Management of Miscarriage

Management of Miscarriage

Your health care provider can perform a variety of tests:

• Pelvic exam. Your health care provider may be able to check to see if your cervix has started to dilate.
• Ultrasound. During an ultrasound, the health care provider will monitor the fetal heartbeat and determine if the embryo is developing normally. If a diagnosis cannot be made, you may need to have another ultrasound in about a week.
• Blood tests. Your health care provider may check the level of the pregnancy hormone, human choriogonadotropin, in the blood and compare it to previous measurements. If the pattern of changes in the level of human choriogonadotropin is abnormal, it could be indicative of a problem. Your health care provider may test you to see if you are anemic, which could happen if you have experienced heavy bleeding, and may also determine your blood type.
• Tissue analysis. If you have expelled tissue, it may be sent to a lab to confirm that a miscarriage has occurred and that the symptoms are not related to another cause.
• Chromosome studies. If you have had two or more previous miscarriages, your health care provider may order blood tests for you and your partner to determine if chromosomes are a factor.

Possible diagnoses include:

• Threatened abortion. If you have bleeding, but your cervix did not begin to dilate, there is a threat of miscarriage. These pregnancies often continue without further complications.
• Unavoidable abortion. If you have bleeding, cramping, and a dilated cervix, abortion is considered unavoidable.
• Incomplete abortion. If you expel remains of the fetus or placenta but some of that material remains in the uterus, the abortion is considered incomplete.
• Retained abortion. In a retained abortion, the tissues of the placenta and embryo remain in the uterus, but the embryo has died and never formed.
• Complete abortion. If you have expelled all the tissues resulting from conception, abortion is considered complete. This is common in abortions that occur before 12 weeks of gestation.
• Septic abortion. If you have an infection in the uterus, a septic abortion occurs. This infection can be serious and requires immediate attention.

Treatment

In the face of the threat of miscarriage, your health care provider may recommend that you rest until the bleeding or pain goes away. Bed rest has not been proven effective in preventing miscarriages; however, it is prescribed as a protective measure. In addition, you may be asked to avoid exercise and sex. Although these measures have not been proven effective in reducing the risk of miscarriage, they may improve your well-being.

In some cases, it’s also a good idea to postpone travel, especially to areas where it may be difficult to get immediate medical attention. Ask your doctor if he or she thinks it’s wise to postpone any upcoming trips you’ve planned.

With ultrasound, it is now much easier to determine if an embryo has died or if it has never formed. In either case, a miscarriage will occur. If you find yourself in this situation, you may have several options:

• Expectant control. If you have no signs of infection, you may choose to wait for the miscarriage to happen naturally. This usually happens within a couple of weeks of the embryo being determined to have died. Unfortunately, it may take three to four weeks. This time can be emotionally difficult. If expulsion does not happen on its own, medical or surgical treatment will be needed.
• Medical treatment. If, after the diagnosis of a certain pregnancy loss, you prefer to speed up the process, some medications can cause the body to expel the pregnancy tissue and placenta. The medication may be taken by mouth or inserted into the vagina. Your health care provider may recommend that you insert the medication into your vagina to increase its effectiveness and minimize side effects, such as nausea and diarrhea. For 70% to 90% of women, this treatment works within 24 hours.
• Surgical treatment. Another option is a minor surgical procedure called dilation and curettage by aspiration. During this procedure, the health care provider dilates the cervix and removes tissue from inside the uterus. Complications are rare, but could include damage to the connective tissue of the cervix or the wall of the uterus. Surgical treatment is necessary if you have a miscarriage accompanied by heavy bleeding or signs of infection.

Physical recovery
In most cases, physical recovery after a miscarriage takes only a few hours or a couple of days. During this time, contact your health care provider if you experience heavy bleeding, fever, or abdominal pain.

You may ovulate as soon as two weeks after a miscarriage. Expect your period to return in four to six weeks. You can start using any type of birth control right away after having a miscarriage. However, you should avoid having sex or putting something in your vagina (such as a tampon) for two weeks after having a miscarriage.

Future Pregnancies
It is possible to become pregnant during the menstrual cycle immediately after a miscarriage. However, if you and your partner decide to try another pregnancy, make sure you are physically and emotionally prepared. Ask your health care provider for advice about when you can try to conceive.

Remember that miscarriage usually occurs only once. Most people who have miscarriages have a healthy pregnancy after abortion. Less than 5 percent of women have two consecutive miscarriages, and only 1 percent have three or more consecutive miscarriages.

If you have several miscarriages, usually two or three in a row, consider getting tested for hidden causes, such as uterine abnormalities, clotting problems, or chromosomal abnormalities. If the cause of miscarriages cannot be identified, do not give up hope. About 60 to 80 percent of women with miscarriages followed for no apparent reason have healthy pregnancies.

Coping and Support Strategies
Emotional healing can take much longer than physical healing. Miscarriage can be a heartbreaking loss that people close to you may not understand. Your emotions can range from anger and guilt to despair. Give yourself time to take on the loss of pregnancy, and seek help from loved ones.

You may never forget the hopes and dreams associated with this pregnancy, but over time acceptance can ease your pain. Talk to your health care provider if you feel deep sadness or depression.

Preparing for Your Consultation
If you have signs or symptoms of miscarriage, contact your health care provider right away. Depending on the circumstances, you may need immediate medical attention.

Below is information that will help you prepare for your visit and know what to expect from your health care provider.

What you can do
Before your consultation, you may want to do the following:

Ask about the restrictions you must respect before the consultation. In most cases, you will be seen immediately. If this is not the case, ask if you should restrict your activities while waiting for your consultation.
Find a loved one or friend who can accompany you to the consultation. Because of fear and anxiety, you may not be able to focus on what your health care provider tells you. Go with someone who can help you remember all the information.
Write down any questions you want to ask your health care provider. This way, you won’t forget anything important you want to ask and you’ll be able to make the most of your time with the health professional.
Here are some basic questions you can ask your health care provider about miscarriage:

• What treatment options are there?
• What kind of tests do I need?
• Can I continue my usual activities?
• What signs or symptoms should prompt me to call you or go to the hospital?
• Do you know what caused the miscarriage?
• What are my chances for a successful pregnancy in the future?
  In addition to the questions you have prepared, don’t hesitate to ask other questions during your visit, especially if you need clarification or don’t understand something.

What to Expect from the Doctor
Your health care provider will probably ask you several questions as well. For example:

• When was your last menstrual period?
• Did you use birth control when you probably became pregnant?
• When did you first notice the signs or symptoms?
• Have the symptoms been continuous or isolated?
• Compared to heavier days of menstrual flow, is the bleeding greater, lesser, or equal?
• Have you had a miscarriage before?
• Have you had any complications in a previous pregnancy?
• Do you have other conditions?
• Do you know your blood type?