Treatment options for miscarriage
Will I need medical treatment?
Any medical treatment for your miscarriage will depend upon your individual circumstances.
Most women who experience a spontaneous complete miscarriage will present to a hospital or health facility when they first have pain and bleeding before progressing to a complete miscarriage. After a medical assessment, if there are no further complications the woman will be discharged home. If there are complications, the woman may be advised to be admitted to hospital.
There are 3 ways to manage a miscarriage.
Expectant management
This occurs in about 50 per cent of missed miscarriages and means waiting for the natural loss of your pregnancy. It can take some time before the miscarriage occurs (following some bleeding and pain).
If the miscarriage doesn’t occur naturally or the miscarriage isn’t completed, you will be offered medical or surgical management. Very occasionally emergency admission to a hospital may be necessary for heavy bleeding or severe pain.
Medical management
This treatment option uses specially prescribed medications and is successful in 80 to 90 per cent of cases. This treatment is suitable when your pregnancy loss occurred in the first 28 weeks, depending on risk.
The medications are given to help to open the cervix (neck of the uterus) and pass the pregnancy tissue (the developing baby, placenta and pregnancy membranes). This usually takes a few hours to start and you may experience some pain, bleeding or clotting (like a heavy period). You may bleed for up to 4 weeks.
You may need more than one dose of the medication. If you are less than 12 weeks pregnant you may require follow-up care through an early pregnancy care unit or your GP. If you are more than 13 weeks pregnant admission to a hospital may be advised.
Surgical management
This treatment involves a surgical procedure known as a dilatation and curettage (D&C) which is done under a general anaesthetic. The procedure will remove any pregnancy tissue from your uterus. It is successful in 95 to 100 per cent of cases but there are small surgical risks.
Find out more about a dilatation and curettage (D&C) procedure.
This option is available in the first 12 weeks of pregnancy as a pre-arranged booked procedure. You may be advised to have surgery immediately if you are bleeding heavily and continuously.
Will I have to stay in hospital?
Admission to hospital may or may not be needed. It all depends on your individual circumstances.
If your doctor has recommended a D&C you may need to stay for a few hours in the Day Surgery Unit or overnight in a hospital ward.
Admission to hospital may be required if there is a miscarriage or fetal death in utero (when the developing baby’s heartbeat cannot be found using ultrasound). Your doctor may recommend that labour be started will explain how this will happen.
If you require medical management of a miscarriage in the first 13 weeks of pregnancy you may be treated as an outpatient (a patient who receives medical treatment without being admitted to a hospital).
Medical management of a miscarriage after 13 weeks of pregnancy or of a fetal death in utero will require you to be admitted to hospital.
An examination under anaesthetic may occur. During this procedure any remaining pregnancy tissue, such as the placenta, will be removed from your uterus.
Your doctor or health carer will explain your options for pain control and will also provide physical and emotional support to you and your partner.
What happens to the pregnancy remains?
Many parents are afraid to ask what will happen to the remains of their pregnancy.
Pregnancy loss in the first 12 weeks
If you experience a loss in the first 12 weeks the pregnancy remains may look like blood clots and small fragments of tissue. You may be asked to consent to a pathology examination of this tissue. The results of the examination will be sent to your doctor.
You may be referred to pastoral care services to help make suitable arrangements – for example, a cremation – for the remains of your pregnancy loss.
Pregnancy loss between weeks 14 and 20
How will my baby look?
The appearance of your baby will depend on the how many weeks pregnant you were at the time of your pregnancy loss, when the developing baby died, and any possible abnormalities.
It may not be possible for you or your health-carers to accurately determine the gender (sex) of your baby at the time of his or her birth. To confirm the gender of your baby you may wish to consult the Perinatal Pathology Department at King Edward Memorial Hospital.
It is important to remember that your baby may appear different to how you imagined, in size, skin condition or features. The fear of the unknown and the imagined is usually much worse than the reality. Staff will recognise that you may be afraid at this time. They will encourage and support you in your choices and will be guided by your wishes.
What will happen to my baby?
Your baby will be taken to a mortuary. You can be confident that the mortuary staff will treat your baby with dignity and respect.
Before you leave hospital your doctor, midwife or nurse will discuss with you the benefits of a post mortem examination of your baby. This means a perinatal pathologist (a doctor who specialises in understanding pregnancy loss) will examine the baby to identify any abnormalities or other factors that may have contributed to the loss of your baby. This examination will only occur with your consent, but may provide valuable information about your baby and for future pregnancies.
If you are a patient or have been referred to King Edward Memorial Hospital
A post mortem coordinator is available to discuss any aspect of the post-mortem examination and the options available to you. Your health carers can contact the post-mortem coordinator for you. Results from the post mortem will be sent to your doctor.
Part of the coordinator’s role is to create mementos and memories that include photographs and hand and foot prints. These are free and can be collected from the Perinatal Pathology Department by phoning 9340 2730, or as arranged with the Pastoral Care Department.
Hospital staff will discuss the cremation options with you. With your consent, the Perinatal Pathology Department will conduct the cremation.
Every effort will be made to carry out your personal wishes, however the possibility of special arrangements need to be discussed with your carers as early as you can. Read more about rituals and ceremonies in Your emotional recovery after pregnancy loss.
If you prefer to make funeral arrangements with a registered funeral director you may do so, however you will need to pay for these services. Your health carers, social workers, and pastoral care staff can assist you with these decisions.
Where to get help
Acknowledgements
Women and Newborn Health Service
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.