management

If you have a miscarriage in your first trimester, you may choose to wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management.

If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy test after 3 weeks.

If the test shows you're still pregnant, you may need to have further tests.

If the pain and bleeding have not started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage has not begun or has not finished. In this case, you should be offered another scan.

After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.

Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.

Medicine

You may choose to have medicine to remove the tissue if you do not want to wait, or if it does not pass out naturally within 2 weeks. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out.

In most cases, you'll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve.

The tablets usually begin to work within a few hours. You'll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to 3 weeks.

In most units, you'll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.

You should be advised to take a home pregnancy test 3 weeks after taking this medicine. If the pregnancy test shows you're still pregnant, you may need to have further tests.

You may be advised to contact your healthcare professional to discuss your options if bleeding has not started within 24 hours of taking the medicine.

Surgery

In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:

you experience continuous heavy bleeding
there's evidence the pregnancy tissue has become infected
medicine or waiting for the tissue to pass out naturally has been unsuccessful

Surgery involves removing any remaining tissue in your womb with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.

After a miscarriage

A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.

For more information, read what happens after a miscarriage.

Page last reviewed: 09 March 2022
Next review due: 09 March 2025

Common Treatments for Miscarriage | AAFP

What is a miscarriage?

A miscarriage is something that happens when a pregnancy stops growing. It is sometimes found when women have bleeding in early pregnancy, or it may be found during routine tests.

Miscarriage happens in a pregnancy that would not have been healthy for reasons beyond your control. It is not caused by stress or regular activities like playing sports or having sex.

What happens during a miscarriage?

If you are having a miscarriage and the pregnancy tissue hasn't fully come out, there are three treatment options:

Watch and wait: wait for the miscarriage to happen on its own.
Medicine: use pills called misoprostol (brand name: Cytotec) to make the miscarriage happen sooner.
Suction procedure: have a doctor remove the pregnancy tissue using a simple office procedure.

All three treatment options are safe and will not affect your ability to get pregnant.

Which treatment should I choose?

The most effective treatment for you may depend on the type of miscarriage you have:

Incomplete miscarriage is when the pregnancy tissue begins to pass on its own. Using the watch-and-wait option, it will pass on its own more than 90 percent of the time, but this can take weeks. Using misoprostol, the tissue passes more than 90 percent of the time within one week.
Fetal or embryonic [EM-bree-ON-ik] demise is when the pregnancy has stopped growing but is not passing on its own. Using the watch-and-wait option, this type of miscarriage will pass on its own about 75 percent of the time, but it can take weeks. Using misoprostol, the tissue passes almost 90 percent of the time within one week.
Anembryonic [AN-EM-bree-ON-ik] pregnancy or “empty sac” is when the pregnancy stopped growing before the fetus developed. Using the watch-and-wait option, this type of miscarriage will pass on its own only 66 percent of the time, and may take many weeks. Using misoprostol, the tissue passes about 80 percent of the time within one week.

Many women choose to watch and wait as their first option. If this takes too long, you can come back to the doctor at any time to try another option. If medicine doesn't work, you may come back for a suction procedure. A suction procedure works 100 percent of the time with any type of miscarriage.

Once I choose my treatment, what should I expect to happen?

What to expect if you choose to watch and wait:

Cramping and bleeding can start at any time. Usually the cramping is worse and the bleeding is heavier than during a period. The heavy bleeding is not dangerous and usually lasts from three to five hours. Lighter bleeding often lasts one to two weeks and it may stop and start a few times. Taking ibuprofen (up to 800 mg every eight hours) and using a heating pad can help ease painful cramps.

What to expect if you choose to use medicine:

Misoprostol pills are placed in the vagina at a time chosen by you. Cramps and bleeding usually start two to six hours after placing the pills and last for three to five hours. A heating pad, ibuprofen, and/or a prescription pain medicine may be used to help ease cramps.

Some women get nausea, diarrhea, or chills soon after using misoprostol. This should get better in a few hours. Taking ibuprofen before using misoprostol helps prevent some of the side effects. The bleeding may be much heavier than a period. This heavy bleeding is not risky; it means the treatment is working. Lighter bleeding often lasts one to two weeks and may stop and start a few times.

What to expect if you have a suction procedure:

Taking pain medicine before the procedure helps to ease cramps. The start of the procedure is like a Pap smear or a routine pelvic exam. To numb pain, local anesthesia is injected around the opening of your uterus, called the cervix. Next, the cervix is gently stretched and the pregnancy tissue is removed with a small plastic device.

