What to Expect

• Vaginal bleeding: can be light (spotting) or heavy (clotting), bleeding may be intermittent or continuous over days to weeks.
• Abdominal pain or “menstrual like” cramping
• In some cases, there are no signs at all that a fetal death has occurred and miscarriage is diagnosed only during a routine ultrasound

Miscarriage is usually diagnosed or confirmed with an ultrasound scan or scans. Ultrasound is used together with the gestational age of the pregnancy and with the level of pregnancy hormone in mom’s blood. (HCG).

Based on the gestational age (weeks from last menstrual period) and the measurements of the embryo (if present), it can be determined if the pregnancy is normal (viable) or not.

An ultrasound scan may be able to detect a pregnancy and a heartbeat in a normal pregnancy at around 6 weeks, but this may vary.

The physical process of miscarriage can vary. It often depends on the size of the pregnancy and on whether the loss happens naturally or as a result of medical or surgical management.

• Early loss: If you miscarry naturally, even in the early weeks of pregnancy, you are likely to have period-like cramps that can be extremely painful. The uterus contracts to push its contents out, which may be recognizable as only clot or perhaps a pregnancy(gestational) sac.
• Missed or incomplete miscarriage: The ultrasound scan shows that your pregnancy has ended but the process of miscarriage hasn’t started. An incomplete miscarriage is when some but not all of the pregnancy tissue has miscarried.
• Threatened miscarriage: Occurs when there is vaginal bleeding/ spotting during early pregnancy accompanied by ultrasound evidence of an intrauterine pregnancy with a viable embryo (heart beat is present).

A miscarriage may be managed naturally (without any intervention), medically (with the administration of medicines) or surgically (an operation).

It may help to know that research comparing natural, medical and surgical management found that:

• The risk of infection or other harm is very small with all 3 methods.
• Your chances of having a healthy pregnancy next time are equally good whichever method you choose
• Women cope better when given clear information, good support and a choice of management methods.

Natural management(also called ‘expectant” or “conservative” management): allows the miscarriage to occur or continue spontaneously without intervention.

Some women prefer to wait and let the process happen naturally. Your provider may recommend this, especially in the first 8-9 weeks of pregnancy.

This process can take anywhere from days to weeks before the miscarriage begins, and the bleeding may go on for 2-3 weeks. It can be very difficult to predict exactly what will happen and when.

In some cases of natural miscarriage the process doesn’t complete itself –even after a few weeks- and some pregnancy tissue remains in the uterus. This then requires either a medical or surgical intervention.

Medical management:

Medical management for early pregnancy loss can be considered in women without infection or excessive vaginal bleeding. Compared with expectant management, this method decreases the time to expulsion of the uterine contents.

Early Pregnancy Loss

Medicines can be given vaginally, sublingually or orally. They can be administered alone or together.

• Mifepristone: a hormone blocker, breaks down the lining of the uterus allowing the pregnancy to separate.
• Misoprostol: induces uterine contractions to start the process of expulsion
• Common side effects of both these medicines include:
  • Low grade fever
  • Diarrhea
  • Nausea
• Medical management is effective in 80-90% of cases.

Surgical Management: (Manual Vacuum Aspiration)

This is a procedure carried out in the out patient office under local anesthesia with or without sedation, allowing you to be aware of the procedure the entire time. A local anesthetic is injected into the cervix the then the cervix is dilated (stretched) gradually. A narrow suction tube is then inserted into the uterus to remove the pregnancy tissue.

Every miscarriage is different; and there is no right way to feel about it. It may affect you, your partner or your family differently and everyone responds and copes individually

Finding Emotional Support After Pregnancy Loss