Date issued: May 2022
Review date: May 2024
Ref: B-228 v5
Early scans do sometimes show there is a problem, although it is important to bear in mind that most pregnancies are successful.
On occasion following your ultrasound scan at the Early Pregnancy Unit it may NOT be possible that you will receive a definite result or outcome.
This means that it is not possible to confirm whether your pregnancy is going to continue (viable) or not, at this moment in time. If this is the case we will recommend that you be rescanned in 14 days although the wait may seem a very long time and you will naturally be worried.
We know that it can be difficult to take in all the facts when you are worried or upset. This leaflet aims to provide some information and advice for you at this time.
Why do I need to have another scan?
There are three main reasons for you not being told exactly what is happening:
It may simply be because it is too early to see an embryo with a heartbeat on ultrasound scan.
The pregnancy is not growing as it should and may turn out to be a miscarriage. This may be why you are having bleeding or pain.
There is a possibility of an ectopic pregnancy (a pregnancy outside the womb) although this is rare, cannot be excluded at this stage and it is too early to diagnose. This is called a pregnancy of unknown location.
Where we are unable to confirm the pregnancy is in the womb (pregnancy of unknown location) we may need to check the pregnancy hormone level in your blood and perhaps repeat the blood test and/or scan in a few days depending on the hormone levels.
The pregnancy hormone that is measured is called βhCG (Beta human Chorionic Gonadotrophin). It is a hormone produced by the developing placental tissue. It is more accurate than the urine test. The urine pregnancy test will just tell you there is pregnancy hormone present and not if the pregnancy is growing in the right place or if the pregnancy is ok or not. We know it is temping to do home pregnancy tests at this time but we need to wait an see the result of the blood hormone test.
What happens at a “Rescan”?
At the next appointment the person doing the scan will be looking for a clear difference in the size of the pregnancy sac and/or, for a developing baby and a heartbeat. This is why it is important to have enough time between scans. We do not recommend scanning if less than 1-2 weeks has passed since your first scan unless we are worried this may be an ectopic pregnancy.
There are strict guidelines set out by the Royal College of Obstetricians and Gynaecologists and NICE for scans in early pregnancy (RCOG 2006). Your sonographer follows these, in order that they will be absolutely sure of any findings before we give you a diagnosis of pregnancy loss.
We appreciate what a worrying time this is for you as it can be very stressful dealing with this uncertainty – some women describe it as being “in limbo”. You may need to find some support for yourself if this happens to you.
Early scans do sometimes show there is a problem, although it's important to bear in mind that most pregnancies are successful and that when you have a rescan we would hope to have a viable pregnancy with a heart beat.
Bleeding can be very common in early pregnancy and is not always a bad sign. Whilst in some cases it is due to an implantation bleed it may be a sign that the pregnancy is not progressing as it should. As long as it isn’t too heavy and you are coping with your symptoms then we would advise you that you can stay at home.
If you develop any sharp pains or are aware of an increasing, possibly crampy, discomfort you may take Paracetamol tablets (if you are not allergic to them). However if the pain is too bad and you are worried please do not hesitate to phone either the Early Pregnancy Unit (EPU) or Ocean Suite (Gynae Ward) if the unit is closed.
*Unfortunately for a small proportion of women the outcome may not be good news and they may actually miscarry between scans.
It is for those ladies we will now give the following advice, please note that we are NOT trying to tell you that this will happen.
Advise for those ladies who may miscarry before their next scan.
Be prepared for when the bleeding starts or becomes heavier. It is difficult to predict just how heavy the bleeding will be, but it will likely be heavier than a normal period.
What to expect
Having a miscarriage can be painful, with mild to severe crampy type pains and lower back ache occurring at any time, but especially when the miscarriage is imminent. The pains are because the uterus has to contract to open your cervix in order to pass blood and tissue.
Some ladies do have heavy bleeding, with clots and bad cramps during a period. But if you have been on the pill or other contraceptive measures that affect the menstrual cycle, then you may not have experienced any heavy bleeding or cramps before and it may catch you by surprise.
