Unfortunately, up to 20% of women will experience a pregnancy loss in their lifetime.
In this post we’ll discuss the options for management of a miscarriage once its diagnosed in the first trimester (up to week 13 of pregnancy).
This can often be a sad and scary time in a woman’s life. Once a miscarriage is identified there are three management options:
- Expectant management (watchful waiting)
- Medical management (use of medications to expedite the miscarriage)
- Surgical management (use of surgical equipment to remove the pregnancy tissue)
Expectant management
This option allows the woman to wait for the tissue to pass on its own. Up to the 13th week of pregnancy, this method is successful in 70-80% of miscarriages. If, however, the tissue does not pass on its own after a reasonable period of time, medical or surgical intervention may be needed to avoid complications related to bleeding and/or infection.
It is unclear exactly when after a miscarriage the tissue will pass or how long it will take. There may be cramping and there will be bleeding which could be heavy. Normally, a follow up appointment will be scheduled to perform an ultrasound and make sure that the pregnancy tissue has fully passed. At this time if there is still evidence of the miscarriage inside the uterus, medical or surgical options may be offered.
Medical management
Medical management usually requires using up to two different medications over the course of 1-2 days. Again, the benefit of this option is that surgery is avoided and that this can be completed at home. The two medications usually used are Misoprostol and Mifepristone. When used together these medications work better than if Misoprostol is used on its own.
Using medications allows for more control of the process, since the patient decides when to use the medications themselves.
This method is effective up to 88% of the time (when using both medications together).
The main risk with this method is that it may not work and a surgical intervention may ultimately be required. The medications can cause some side effects such as nausea, vomiting, diarrhea, abdominal pain or mild fever. More significant complications can include infection or heavy bleeding but they are rare (<1-2%).
Antibiotics are not needed for this process and if the tissue does not pass after one dose of medication a repeat dose can be used after 24 hours.
This process can be painful so your health care provider may give you a prescription for a higher dose of Motrin or Ibuprofen.
Surgical management
For women who choose to have a surgical removal of the miscarriage they may be awake or asleep for the process. There will be antibiotics given and pain medications to use afterwards.
If a woman chooses to be awake during the process, then local pain medication may be injected near the cervix.
A flexible plastic cannula is placed inside the uterus and the tissue is removed with the use of suction. Sometimes an ultrasound will be used after the procedure to determine if the tissue has been adequately removed.
Generally, there is minimal spotting after the procedure and pain can be managed with medications like Motrin or Tylenol.
Ultimately, a miscarriage can be a sad and difficult time for many women. Speak to your health care provider regarding your options.
I am a Ob/Gyn practicing in Orange County, California. My area of focus since completing my training at USC has been Minimally Invasive Surgery and pelvic pain. My goals as a physician have included educating and being transparent with my patients about their diagnosis and treatment options. A team approach to pelvic pain and endometriosis has been proven to be most effective therefore, empowering my patients with accurate and evidence based information is essential to demystifying this often misunderstood condition.