There are different ways of managing a pregnancy that is not progressing. Sometimes no action is required, this usually happens when you have already passed the embryo or foetus naturally and your womb is empty when you have your scan. If however some or all of the pregnancy tissue remains in your womb there are three ways of managing the miscarriage depending on your individual circumstances.
1. Conservative Management (wait and see)
With modern ultrasound it has become possible to adopt a “wait and see approach”. For women who prefer no intervention, most miscarriages will occur naturally within two to three weeks in the majority of cases.
When a miscarriage is happening, you will feel contractions of the womb similar to very strong period like pains. You may pass the pregnancy sac with a recognisable foetus or baby inside. You will experience bleeding, sometimes heavy and you are likely to pass large clots. If you are bleeding heavily or the pain is very severe you might need to be admitted to hospital. Do contact the hospital for advice if you are worried or feel you need to.
For a small number of women, it may take longer, and they may need some medication, or possibly an operation to make sure the pregnancy sac and tissue has passed. An Ultrasound can be performed to assess what has occurred and how best to manage the situation. It is important to ensure that nothing remains behind in the womb that could cause infection.
The risk of infection if you decide on conservative management is small. However if you have any of the following symptoms you should contact your doctor or hospital immediately:
- Excessive bleeding
- Unpleasant discharge
- Lasting pain
- High temperature/ fever
2. Medical Approach
If the woman decides that the conservative approach is not preferred, then medicines may be used to start the process. Usually you are given some tablets containing misoprostol to take along with a prescription for pain relief. It is expected that you will experience very strong period like pains and heavy bleeding initially for a couple of hours. You may pass a pregnancy sac sometimes with a recognisable foetus or baby inside and also some tissue and clots but soon the pain and bleeding will settle down and continue like a period for up to 7–10 days.
In most cases the above treatment is all that is needed. Sometimes further intervention may be necessary should there be still be some tissue left within the womb or the bleeding becomes heavier.
A follow up scan appointment should be made for 7 -10 days after taking the tablets. Should you pass a pregnancy sac, tissue/clots please take these with you, if possible, when you attend for your hospital scan.
3. Surgical Approach.
Taking this approach the pregnancy tissue is removed surgically via a procedure called an ERPC (Evacuation of Retained Products of Conception). This procedure is also referred to as a D & C (dilation and curettage). The procedure is carried out under general anaesthetic, and done vaginally, so there is no incision or stitches.
The risks associated with the surgical management of miscarriage include:-
- Anaesthetic risks
- Surgical risks – haemorrhage, uterine/bowel perforation, intrauterine adhesion, cervical trauma and ascending infection.
The midwives, bereavement team or chaplain at the hospital you are attending can give you advice and support regarding your baby’s remains, should you need it.
If you wish you can discuss bringing your baby’s remain back to the hospital to see if any examination of the remains can be carried out.