If a miscarriage has begun, there is nothing that can be done to stop it. Any treatment you have will be aimed at avoiding heavy bleeding and infection.
You may be offered medication to help the pregnancy tissue pass, or surgery to empty the tissue out of the uterus.
You may prefer to wait for nature to take its course; this is sometimes called ‘expectant management’ and is usually safe to do and, if it isn’t, the doctor will tell you.
A discussion with the doctor or nurse will help you to work out which treatment options are best and safest for you.
No treatment (expectant management)
You can choose to wait and see what will happen. Health professionals refer to this is as expectant management. If nothing is done, sooner or later the pregnancy tissue will pass naturally. If it is an incomplete miscarriage it will often happen within days, but for a missed miscarriage it might take as long as three to four weeks.
While you are waiting you may have some spotting or bleeding, much like a period. When the pregnancy tissue passes, you are likely to have heavier bleeding with crampy, period-like pains. You can use sanitary pads and take pain relieving tablets, such as paracetamol (with or without codeine).
If your miscarriage is incomplete, with just a small amount of pregnancy tissue remaining, it’s probably best to take a wait and see approach. But it there is heavy bleeding or signs of infection you will need treatment.
If the tissue does not pass naturally or you have signs of infection, the doctor will recommend a dilatation and curettage (D&C). You and the doctor can discuss and decide the preferred option for you.
Things to know
- There are many reasons why some women prefer to wait and see. It may feel more natural, it may help with the grieving process or it may give you more of a sense of control.
- Some women become worried or frightened when the bleeding gets heavier, especially if blood clots, tissue or even a recognisable embryo is passed.
- Usually, the wait and see approach takes longer than any other approaches such as surgery or medication. Sometimes 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 and anaesthetic risks are uncommon, they do happen and can be avoided with a wait and see approach.
- 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 medicine
There is medicine available that can speed up the process of passing the pregnancy tissue. For an incomplete miscarriage, the medicine will usually encourage the pregnancy tissue to pass within a few hours. At most it will happen within a day or two. For a missed miscarriage, it may happen quickly, but it can take up to two weeks; occasionally longer.
- Medicine 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).
Things to know
- The pregnancy tissue will pass between four to six hours after taking the medicine, during which you may be in hospital. After a few hours, if the pregnancy hasn’t passed, you may be sent home to wait. This will depend on where you are and the hospital you are booked into.
- The medicine has side effects which usually pass in a few hours but can be unpleasant, such as 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.
- After receiving the medication there may be some spotting or bleeding like a period. When the pregnancy tissue passes, you are likely to notice heavier bleeding and clots with strong cramping, period-like pains. You can use sanitary pads and take pain relieving tablets such as paracetamol (with or without codeine).
- Some women may experience strong pain and will need strong pain killers or pain relieving injection.
- 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)
A D&C (or ‘curette’) is a minor operation. The full name is dilatation and curettage. It is done in an operating theatre, usually under general anaesthetic. There is no cutting involved because the surgery can happen through the vagina. The cervix (neck of the uterus) is gently opened and the remaining pregnancy tissue is removed so that the uterus is empty. Usually the doctor is not able to see a recognisable embryo.
The actual procedure usually only takes five to ten minutes, but you will usually need to be in the hospital for around four to five hours. Most of this time will be spent waiting and recovering. Delays can be quite common because of urgent cases.
Some women will be asked to attend a few hours before the procedure to have medicine to soften the cervix before the curette. The medicine may have side effects including nausea, vomiting, diarrhoea, fever and chills.
You may have to wait a day or two to have a curette and sometimes, while you are waiting, the pregnancy tissue will pass on its own. If this happens and all of the tissue is passed you may not need to have a curette.
A curette is done in the following circumstances:
- you have heavy or persistent bleeding and/or pain.
- 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.
- this is an option you prefer.
Things to know
The risks of a D&C are very low, but include:
- a risk that the surgery has not removed all of the pregnancy tissue (around one to two per cent). 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
If you have heavy bleeding with clots and crampy pain, it is likely that you are passing the pregnancy tissue. The bleeding, clots and pain will usually settle when most of the pregnancy tissue has been passed. Sometimes the bleeding will continue to be heavy and you may need further treatment. If you think you are having, or have had, a miscarriage you should see a doctor or go to an emergency department for a check-up.
