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Treatment Options for Miscarriage

Understanding your treatment options may help you to feel more in control. Once an ultrasound confirms a miscarriage will occur, there are three treatment options available to you

  • Expectant management
  • Medical management
  • Surgical management (Dilation and curettage or 'D&C')

These options are safe and do not affect your future pregnancies. Your healthcare provider will discuss each of these with you to help you determine the best option for you. 

Expectant management
Expectant management is when you wait for the miscarriage to occur on its own. Approximately 50% of patients will miscarry on their own within 2 weeks of a diagnosis of pregnancy demise in the first trimester. The timing of miscarriage can vary significantly. It can sometimes take up to 6-8 weeks for miscarriage to occur after diagnosis.

Most who choose expectant management will have a complete miscarriage on their own, however approximately 1 in 4 will need an emergency dilation and curettage (D&C), a surgical procedure to make sure all the pregnancy tissue is removed.

The experience of miscarriage varies from person to person. When you wait for your miscarriage to occur, it can happen at any time. You are likely to experience cramping and bleeding that lasts several hours. For many, heavy bleeding and severe cramping may last 2-3 hours while the miscarriage is occuring. You may experience nausea and fatigue until your miscarriage is completed.

After the passage of pregnancy tissue, you may continue to have some cramping and bleeding for up to 2 weeks. The amount of blood after a miscarriage is often similar to a menstrual period.

It is not necessary to have another ultrasound after you have miscarried, unless you continue to have heavy bleeding (soaking 1 pad per hour for more than 3 hours), or you experience ongoing bleeding or cramping 2 weeks after your miscarriage.
 
  • Have a family member or friend you can call for emotional support
  • Use a hot compress or water bottle on your lower abdomen
  • Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain, and dimenhydrinate (Gravol) for nausea, as needed
  • We recommend you use pads, not tampons, and avoid swimming and sexual intercourse during this time
 

You may experience 

  • Heavy bleeding which may require a visit to the emergency department, D&C and rarely, a blood transfusion.
  • Fever or severe cramping that indicates an infection requiring antibiotics
  • Ongoing bleeding or cramping for more than 3 weeks after your miscarriage that may be due to pregnancy tissue remaining in your uterus
 




When to get help

Go the nearest emergency department immediately if you have any of the following

  • Sudden severe pain in your abdomen 
  • Sudden feelings of faint or dizziness
  • Very heavy bleeding (soaking more than 3 maxi pads in 3 hours)
  • Fever of greater than 38°C (103° F) 
Medical management

Medical management allows you to miscarry at home with greater control over when it may occur.


In BC, medical management is possible using a 2-drug combination of mifepristone and misoprostol. Mifepristone helps to prepare your uterus for miscarriage, followed by misoprostol 24-48 hours later which helps the cervix soften and dilate to expedite the miscarriage. Depending on the timing of your pregnancy demise, this 2-drug combination can be up to 92% successful in completing your miscarriage.


In some cases, medical management will not succeed and you will need further medication or surgical management to make sure all the pregnancy tissue is removed.

Your healthcare provider will give you a prescription for mifepristone/ misoprostol that may also include pain medication. You should call your pharmacy to ensure this medication is available.


  1. You will first take mifepristone orally. You may experience some spotting in the 24 hours that follow mifepristone. Some people find they do not experience any symptoms and continue to work during this time. 
  2. 24-48 hours later, you will place 4 tablets of misoprostol in your vagina. The miscarriage will usually occur within 4-12 hours from the time you insert the misoprostol tablets. 
  3. Your provider should arrange a telephone follow-up with you 1 week after you take the medication to ensure you have had the miscarriage.

You are likely to experience cramping and bleeding that lasts several hours. For many, heavy bleeding and severe cramping lasts 2-3 hours while the miscarriage is occuring. You may continue to feel symptoms of pregnancy such as nausea and fatigue until your miscarriage is completed. 


After the passage of pregnancy tissue, you will continue to have some cramping and bleeding for up to 2 weeks. Bleeding after a miscarriage is often similar to a menstrual period. 


It is not necessary for you to have an ultrasound after you have miscarried, unless you continue to have heavy bleeding following the miscarriage (soaking 1 pad per hour for more than 3 hours), or you experience ongoing bleeding or cramping 2 weeks after your miscarriage. 


Side effects are usually mild and can include nausea, vomiting or diarrhea. Please alert your provider if you experience vomiting within 1 hour of taking mifepristone. 


You may continue to breastfeed while taking this two drug combination. 

 
  • Have a family member or friend you can call for emotional support
  • Use a hot compress or water bottle on your lower abdomen
  • Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain, and dimenhydrinate (Gravol) for nausea, as needed
  • We recommend you use pads, not tampons, and avoid swimming and sexual intercourse during this time.

You may experience 

  • Heavy bleeding which may require a visit to the Emergency Room, a D&C and rarely, a blood transfusion
  • Fever or severe cramping that requires antibiotics to treat an infection
  • Ongoing bleeding or cramping >3 weeks after your miscarriage may be due to pregnancy tissue remaining in your uterus

 

When to get help

Go the nearest emergency department immediately if you have any of the following

  • Sudden severe pain in your abdomen 
  • Sudden feelings of faint or dizziness
  • Very heavy bleeding (soaking more than 3 maxi pads in 3 hours)
  • Fever of greater than 38°C (103° F)

Surgical management (D&C)

Dilation and curettage (D&C) is a surgical procedure in which the cervix is gently opened (dilation) and the pregnancy is removed with a suction device (curettage). Depending on your health history and the size of the pregnancy demise, your provider may recommend this procedure for you. 

Although it is called a D&C, it is generally done with a suction device and is better described as a suction and evacuation procedure. While performing this procedure, a thin tube is inserted into the uterus and connected to a source of suction. This source can either be an electric or handheld pump. 


The procedure generally lasts 10 to 15 minutes. It can be done with oral or intravenous pain medication as an outpatient procedure. 


You may recover for 30-60 mins after the procedure before going home. It is 99% successful in completing your miscarriage. 

  • Have a family member or friend you can call for emotional support
  • Use a hot compress or water bottle on your lower abdomen
  • Take acetaminophen (Tylenol) or ibuprofen (Advil) for pain, and dimenhydrinate (Gravol) for nausea, as needed
  • We recommend you use pads, not tampons, and avoid swimming and sexual intercourse during this time

Possible complications include:

  • Heavy bleeding which may require a visit to the emergency room, a second D&C, or rarely, a blood transfusion.
  • Fever or severe cramping that requires antibiotics to treat an infection
  • Ongoing bleeding or cramping >3 weeks after your procedure that may be due to pregnancy tissue remaining in your uterus
  • Possible injury to the uterus, including cervical tears, perforation (hole in the uterus) or Asherman's Syndrome (scarring inside the uterus). 
    • These complications are rare (less than 1%). 
    • If you do not menstruate by the 3rd month after D&C, please alert your provider as this could be a sign of scarring. Scarring in your uterus is treatable, but could delay your plans to become pregnant again.
 

When to get help

Go the nearest emergency department immediately if you have any of the following

  • Sudden severe pain in your abdomen 
  • Sudden feelings of faint or dizziness
  • Very heavy bleeding (soaking more than 3 maxi pads in 3 hours)
  • Fever of greater than 38°C (103° F)


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