The procedure usually takes less than 10 minutes. After resting for 15 to 30 minutes, you will then be able to go home. Most women are able to return to their usual activities the next day. It is normal to have mild cramping and bleeding for a few days after the procedure.

What happens after a miscarriage?

You will be given take-home instructions. Call your doctor if you have any of the following:

Bleeding that soaks more than two maxi pads per hour for two hours in a row.
Fever greater than 102°F (a slight fever of 102°F or less is common with misoprostol use).
Feeling very ill, with lower abdominal pain after the heavy cramping and bleeding are over.

At your follow-up visit, your doctor will make sure the miscarriage is over using ultrasonography, a blood test, or both. This visit is also a chance to talk about any emotional issues you may have after the miscarriage.

Once the miscarriage is over, you can try to get pregnant again as soon as you and your partner feel ready. If you do not want to become pregnant right away, be sure to use birth control.

Where can I get more information?

Your doctor

AAFP's Patient Education Resource

Web site: https://familydoctor. org/miscarriage/

National Institutes of Health: Medline Plus

Web site: http://www.nlm.nih.gov/medlineplus/miscarriage.html

Miscarriage, how to avoid - Planning and management of pregnancy in the gynecology of the Literary Fund polyclinic after a miscarriage

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A miscarriage is always associated with severe consequences for the whole body of a woman and for her reproductive organs in particular, it also affects the family situation, disrupts the woman's work schedule. An unfavorable outcome of pregnancy requires great mental and physical costs on the part of parents. Therefore, contacting doctors to find out the causes of the problem is the very first and correct step towards the birth of a child. nine0033

Any competent gynecologist will tell you that the problem of miscarriage can be solved. With proper preparation for pregnancy and its management, the next time you will have a successful pregnancy. Most girls after a miscarriage go to extremes: they try to get pregnant again as soon as possible. And if this succeeds, then the miscarriage is very often repeated. And you need to give the body a rest for 2-3 months, then identify and eliminate the cause. And only then try.

Causes of miscarriage

Many are convinced that miscarriages are due to a fall, bruise, or some other physical shock. Any woman who has had a miscarriage can remember that not long before she either fell or lifted something heavy. And I am sure that she lost her unborn child precisely because of this. However, those women whose pregnancy was normal also fall and lift heavy things. Most sudden miscarriages do not occur for this reason. The reason is in violations of the pregnancy itself. Approximately half of miscarriages are due to abnormal genetic development of the fetus, which can be hereditary or accidental. Merciful nature, following the principles of natural selection in everything, destroys the defective and unviable fetus. But you should not be afraid of this. The fact that there is a defect in one embryo does not mean at all that all the others will be the same. nine0033

The woman's body is almost always to blame for the other half of miscarriages. They are caused by various known and unknown factors, such as: acute infectious diseases suffered in the first trimester of pregnancy, poor environment or difficult working conditions, excessive psychological or physical stress, abnormal development of the uterus, radiation, alcohol, smoking and certain types of drugs.

The causes of early and late miscarriage may differ, although they may overlap. The most important thing is to find out and eliminate or compensate for your own cause of miscarriage. Having discovered the cause, the gynecologist will tell you how to avoid another loss. nine0033

Miscarriage

Miscarriage statistics also include “missed pregnancy”. Sometimes it happens that the embryo dies and lingers in the uterine cavity. Most often, this fact is detected by ultrasound. The dead fetus may begin to decompose, and this, thereby, will lead to poisoning of the mother's body.

Doctors resort to surgical curettage, which is associated with a risk of inflammation and complications. With such a miscarriage, the next pregnancy is planned after the body is fully restored - not earlier than a year. During this year, you will have to find out the cause of the missed pregnancy and treat it. nine0033

Miscarriage up to 6 weeks

The main causes of miscarriage on this line are malformations of the embryo itself. Statistics say that from 70-90% of embryos had chromosomal abnormalities: they are random and will not occur in other pregnancies. You may have been ill, taken medication, or were under the influence of other harmful factors. Fate saved you from a child with malformations.

The human body is perfect and finds a way to correct the situation by miscarriage. Today is a tragedy for you. The real tragedy would be the preservation and birth of a sick, non-viable child. So don’t cry and understand: everything is for the best, you won’t help grief with tears ... And after three months, try again - it will almost certainly turn out to be successful. nine0033

It should also be noted that the fact of a miscarriage does not mean that you have lost something. So for a period of 7-8 weeks, the absence of an embryo in the fetal egg is found - "anembryony". It is believed that in 80-90% of cases, miscarriages are undiagnosed non-developing pregnancies.

