Treatment for miscarriage

Your treat­ment plan depends on whether you have had a com­plete or incom­plete mis­car­riage (whether there is any foetal tis­sue left in your womb). If you have had a com­plete mis­car­riage, no fur­ther med­ical treat­ment is required. If you have had an incom­plete mis­car­riage, it will be neces­sary to remove the foetal tis­sue as there is a risk that it could become infec­ted. This can be done in three ways:

• sur­gical treat­ment, where minor sur­gery is used to remove the tissue,
• med­ical treat­ment, where med­ic­a­tion is used to remove the tis­sue, or
• expect­ant treat­ment, where you wait for the tis­sue to pass nat­ur­ally out of your womb.

All three treat­ments are equally effect­ive in pre­vent­ing infection.

Med­ical and expect­ant treat­ments some­times fail to remove all the foetal tis­sue or can cause other com­plic­a­tions. This means that there is a slightly higher risk that you will need fur­ther unplanned surgery.

Dis­cuss the treat­ment options with the doc­tor in charge of your care.

Sur­gical treatment

Sur­gery usu­ally takes place within a few days of a mis­car­riage. How­ever, there are a num­ber of cir­cum­stances where you may be advised to have imme­di­ate sur­gery, including:

• if you exper­i­ence con­tinu­ous heavy bleeding,
• if there is evid­ence that the foetal tis­sue has become infec­ted, or
• if med­ical and expect­ant treat­ments have pre­vi­ously been unsuccessful.

Sur­gery is usu­ally per­formed under gen­eral anaes­thetic. Your cer­vix will be opened with a small tube, known as a dilator, and the tis­sue will be removed using a suc­tion device. This type of sur­gery is known as evac­u­ation of retained products of con­cep­tion (ERPC).

Before sur­gery, you may be given med­ic­a­tion to soften the cer­vix and to make it easier to per­form the surgery.

ERPCs are usu­ally very safe. How­ever, as with all sur­gery, there is a small risk of complications.

Com­plic­a­tions of ERPC include:

• infec­tion,
• excess­ive bleed­ing, and
• the womb being torn dur­ing the pro­ced­ure (which would require sur­gery to repair it).

In 95% of cases, sur­gical treat­ment is suc­cess­ful in remov­ing foetal tissue.

Med­ical treatment

Med­ical treat­ment for mis­car­riage involves tak­ing tab­lets that cause the cer­vix to open, allow­ing the tis­sue to pass out. The tab­lets can either be swal­lowed or inser­ted dir­ectly into your vagina (pess­ar­ies), where they dissolve.

The effects of the tab­lets usu­ally begin within a few hours. You will exper­i­ence symp­toms sim­ilar to a heavy period, such as cramp­ing and heavy vaginal bleed­ing. You may also exper­i­ence some fur­ther vaginal bleed­ing for up to three weeks.

Med­ical treat­ment is suc­cess­ful in remov­ing foetal tis­sue in 85% of cases. How­ever, you will need to have sur­gery if the treat­ment is unsuccessful.

Expect­ant treatment

If you have expect­ant treat­ment, it may be some time before you exper­i­ence vaginal bleed­ing. The bleed­ing tends to be heav­ier than your usual period and you may also exper­i­ence cramp­ing. Bleed­ing can last for up to three weeks.

If the bleed­ing becomes par­tic­u­larly heavy or you exper­i­ence severe pain, con­tact your hos­pital as soon as pos­sible. You should be given a 24-hour helpline num­ber to call in case of emergency.

Expect­ant treat­ment is suc­cess­ful in remov­ing foetal tis­sue in 50% of cases. If treat­ment is unsuc­cess­ful, you will need either med­ical or sur­gical treatment.

After your treatment

Once your treat­ment has fin­ished, you can decide what hap­pens with the remains of your preg­nancy. Some women prefer to leave the decision to the hos­pital staff whereas oth­ers prefer to dis­cuss the avail­able options.

It is pos­sible to arrange a memorial and burial ser­vice. In some hos­pit­als or clin­ics, it may be pos­sible to arrange a burial within the grounds. You can also arrange to have a burial at home, although you will need to con­sult your local author­ity before doing so.

Crema­tion is an altern­at­ive to burial and can be per­formed at either the hos­pital or a local crem­at­orium. How­ever, not all crem­at­ori­ums provide this ser­vice and they have no legal oblig­a­tion to do so.

The crema­tion of foetal tis­sue does not provide any ashes for you to scatter.

Treat­ing recur­rent miscarriages

Hughes syn­drome

Cur­rently, Hughes syn­drome is the only cause of recur­rent mis­car­riage that can be suc­cess­fully treated.

Research has shown that a com­bin­a­tion of aspirin and hep­arin (a medi­cine that is used to pre­vent blood clots) can improve preg­nancy out­comes in women with Hughes syn­drome. About 74% of women who receive this type of treat­ment go on to have a suc­cess­ful pregnancy.

Sug­ges­ted treatments

A num­ber of other sug­ges­ted treat­ments for recur­rent mis­car­riages have been stud­ied. These include:

• hor­mone treat­ments dur­ing pregnancy,
• using spe­cially mod­i­fied anti­bod­ies dur­ing preg­nancy, and
• tak­ing vit­amin sup­ple­ments dur­ing pregnancy.

The res­ults of all these stud­ies have been dis­ap­point­ing and there is no evid­ence that these treat­ments can pre­vent miscarriages.

Com­plic­a­tions of miscarriage  

Emo­tional impact

A mis­car­riage can have a pro­found emo­tional impact, not only on a woman but also on her part­ner, friends and fam­ily. Some­times, the emo­tional impact is felt imme­di­ately after the mis­car­riage, whereas in other cases it can take sev­eral weeks to emerge.

The most com­mon emo­tions that are felt after a mis­car­riage are grief and bereavement. They can cause phys­ical and emo­tional symptoms.

Phys­ical symp­toms of grief and bereave­ment include:

• fatigue (tired­ness),
• loss of appetite,
• dif­fi­culties con­cen­trat­ing, and
• sleep­ing problems.

Emo­tional symp­toms of grief and bereave­ment include:

• guilt,
• shock and numbness,
• anger (some­times at a part­ner, or at friends or fam­ily mem­bers who have had suc­cess­ful preg­nan­cies), and
• an over­whelm­ing sense of sadness.

Dif­fer­ent people grieve in dif­fer­ent ways. Some people find it com­fort­ing to talk about their feel­ings while oth­ers find the sub­ject too pain­ful to discuss.

Some women come to terms with their grief after a few weeks of hav­ing a mis­car­riage and start plan­ning for their next pregnancy. For other women, the thought of plan­ning another preg­nancy is too trau­matic, at least in the short term.

If you are wor­ried that you or your part­ner are hav­ing prob­lems cop­ing with grief, you may need fur­ther treat­ment and coun­selling. There are a num­ber of sup­port groups that can provide or arrange coun­selling for people whose lives have been affected by miscarriage.

Altern­at­ively, your doc­tor should be able to provide you with sup­port and advice.

Pre­vent­ing miscarriage 

Even if you take the best care of your­self dur­ing preg­nancy, you often can’t pre­vent a miscarriage.

However, there are ways to lower your risk of miscarriage:

• do not smoke dur­ing pregnancy,
• do not drink alco­hol dur­ing pregnancy,
• do not use illegal drugs dur­ing pregnancy,
• drink at least 1.2 litres (six to eight glasses) of flu­ids, such as water and fruit juice, every day, and

eat a healthy, bal­anced diet with at least five por­tions of fruit and veget­ables a day.