You may pass blood clots in varying sizes, tissue and even a recognizable sac with, or without, an embryo (baby) which may be alarming. Once you have actually miscarried (passed clots of blood or tissue) then the bleeding should ease and become lighter. Sometimes not all will be passed and some further bleeding with clots may occur. Then the bleeding should become lighter and the cramping should ease.
If you are concerned that the bleeding is excessive and that it is more than you can cope with, then you can contact the Early Pregnancy Unit or Ocean Suite for advice. Both the EPU and the Ward staff are ready to support you during this difficult time.
It is not unusual to bleed for over 10- 14 days after the miscarriage, but this bleeding should be noticeably lighter, more period like.
We understand that bleeding at home can be very frightening and please do ring for advice if you are unsure of what to do and support. If you are bleeding heavily, using more than two pads an hour for two hours or feeling dizzy and/or unwell please seek medical attention.
Early Pregnancy Unit
(0800 - 1730, Monday - Friday)
01752 430887/ 01752 245212
Ocean Suite (all other times) 01752 430026
Reducing the risk of Infection
Whilst you have bleeding we always advise that in order to reduce the chance of infection you are advised NOT to wear tampons or to have sexual intercourse. It is also advisable NOT to go swimming or to take long soaks in the bath as these may increase the chance of infection.
Your cervix is opened slightly to allow blood to drain and we want to reduce the chances of infection getting in. Avoid very hot baths whilst you are bleeding heavily, as you may feel faint. However, it is safe for you to shower or have a bath. Once you have stopped bleeding then you can continue as normal.
Signs of Infection
If you start to feel unwell, develop an unpleasant smelling discharge, a high temperature, experience “tummy” pain that is not helped by pain relief, or the bleeding increases then this may be a sign of infection and you need to contact your Doctor or the staff on the Early Pregnancy Unit or Ocean Suite as soon as possible.
Going back to work is an individual decision. It depends on how heavy your bleeding is, and how you feel generally, the loss of a pregnancy can be a very distressing event in a woman’s life. You may decide that you need to take some time off whilst the actual miscarriage is happening. Some ladies need more time off than others. Many women feel that at least a few days off work may be necessary.
You can self certificate for the first week off work, and thereafter you will need to see your GP to be provided with a sick certificate. Women who work in the home also need support from partners, family or friends at this difficult time.
Do I need to inform anyone if I think I have actually miscarried?
Please ring the Early Pregnancy Unit itself. If we have seen you recently then we will need to decide whether it is a long enough duration since your last scan to confirm whether you have had a miscarriage. This will depend on what the findings were at your last scan.
If we feel it is too soon we may advise we still see you at the appointment already arranged.
If you are certain that you have miscarried and do not wish to have a rescan we may advise you to do a pregnancy test two to three weeks after you stop bleeding.
Please note that occasionally we may recommend that we do need to see you again but this is on an individual basis and only with the ladies where we have been unable to confirm that the pregnancy was in the womb.
If you don’t want, or need, to re-attend then we will cancel your appointment and send information to your GP, community midwife and ultrasound scan department and hospital appointments, so you will not need to worry about doing this.
When can I expect a period
Every woman is different regarding how soon after they miscarry that they have their next period. This can range from 3 to 6 weeks. Remember that this can vary as you are experiencing a loss of a pregnancy, not a period, and your body and hormones can take time to return to normal. Often the next period can be different than that which you normally experience (heavier or lighter, again this is nothing to be concerned about, unless the bleeding is very heavy and prolonged – in which case consult with your GP)
If you do not have a period, within 6 weeks of your miscarriage, it may be advisable to contact your GP.
Whether you decide that you wish to try for another baby is an extremely personal decision that only you and your partner can decide.
Should you feel that at some time you may be ready to try again it is recommend that you take daily folic acid (preferably for 3 months before a pregnancy) and wait for at least one period following a miscarriage before trying for another baby. Once you have had a period then we know that your hormones are back to normal and you are fit and healthy for the next pregnancy.
For emotional or psychological support:
Kirsty Willis (Bereavement midwife) 01752 433148
Please remember that nothing is too trivial to talk about.
If you are worried, we’d like to know.
Early Pregnancy Unit
(0800- 1730, Monday - Friday)
01752 430887/ 01752 245212
Ocean Suite (all other times) 01752 430026