Miscarriage between 6 and 12 weeks

Miscarriage in this period is also considered early. Its most common causes are:

Endocrine disorders

Endocrine disorders, when the ovaries do not synthesize enough hormones to keep the fetus in the womb, or the amount of male sex hormones is increased, is one of the most common causes of miscarriage and miscarriage. nine0033

Imbalance of hormones in a woman's body is very likely to lead to an early termination of pregnancy. With a lack of the main hormone progesterone produced by the ovaries, this happens most often. Another hormonal problem is an increase in the tone of the uterus, which provokes the expulsion of the fetus.

Progesterone prepares the uterine mucosa for implantation and is the hormone for maintaining pregnancy in the first months. If conception occurs, the fetus cannot properly establish itself in the uterus. As a result, the fertilized egg is rejected. But pregnancy can be saved with the help of progesterone preparations if this problem is detected in time. nine0033

An excess of male sex hormones that suppress the production of estrogen and progesterone can also be the cause of an early miscarriage. Often, the cause of recurrent miscarriages are androgens that affect the formation and development of pregnancy; as well as thyroid and adrenal hormones. Therefore, a change in the function of these glands can lead to miscarriage.

Undertreated sexual infections

This problem must be solved before conception. Often the cause of miscarriage is sexually transmitted infections: syphilis, trichomoniasis, toxoplasmosis, chlamydia, cytomegalovirus and herpetic infections. Their effect on the fetus and the course of pregnancy is different for each woman and depends on the timing of infection, the activity of the microorganism, the degree of immune protection and the presence of other adverse factors. Depending on the situation, they can lead to the formation of fetal malformations, intrauterine infection, feto-placental insufficiency, early miscarriage or premature birth. Infection of the fetus and damage to the membrane of the fetus leads to miscarriage. To avoid this, infections should be treated before pregnancy. The use of therapy is possible during pregnancy as prescribed by a doctor. nine0033

Viral infections and other diseases

Any disease accompanied by intoxication and fever above 38 ^about C can lead to a miscarriage. Rubella, influenza and viral hepatitis occupy a leading position in this list. At a period of 4-10 weeks for pregnancy, ordinary tonsillitis can also become tragic, pneumonia carries a more serious risk. Pyelonephritis and appendicitis can cause early labor. When planning a pregnancy, it is imperative to undergo a medical examination in order to identify and treat foci of infections. nine0033

Extremely dangerous during pregnancy rubella - it leads to severe fetal malformations, so infection during pregnancy is an indication for medical abortion.

Any disease during pregnancy can lead to non-viability of the fetus. And the body, through a miscarriage, insures you against unwanted offspring. With such a miscarriage, the next pregnancy has every chance of going well.

Immune causes of miscarriage

Sometimes antibodies that are hostile to the fetus are formed in the blood of a pregnant woman. This cause can be predicted and eliminated in advance. Most often, the conflict occurs when the embryo inherits the positive Rh factor of the father, and the negative Rh factor, the mother's body rejects the embryonic tissues that are alien to it. Constant monitoring of antibody titer and the introduction of anti-Rhesus immunoglobulins allows you to maintain and maintain pregnancy. In case of an immune conflict, progesterone preparations are also used to prevent miscarriage, which in this case has an immunomodulatory effect. nine0033

Reduced immunity

Reduced immunity during pregnancy also refers to immune causes. The body is simply not able to grow a new life in itself. You need to take care of yourself and recover before the next conception.

Anatomical causes of miscarriage

Anatomical causes of miscarriage are the most intractable. Malformations of the uterus are a serious reason for miscarriage. Sometimes you just have to deal with it.

Miscarriage between 12 and 22 weeks

Such a miscarriage is considered late. Its causes coincide with the causes of miscarriages in the early stages (anatomical, immune, infectious, endocrine).

At this time, miscarriage also occurs due to isthmic-cervical insufficiency - a weak cervix cannot hold the fetus and opens. For this reason, a miscarriage can occur in the 2nd or 3rd trimester. Isthmic-cervical insufficiency is observed in 15.0-42.7% of women suffering from miscarriage. Careful monitoring of the pregnant woman allows you to identify the problem in time and make surgical correction of the cervix before the onset of childbirth. nine0033

In isthmic-cervical insufficiency, there is only one method of treatment - mechanical narrowing of the cervical canal. To do this, the neck is either sewn up or a special ring is put on it. However, the latter method is less efficient, because the ring can easily slide off the neck, then it will no longer hold back the process of opening it.

