Date issued: June 2022
Review date: June 2024
Ref: B-352/KN/maternity/medical management of miscarriage 10-12 weeks v4
We are very sorry you have had a miscarriage. We hope this information is useful for you in preparing to come into hospital for your procedure.
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
Inevitable miscarriage. This is when you have bleeding early in your pregnancy and your cervix is open, which means your pregnancy will be lost.
Incomplete miscarriage. This is when a miscarriage has started but there is still some tissue left in your womb. Your cervix is usually open.
Complete miscarriage. This means that your pregnancy has been lost. Your womb is empty and your cervix has closed.
Delayed or missed miscarriage. This means that although your developing baby has died, you haven’t had much or any bleeding. It is not unusual to have much in the way of pain or bleeding when this type of miscarriage occurs
The pregnancy may have stopped growing several weeks prior to the diagnosis.
What is Medical Management of Miscarriage? Medical management of miscarriage is where your body goes through the process of miscarrying the pregnancy like a natural miscarriage. This process is brought on by taking some tablets, orally and vaginally. This almost certainly means experiencing some heavy vaginal bleeding and cramping pains which can be quite severe
Advantages of Medical management
In more than 90% of cases there is no need for any further procedures e.g., an operation under local or general anaesthetic.
As no instruments are introduced into the womb, there is less risk of infection
You may feel more “in control” of the process because it is more like a natural miscarriage, rather than undergoing minor surgery.
Disadvantages of Medical management
There may be some side effects from the medication that may be used, especially when taken orally. These include nausea, diarrhoea, and very occasionally hot flushes. In order to avoid these we do recommend that the Misoprostol tablets are given vaginally.
You will experience pain of varying degrees, and most certainly heavy bleeding but again this is variable.
In about 5 -10% of cases the miscarriage is incomplete. After discussion with the medical team it may be decided to complete the process by an operation under a general anaesthetic or local anaesthetic. Alternatively you may decide to have further medical management.
Before you start your treatment we may need to take a blood test to check your blood count to make sure you are not anaemic.
What will happen?
You will be given a tablet called Mifepristone orally. It works by stopping the supply of hormones that maintain the interior of the uterus. You will then be able to go home.
Approximately 48 hours after the Mifepristone you will be admitted to the Gynaecology ward for the second part of the regimen of tablets called Misoprostol which are normally given vaginally. The length of stay depends on how quickly the process takes, everyone is different.
The Misoprostol causes the cervix (neck of the womb) to soften and the uterus to contract.
You will be given this every 3 hours either orally or vaginally for a maximum of 4 doses.
What to Expect
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 be heavier than a normal period. You may pass blood clots in varying sizes, a recognizable pregnancy sac and baby, which may be alarming. The staff on the ward are there to support you.
Once you have actually miscarried then the bleeding should ease and become lighter. Sometimes not all pregnancy tissue will be passed and some further clots and bleeding may occur on and off over the next couple of weeks. 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.
Having a miscarriage is painful and can vary from 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 the pregnancy.
You will of course be prescribed pain relief to take whilst on the ward.
You are advised NOT to wear tampons or to have sexual intercourse whilst you are bleeding. 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 warm 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.
What happens to the baby?
All pregnancies are treated sensitively and with the utmost respect in accordance with the choices of the mother. You will be given information about the choices available and can discuss this with the nurse looking after you.
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. 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.
When can I expect a period?
Every woman is different in regard to how soon, after they miscarry, they will 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 or Ocean Suiter 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.
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
(0800-17.30, Monday –Friday):01752 430887/ 245212
All other times:
Ocean Suite (Gynae ward) 01752 430026