Expectant Management of Miscarriage
Date issued: May 2022
Review date: May 2024
Ref: B-126 v7
PDF: Expectant Management of miscarriage final May 2022 v7.pdf[pdf] 157KB
Introduction
Miscarriage of pregnancy is very common with as many as one in four to five confirmed pregnancies ending this way. Most happen in the first 12 weeks of pregnancy. This leaflet is designed to guide you through the process.
Types of miscarriage
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Inevitable miscarriage. This is when you have bleeding early in your pregnancy and your cervix is open, which means your pregnancy will be lost.
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Incomplete miscarriage. This is when a miscarriage has started but there is still some tissue left in your womb. Your cervix is usually open.
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Complete miscarriage. This means that your pregnancy has been lost. Your womb is empty, and your cervix has closed.
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Delayed or missed miscarriage. This means that although your developing baby has died, you have had little or no bleeding. It is not unusual to have little or no pain or bleeding when this type of miscarriage occurs. The pregnancy may have stopped growing several weeks prior to the diagnosis. Studies suggest that approximately 60-80% of women diagnosed with a missed miscarriage will miscarry over a four-week period.
What is Expectant Management of Miscarriage?
Expectant management of miscarriage is where your body goes through the process of miscarrying the pregnancy naturally, without any medical or surgical intervention. This almost certainly means experiencing some heavy vaginal bleeding and cramping pains.
Advantages of Expectant Management
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There is no need to be in hospital
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You may feel more in control of the process because you are aware of why the miscarriage is happening.
Disadvantages of Expectant Management
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You cannot predict when the miscarriage will occur or be complete.
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You may experience pain, and heavy bleeding. This is variable. Some will have very little pain and bleeding and others will have more.
What will happen?
The process of miscarriage can take some time before any bleeding starts and it is normal for this to continue for up to three – six weeks. This amount of time does vary from woman to woman.
What to Expect
You can lead life as “normal” and be out and about, but we would recommend that you be prepared for the miscarriage process.
Bleeding
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.
You may pass blood clots in varying sizes, tissue and even a recognizable sac with, or without, an embryo or baby, which may be alarming. 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.
We understand that bleeding at home can be very frightening and please do ring for advice if you are unsure of what to do. 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.
A question that is often asked is ‘what will happen to my baby?’
Most women who choose this type of management make their own arrangements. If this is not what you want, then please ask for information about the options available for the treatment of your pregnancy loss.
Early Pregnancy Unit
(0800- 1730, Monday - Friday)
01752 430887/245212
Ocean Suite (all other times) 01752 430026.
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 clots may be passed. Then the bleeding should become lighter, and the cramping should ease. It is not unusual to bleed for 10- 14 days after the miscarriage, but this bleeding should be noticeably lighter, more period like.
Discomfort /Pain
Having a miscarriage can be very painful, with cramping 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. It is advisable to be prepared with a suitable type of pain relief which you are able to tolerate.
The following pain relief are all very useful:
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Paracetamol
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Ibuprofen
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Codeine based painkillers
Most of these can be brought over the counter although your GP or the hospital may prescribe you codeine-based pain relief if necessary.
Sometimes using a hot water bottle (not too hot) and warm baths or showers can help.
Hygiene
You are advised NOT to wear tampons or to have sexual intercourse whilst you are bleeding at all. 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 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 for advice.
Work
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.
What happens next?
If after two weeks, you are certain you have miscarried then we do not need to see you again. However, if you are in any doubt, or have had little or no vaginal loss, then please contact the Early Pregnancy Unit for advice. It is not always necessary for us to see you on the Early Pregnancy Unit again and you may wish to carry on with expectant management. If you have not miscarried after two weeks, as long as you are well in yourself, you can wait up to another 3-4 weeks for things to happen (or you can choose to have one of the other options). If after this, you still haven’t miscarried then we would like to see you again to reassess the situation and review your care. If you are not sure whether the miscarriage is complete, we may ask you to do another pregnancy test to determine whether any pregnancy hormone is still in your system. Following this the staff may ask you to come back to the Early Pregnancy Unit for further assessment if it is still positive.
This may be a blood test and/or an ultrasound scan.
Can I change my mind?
Yes, you can change your mind about having Expectant management. The other options are:
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Surgical Management of miscarriage (under a general or local anaesthetic).
- Medical Management of miscarriage. The use of medication to bring on the miscarriage process and hopefully miscarrying sooner.
Please ring the EPU department to discuss your options at any time.
When can I expect a period?
Every woman is different regarding how soon, after they miscarry, 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 the body and your 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.
Do I need to inform anyone about my miscarriage?
No, The Early Pregnancy Unit will have sent out information to your GP, community midwife and ultrasound scan department and hospital appointments, so you will not need to worry about doing this.
The future
Weather 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 at some time you may be ready to try again we would recommend that you take daily folic acid (preferably for 3 months before a pregnancy) and wait for at least one period before you try for another baby. Once you have had a period, we know that your hormones are back to normal, and you are fit and well for the next pregnancy.
For emotional or psychological support:
Kirsty Willis (Bereavement midwife) 01752 433148
or kirstie.willis@nhs.net
www.miscarriageassociation.org.uk
www.nhs.uk/conditions/miscarriage
www.pregnancycrisiscare.org.uk
Please remember that nothing is too trivial to talk about. If you are worried we’d like to know.
Contact numbers
Early Pregnancy Unit
(0800-17.30, Monday –Friday) 01752 430887/ 245212.
All other times:
Ocean Suite (Gynae ward) 01752 430026