After suturing, if necessary, it is possible to use antibiotics and drugs that normalize the microflora of the vagina. The treatment of the vagina and the control of the state of the seams are carried out daily for 5 days. Stitches are removed at 37-38 weeks and with premature onset of labor. nine0033

Isthmic-cervical insufficiency may be primary (for no apparent reason), may be the result of abortion or hormonal disorders (increased levels of androgens - male sex hormones or their precursors).

Miscarriage after 22 weeks

Such a loss is hard to forget. Obstetricians talk about premature birth after the 28th week of pregnancy. Traditionally, a child born after this period is considered viable. But medicine knows many cases when it was possible to save the life of earlier children. nine0033

We recommend that you be carefully examined for miscarriage, check the above factors. In addition to them, the cause of a miscarriage can be antiphospholipid syndrome, while the woman's body perceives the child as something alien and rejects it. This disease, like the others listed, can be corrected; you have a very real chance of bearing a child.

Miscarriages due to hemostasis disorders

All of the above causes account for only 30-40%. Up to 70% of miscarriages are caused by disorders in the blood coagulation system (hemostasis). nine0033

Blood coagulation disorders leading to pregnancy loss can be divided into thrombophilic (increased clotting) and hemorrhagic (bleeding tendencies). Both of these extremes are dangerous to the fetus. Various disorders leading to the formation of small blood clots lead to the fact that the fetus loses sufficient blood supply, development is disturbed and the fetus is rejected.

The main hemorrhagic changes can appear even in childhood in the form of increased bleeding during cuts, tooth extractions, the onset of menstruation. But sometimes they declare themselves only during pregnancy and are the cause of a miscarriage. Bleeding in the early stages and detachment of the chorion is difficult to stop. nine0033

You may not guess, but incomprehensible headaches, weakness, fatigue, temporary loss of smell or hearing may be symptoms of disorders in the blood coagulation system.

When planning a pregnancy, a genetic examination should be carried out and, if necessary, treatment should be initiated.

It is advisable to be examined for hidden hemostasis defects even for those who consider themselves healthy. This will allow you to predict the occurrence of complications and prevent loss. Early therapy can prevent miscarriage at 98% of cases. If defects in hemostasis are already detected during pregnancy, it can be difficult to maintain it.

What to do after a miscarriage?

Find the cause! The ideal option is to be examined by future parents: it is much more reasonable to postpone conception and spend two or three months to identify the causes than to risk getting pregnant again, spend two months waiting, and then lose everything again and still go to the doctors.

Until you understand the reason, it will not evaporate. In most cases, the answers lie on the surface. Take care of your health and your future baby. nine0033

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Miscarriage - Symptoms, Diagnosis and Treatment

Last viewed: 23 November 2022

Last updated: 05 August 2020

Unintentional, spontaneous termination of pregnancy up to 20-24 completed weeks (gestation varies by country). Occurs in one third of pregnancies

Defined as threatened, imminent, incomplete, complete or recurrent miscarriage or non-progressive pregnancy.

The presence of pain, hypotension, tachycardia and/or anemia confirms the exclusion of a life-threatening differential diagnosis such as ectopic pregnancy.

Serial beta-hCG serum titers and transvaginal ultrasound help in the diagnosis. nine0033

When the pregnancy is no longer viable, medical or surgical evacuation is recommended. The patient may also be offered the choice of conservative treatment if there is no heavy, heavy and prolonged bleeding.

The memory of a miscarriage is associated with psychological effects of varying intensity in the short or long term or both.

Definition

Miscarriage is the unintended, spontaneous loss of pregnancy before 20-24 completed weeks.[1]World Health Organization, UNICEF, United Nations Population Fund. Vaginal bleeding in early pregnancy. In: Managing complications in pregnancy and childbirth: a guide for midwives and doctors - 2nd edition. 2017 [internet publication]. http://www.who.int/maternal_child_adolescent/documents/managing-complications-pregnancy-childbirth/en/ The gestational threshold, by definition, varies from country to country: in the United States it is typically 20 weeks[2]Centers for Disease Control and Prevention. Facts about stillbirth. October 2017 [internet publication]. https://www.cdc.gov/ncbddd/stillbirth/facts.html (but may differ from state to state), while in the UK the Royal College of Obstetricians and Gynecologists defines it as 24 weeks.[3]Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage, investigation and treatment of couples. Green top guideline no. 17 April 2011 [internet publication]. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg17/ Beyond these limits, fetal loss will be defined as a stillbirth. A miscarriage is associated with unexplained vaginal bleeding and suprapubic pain or no pain.