Managing your miscarriage
Managing a miscarriage can be difficult. You may need help to understand your options and how to care for yourself.
Types of miscarriage
All miscarriages are not the same.
You may have had a miscarriage diagnosed on a routine scan and had very little or no bleeding or pain. This is called an early pregnancy loss — other names for this are missed miscarriage, non-viable pregnancy or blighted ovum.
You may have gone for medical help because of bleeding, pain in pregnancy, or both. You might have have already passed some pregnancy tissue. If this happens it is called an incomplete miscarriage.
A complete miscarriage is when all of the pregnancy tissue has been passed. In this situation no further treatment is necessary.
Conservative or expectant management
Not all pregnancy loss needs treatment straight away. If you have had an early pregnancy loss and there is pregnancy tissue left in the uterus, it may empty itself naturally within a few weeks. It is hard to say exactly when — almost 2 out of 3 women have an empty uterus by the end of 4 weeks. Other women need a medical intervention.
If you choose conservative management, your pregnancy hormone (beta-hCG) is monitored weekly and a scan is arranged for 2 weeks’ time, if needed. You can call the clinic to change your preference at any time.
Medical management
Medical management involves using the medicines mifepristone and misoprostol.
These 2 medicines (sometimes called MifeMiso) help the natural passing of pregnancy tissue. Both medicines are also used for inducing labour.
Mifepristone (Mifegyne) blocks the action of the hormone progesterone — a hormone that helps the uterus keep the
pregnancy. Mifepristone prepares the uterus for delivery by causing the lining to break down.
Misoprostol is a medicine in the same group as prostaglandin. It is widely used in gynaecology as it allows the cervix (neck of the uterus) to soften and the uterus to contract.
The most common side effects of misoprostol are:
- moderate to severe abdominal pain
- heavy vaginal bleeding.
Less commonly, you may have some:
- runny poos (diarrhoea)
- feeling sick (nausea)
- very rarely, throwing up (vomiting).
3-day medical management plan
Day 1
Your medicines are provided by an early pregnancy assessment nurse. The mifepristone is taken by mouth at the early pregnancy assessment unit. You can also choose to take this to have at home at a time that suits you and your support person.
Day 1
Your medicines are provided by an early pregnancy assessment nurse. The mifepristone is taken by mouth at the early pregnancy assessment unit. You can also choose to take this to have at home at a time that suits you and your support person.
Day 2
You take the misoprostol at home, no sooner than 24 hours after the mifepristone. There is less risk of side effects if you let the misoprostol dissolve in your mouth or against the inside of your cheek — this way it acts more quickly on the cervix and uterus. You should have a support person with you at home on this day.
Day 2
You take the misoprostol at home, no sooner than 24 hours after the mifepristone. There is less risk of side effects if you let the misoprostol dissolve in your mouth or against the inside of your cheek — this way it acts more quickly on the cervix and uterus. You should have a support person with you at home on this day.
Day 3
You will get a phone call from the nurse to ask about your bleeding and any pain. You may need a follow up dose of misoprostol the next day. A blood test will be arranged for 1 week later.
Day 3
You will get a phone call from the nurse to ask about your bleeding and any pain. You may need a follow up dose of misoprostol the next day. A blood test will be arranged for 1 week later.
What to expect with conservative or medical management
Bleeding
When the miscarriage is about to happen, you can expect very heavy bleeding for a short time. It lasts at least a couple of hours, with some pregnancy tissue and clots being passed.
This should settle to moderate bleeding within a few hours, similar to the heaviest day of your monthly menstrual period. After that you should expect light bleeding, which should slowly ease over several days. The amount of time until bleeding stops varies.
The total amount of blood lost during conservative or medical management of a miscarriage is the same as if you had a surgical evacuation (D&C, dilatation and curettage). With a D&C, most of the blood loss is during surgery, so it settles down more quickly. Without surgery, the bleeding is over a longer time.
Sometimes it is possible to see the fetus in the pregnancy tissue that has passed. You may find this upsetting and or find it helpful to see what has happened. You may be given a small container for the pregnancy tissue. You can bring it to the hospital (within 3 days) so it can be sent to the laboratory if you wish. They can confirm whether it is pregnancy tissue.
Pain
The emptying process of the uterus can be painful — but the pain should only last a few hours. You can take tablets for pain relief such as:
- paracetamol
- ibuprofen
- other prescription pain relief.
You will be provided with a prescription for these medicines. Heat packs are also very helpful for pain relief.
Surgical management
Having an operation following a miscarriage is called a D&C or an evacuation. It is a relatively safe procedure but there is still a small risk of complications such as:
- anaesthetic-related problems
- damage to the uterus and internal organs.
The risks will be discussed with you.
You may prefer the pregnancy tissue to be removed rather than wait for it to pass naturally. If you choose the surgical option, you must complete some forms and return for your surgical appointment — usually within about a week.
What to expect after a miscarriage
It is normal to bleed for 1 to 2 weeks after a miscarriage, perhaps with some light spotting for longer. During this time, it is important to take extra care of yourself and to know when to get help.
Care of your pregnancy tissue
It is tikanga in Aotearoa New Zealand that pregnancy tissue is buried in a significant place. Doing this reinforces the relationship between pregnancy tissue — ira tangata (tissue of human origin) — and the land.
This is a very personal decision. You may choose to test your pregnancy tissue, and you can get support you if you wish to test. It is your choice to choose to test, or not.
Testing can confirm you have passed pregnancy tissue. It can identify molar pregnancy (gestational trophoblastic disease).
If you have had surgical management, your pregnancy tissue will be sent for testing. Let the staff know if you do not want this and if you wish to have your pregnancy tissue returned to you.
You may wish to bury it. If you have no access to private land, some whānau select a special pot plant to use.
Tissue left at the hospital is cremated. Private cremations may be possible — ask if there is a form to assist in this process. Staff are available to answer your questions and will do their best to help.