Management of Miscarriage

Miscarriage is common, occurring in up to 1 in 5 pregnancies, and there is often no particular cause found. It can be a very emotional and distressing experience, especially if you were unaware of anything going wrong with the pregnancy.

It can be difficult to think clearly and make decisions about your care, but it is important that you are aware of the options and make the right choices for you. This page provides details about surgical, medical, and natural management of miscarriage to help in the decision-making process.

Types of miscarriage

Complete miscarriage: The miscarriage has already taken place by the time you have your scan and the diagnosis is made. Generally, no further treatment is required.
Silent or delayed miscarriage: The pregnancy ends at an early stage, but it may take time before you notice any changes. You may still have some pregnancy symptoms.
Incomplete miscarriage: You have already had vaginal bleeding or passed some tissue, but the process is not complete.

Options for management

If you are feeling well, there are three options for care and management of incomplete or silent miscarriage:

Natural management: Allowing nature to take its course.
Medical management: Using medication.
Surgical management: Sometimes referred to as a D&C or evacuation.

There is no right or wrong choice. Your wishes will be fully discussed and respected.

Surgical management of miscarriage

The cervix is gently opened and the pregnancy tissue removed using a suction device.
Vaginal pessaries are usually given before the operation to soften the cervix.
Tissue removed may be sent for laboratory analysis to confirm the pregnancy was inside the womb and not ectopic, and to check for abnormal changes in the placenta.
The operation is safe, but there is a small risk of complications such as heavy bleeding, infection, perforation of the uterus, or tear of the cervix (about 1%).
Surgical evacuation may be advised if you are bleeding heavily, there is a large amount of tissue in your womb, or if natural or medical management are unsuccessful.
The procedure is usually successful, but occasionally a repeat operation may be needed.

What to expect

The procedure takes 10–15 minutes, but you will be in hospital for 6–8 hours.
Admission is arranged on a weekday, usually within 10 days of diagnosis.
On admission, four tablets are inserted vaginally and an antibiotic suppository is given.
You will attend a pre-operative assessment clinic for medical history, medication review, allergies, blood pressure, and blood tests.

After theatre

You may experience cramp-like period pains and some bleeding, which should not be heavier than a normal period.
Painkillers are available if needed.
You will be given an antibiotic tablet prior to discharge. If your blood group is Rhesus negative, you will be offered an injection of anti-D.
Most women stay for about 3 hours after the procedure and can go home if feeling well and bleeding is not heavy.

Medical management of miscarriage

Medication is given to help the womb empty.
You may experience cramp-like period pains and heavier bleeding than a normal period, possibly passing tissue.
Most women stay in the ward for about six hours; occasionally, an overnight stay is required.
Painkillers are available if needed.
You may need an internal examination or repeat scan to ensure the procedure has been successful.
About 1 in 20 women may require surgery if medical management is unsuccessful.
A repeat pregnancy test at home after three weeks is advised.
You can change your mind and opt for another management option before starting treatment.
You will be nursed in a single room, and someone can stay with you if you wish.

After medical or surgical management

You can go home if you are well and bleeding is not too heavy; most people go home the same day.
You will be given an antibiotic tablet prior to discharge.
It is advised that someone comes to pick you up and that you are not alone overnight.
Do not drive home after either procedure.

When to get urgent medical help

Bleeding that soaks 2 or more sanitary pads per hour for 2 consecutive hours.
Passing large clots or feeling faint or dizzy.
A high temperature, flu-like symptoms, or feeling unwell.
Severe or worsening abdominal pain.
Offensive (smelly) vaginal discharge.

If you experience any of these symptoms, contact Ward 6, the Early Pregnancy Assessment Service, your GP, or NHS 111.

Bleeding after miscarriage

Bleeding usually lasts 1–2 weeks but can continue for up to 3 weeks.
If bleeding persists, becomes offensive smelling, or is very heavy with clots, seek medical advice as this could be a sign of infection.
Use sanitary towels rather than tampons to reduce the risk of infection.

Resuming sexual intercourse and future fertility

Avoid sexual intercourse until bleeding has stopped.
These procedures should not affect your future fertility.
Ovulation can occur before your next period, so pregnancy is possible within the first month.
Your next period will usually return within 4–6 weeks.
Give yourself time to recover emotionally and physically.
Start folic acid tablets when you are planning a pregnancy.
If you do not want to get pregnant, ensure contraception is arranged before leaving the ward.

Natural management of miscarriage

You will have a blood test, blood pressure, and temperature checked. If all is well, you can go home with a follow-up plan.
Incomplete miscarriage may complete within the next 7 days; silent miscarriage may take longer.
You may experience pain and bleeding, possibly passing tissue.
A 24-hour phone number is provided for advice.
If bleeding becomes heavier, hospital assessment is recommended.
Pain relief such as paracetamol can be taken if needed.
You do not need to stay in bed unless you wish.
Let staff know if you feel unwell, have heavy bleeding, or develop a temperature.
Follow-up calls and appointments are arranged as needed.
You can change your mind and opt for another management option at any stage.

Emotional wellbeing

It is normal to experience a range of emotions after a miscarriage due to hormonal changes and the impact of your loss. If you would like support, speak to your GP, who can provide advice or arrange counselling.

Contacts

Early Pregnancy Assessment Service, Forth Valley Royal Hospital: 01324 567119 (Monday to Friday, 08:30–16:30)
Ward 6, Forth Valley Royal Hospital: 01324 566390 (24 hours)
Maternity Triage, Forth Valley Royal Hospital: 01324 567098 (over 14 weeks)