You should go to your nearest emergency department if you have:
- 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.
- 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 (with or without codeine) 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.
After a miscarriage
Whether your miscarriage was natural, assisted with medication or treated with a curette the following information is important.
- It is usual to have pain and bleeding after a miscarriage. It will feel similar to a period and will usually stop within two weeks. You can take ordinary painkillers with paracetamol or codeine for the pain. Your next period will usually come in around four to six weeks after a miscarriage.
- See a doctor or attend a hospital emergency department if you have strong pain and bleeding (stronger than period pain), abnormal discharge, (especially if it is smelly), or fever. These symptoms may mean that you have an infection or that tissue has been left behind.
- Try and avoid vaginal sex until the bleeding stops and you feel comfortable.
- You can use sanitary pads until the bleeding stops (do not use tampons).
- Wait for at least one normal period before trying to get pregnant. This is because some research suggests that you have a higher chance of another miscarriage if you get pregnant straight away.
- All contraceptive methods are safe after a miscarriage
- See a GP (local doctor) in four to six weeks for a check-up.
Anti D injection after a miscarriage
It is important to have your blood group checked. If you’re RhD negative and the fetus is RhD positive this can cause problems for future pregnancies. This is because the fetus’s blood cells have RhD antigen attached to them, whereas yours do not. If small amounts of the fetus’s blood mixes with your blood, your immune system may perceive this difference in blood cells as a threat and produce antibodies to fight against the fetus’s blood. Once your body has made these antibodies they can’t be removed. This is unlikely to have caused your miscarriage and is more likely to affect future pregnancies. That’s because the process of producing antibodies takes time. Women with a negative blood type usually need an Anti D injection which will stop the antibodies from forming.
Future pregnancies after a miscarriage
One of the most common concerns following a miscarriage is that it might happen again. However, if you have had one miscarriage the next pregnancy will usually be normal.
We suggest that you wait at least until after the next normal period (four to six weeks) before trying again, as there is a slightly higher risk of miscarriage if you get pregnant straight away. It is possible to become pregnant straight away, so if you do plan to wait, you will need to use some form of contraception.
After a miscarriage, you may have mixed feelings about becoming pregnant again. Some couples decide that they want to try for a pregnancy straight away, while others need time to adjust to their loss. Apart from the advice to wait for one period, there is no ‘right’ thing to do. If you feel anxious about a possible loss in future pregnancies, you may find it helpful to talk to someone about this. Your doctor, community support group and counsellors can provide information and assistance.
If you do try for another pregnancy make sure that you avoid any of the lifestyle factors that are known to increase the risks of miscarriage like smoking, alcohol and excess caffeine. It is recommended that all women take folic acid while trying to conceive, and continue until three months of pregnancy. In your next pregnancy you are encouraged to see your GP and have an ultrasound at about seven weeks. If ultrasound is done too early in pregnancy the findings are often uncertain and cause unnecessary worry.
Feelings and reactions
There is no ‘right’ way to feel following a miscarriage. You may experience a range of physical or emotional reactions, or you may feel very little at all. Some degree of grief is very common, even if the pregnancy wasn’t planned. Partners may react quite differently, just as people can respond differently to a continuing pregnancy. Try to take it a day at a time and to acknowledge your feelings and reactions as they arise. Most people find it helpful to talk about their feelings; this may be with your partner, other family members or close friends. Some friends and family may not understand the depth of emotion that can be attached to a pregnancy and may unreasonably expect for you to move on before you are ready. It can also be difficult to talk to family and friends if you have chosen not to share the news of the pregnancy. You may prefer to talk with a doctor, nurse or other health professional.
Some women and their partners continue to experience feelings of loss long after a miscarriage occurs. In particular it is common to feel upset around the date of the expected birth, or the anniversary of the miscarriage. Family or close friends can be a great source of support at these times. Alternatively, you may choose to seek professional support.
The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.