Early Pregnancy Loss (Miscarriage): Understanding your options

Early Pregnancy Loss (Miscarriage): Understanding your options

To help you manage an early pregnancy loss, it's helpful to know your options so you can make the decision that is right for you. We are here to support you through this process.

What is an early pregnancy loss? 

Early pregnancy loss is a miscarriage or nonviable pregnancy that occurs before 20 weeks. The pregnancy ends because the embryo or fetus stops developing. About 15 to 20 percent of all pregnancies result in early pregnancy loss. Most occur during the first 12 weeks.

A nonviable pregnancy means your fetus has no heartbeat or there is no embryo. Ultrasound imaging helps to diagnose a nonviable pregnancy. Other medical terms for nonviable pregnancy include blighted ovum, missed abortion, embryonic demise or anembryonic pregnancy.

What are my options?

You usually have a few options to consider with an early pregnancy loss. These include:

  • Expectant management (waiting for spontaneous miscarriage)
  • Dilation and curettage (D&C)
  • Medication management

Take time to think about your options. Knowing what to expect and the advantages and disadvantages of each, can be helpful in making your decision (see the table on next page for a summary). 

Regardless of which option you choose, your clinician will need to know your Rh factor. If your Rh factor has not yet been determined, please make a lab appointment to check blood type and Rh factor. 

If you are Rh negative, you will receive a dose of Rho(D) human immune globulin (RhoGAM). This helps protect you against a future pregnancy complication.

Spontaneous miscarriage

This option means you wait and allow time, rather than surgery or medication, for a miscarriage to occur naturally. A miscarriage can occur within hours, days or even several weeks after an early pregnancy loss is diagnosed. About 80% of the time a miscarriage will happen within 8 weeks of diagnosis.

What to expect

  • Once spotting starts, it can progress to heavy bleeding. Clotting and cramping often occur.
  • Bleeding and pain may increase over several hours as the tissue passes. Tissue is often whiteish-gray or pink in color. You may see a small balloon-like sac.
  • Bleeding and pain will improve after you pass the tissue. Let your clinic know when this happens. If your clinician wants to send the tissue to pathology, they will talk to you about how to collect the tissue.
  • You may take 600 mg ibuprofen (Advil or Motrin)to help with cramping. You can also take acetaminophen (Tylenol) as directed on the label for pain. If cramping and bleeding continue for more than 6 hours, a D&C might be recommended.
  • Discuss with your clinician when to follow up if a miscarriage is not completed within a certain period of time (often 1 to 2 weeks). Depending on your situation, you may be given more time, or another option may be recommended. 

When to call

Call your clinic if you experience any of the following:

  • Bleeding so heavy you need to change your pad every 30 to 60 minutes, for more than 2 hours
  • Fever of 100.4°F (38°C) or higher
  • Feel light-headed or dizzy

Dilation and curettage (D&C)

This option usually involves an outpatient, surgical procedure in the operating room. D&C removes the tissue in your uterus and is the most effective option in managing a miscarriage with a success rate over 99%.

What to expect

  • Arrive 1½ hours before your procedure. The procedure usually takes about 30 minutes.
  • You may receive medication through an IV for relaxation and pain relief along with local anesthesia on your cervix and uterus to block pain. Or you may receive general anesthesia.
  • Your cervix will be dilated (widened), and tissue will then be removed by suction.
  • Plan to stay for 1 to 2 hours after the procedure.

Sometimes a similar procedure called Manual Vacuum Aspiration can be done in the clinic. If this is an option, your clinician will discuss it with you.

Medication management

Mifepristone and Misoprostol (also known as Cytotec) are both medications that help pass the miscarriage. Misoprostol can be used alone or together with mifepristone. 

Misoprostol used alone has a success rate around 70%. When the medications are used together, the success rate is around 90%.

Compared to no treatment, these medications decrease the time and increase the success of a miscarriage passing. They also reduce the need for D&C but if the miscarriage is not complete, your clinician may recommend a D&C. 

What to expect

  • Your clinician will talk to you about the different medication options and plans for follow-up. 
  • Side effects are minimal and may include stomach pain, diarrhea and headache.
  • Let your clinic know when you have miscarried. If your clinician wants to send the tissue to pathology, they will talk to you about how to collect the tissue.

If you choose to schedule a D&C or use medication, talk to your clinician. After your miscarriage, it's important to schedule a follow up visit in 2 to 3 weeks.

Phone numbers

  • Amery Hospital & Clinic
    715-268-8000
  • Park Nicollet Ob/Gyn Call Center 
    952-993-3282
  • Stillwater Medical Group  
    651-439-1234 
  • Westfields Hospital & Clinic 
    715-243-2600
       
Options to Manage MiscarriageAdvantagesDisadvantages
Spontaneous miscarriage
  • Miscarriage occurs naturally
  • No trauma to cervix or uterus
  • Uncertainty as to when the miscarriage will occur
  • May still need a D&C if any tissue remains
Dilation and curettage (D&C)
  • Know when the miscarriage will be complete
  • Medication for pain control
Slight risk (less than 1%) of:
  • Infection
  • Small tear to uterus or cervix
  • Possible need to repeat the procedure if any tissue remains
Medication management
  • Use at home (usually avoid surgery)
  • Decreased risk of infection and trauma to cervix and uterus
  • Possible stomach cramping, diarrhea and headache
  • May still need a D&C if any tissue remains

 

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