Miscarriage: Treatment for miscarriage

Nothing can be done to prevent a miscarriage once it has begun. Treatment is aimed at avoiding heavy bleeding and infection. It is also aimed at looking after you, physically and emotionally.

No treatment (expectant management)

Things to consider if you choose not to be treated

• Some women feel this is a more natural approach and feel more in control of the situation. However, some women are worried or scared when the bleeding gets heavier, especially if they pass blood clots, tissue or even a recognisable embryo.
  

• Overall an untreated miscarriage will usually take more time to pass than with medication or surgical treatment – sometimes the bleeding can last for up to four weeks.

• Although excessive bleeding and blood transfusion are very rare, they are slightly more common with expectant management than with surgery.

• Although surgical complications are very rare, expectant management avoids any surgical and anaesthetic risks.

• A few women still need to have surgery – sometimes urgently – if they develop infection, bleed heavily or if the tissue does not pass naturally.

• The waiting time can be emotionally draining for some women.

Treatment with medication

• While you are waiting, there may be some spotting or bleeding like a period. When the pregnancy tissue passes, you are likely to notice heavier bleeding with cramping, period-like pains. You can use sanitary pads and take pain relieving tablets such as paracetamol (with or without codeine).

• Medication may be suitable for an incomplete miscarriage if there are large amounts of tissue remaining and it is sometimes suitable when there is a missed miscarriage.

• Medication is not suitable if there is very heavy bleeding or signs of infection. It is usually not recommended for pregnancies that are older than about nine weeks.

• If the tissue does not pass naturally, eventually your doctor will recommend a dilatation and curettage (D&C). You and your doctor can discuss this if and when this should occur.

Things to consider about treatment with medication

• The experience of medication management is much like expectant management but likely to be quicker.

• The medication has side effects which usually pass in a few hours, but can be unpleasant, including nausea, vomiting, diarrhoea, fever and chills. The tablets can be swallowed or dissolved under the tongue, depending on the circumstances. However, there may be fewer side effects if the tablets are given in the vagina.

• Many women will stay in hospital for a few hours after the medication is given to wait for the tissue to pass.

• A few women still need to have surgery, sometimes urgently, if they develop infection, bleed heavily or if the tissue does not pass.

Surgical treatment (curette)

What is a curette?

When is a curette done?

• If you have heavy or persistent bleeding and/or pain.
• If the medical staff advise that this is a better option for you; this may be because of the amount of tissue present, especially with a missed miscarriage.
• If you prefer this option.

Waiting for a curette

• A curette will usually be booked for the next business day, or a later day if you prefer. Sometimes a natural miscarriage will occur overnight or while you are waiting (see below: Waiting for treatment).
• If it is found that the miscarriage has happened and the tissue has already passed, you may no longer need to have a curette.

Things to consider about surgical treatment

• a risk that the surgery has not removed all of the pregnancy tissue(around 1–2%). This can cause prolonged or heavy bleeding and the operation may need to be repeated
  

• infection needing antibiotics. Some studies suggest this is more common after surgery than other treatments, while others suggest the rates are similar
  

• a risk that the cervix or uterus is damaged during surgery. This is very rare (around 1 in 1000) and, when it does happen, it is usually a small hole or tear which will heal itself
  

• excessive bleeding. This is very rare; in a few cases (1 to 2 in 1000) a blood transfusion will be needed
  

• anaesthetic risks. These are very low for healthy women, but no anaesthetic or operation is without risk.
  
  

Waiting for treatment

• increased bleeding, for instance soaking two pads per hour and/or passing golf ball sized clots
• severe abdominal pain or shoulder pain
• fever or chills
• dizziness or fainting
• vaginal discharge that smells unpleasant
• diarrhoea or pain when you open your bowels.

What to do while you are waiting

• You can try to rest and relax at home.
• As much as you can, continue your usual day to day activities. Usual activity, that is not too strenuous, will not be harmful. You can go to work if you feel up to it.
• If you have pain you can take paracetamol (such as Panadol or Panadeine) according to instructions on the packet.
• Many authorities advise avoiding tampon use during or after a miscarriage. This is because of a possible risk of infection although tampons have not been proven to cause infection in this situation.
• For similar reasons it is suggested that you avoid soaking in a bath during a time of heavy bleeding.
• Most people prefer to avoid sex if there is pain or bleeding. Once bleeding settles, it’s OK to have sex if you feel comfortable.

Who should I contact for help?

General contact options

• Your GP
• Community health service
• Nearest emergency department
• Nearest early pregnancy assessment service
• Nurse on Call - 1300 60 60 24

Royal Women's Hospital options

• Miscarriage

• After a miscarriage

• Pain and bleeding in early pregnancy

References

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