It’s devastating enough to be told you’re having a miscarriage, or that you’ve had one. But in some circumstances, you may also need to make a difficult decision about treatment. Here’s why, and what to expect.

When you may need treatment after a miscarriage

Many miscarriages don’t need any medical intervention. When something goes wrong with the pregnancy and the baby dies or doesn’t develop in the first place, the womb often empties itself completely. You’ll probably have an ultrasound scan in hospital and may have blood tests too. The tests will confirm whether you’re having – or have had – a miscarriage. They’ll also show whether all the pregnancy tissue has miscarried.

Sometimes, the womb doesn’t empty completely and some or all pregnancy tissue is left. Doctors may suggest you consider treatment if you have:

 

A missed miscarriage

Sometimes the baby dies at some point early in pregnancy but stays in your uterus, sometimes for weeks. You only find out you’ve had a miscarriage when you go for a scan. It can be extremely upsetting because you may not have had any signs of a problem. 

 

An incomplete miscarriage

This is where the womb expels some of the pregnancy tissue but not all. You may have a lot of bleeding and pain but there could still be some pregnancy tissue left in your womb.

 

A blighted ovum

A pregnancy sac develops and grows but there’s nothing inside it. As with a missed miscarriage, you may not know about this until you have a scan. 

 


Your miscarriage treatment options

Doctors tend to talk about ‘management’ of miscarriage. There are three different approaches that may be taken.

Natural management

Also called ‘conservative’ or ‘expectant’ management, this is a ‘watch and wait’ approach that allows the miscarriage to happen naturally. Guidelines that doctors follow suggest this should be the first approach considered as it involves the least intervention. But it’s important to think about what works for you. 

The miscarriage may start anything from a few days to a few weeks after you’ve found out your pregnancy has stopped developing. There may be a lot of bleeding, like a very heavy period, and cramp-like pain, which can be managed with painkillers. The bleeding may continue to some degree for two or three weeks. You may pass the pregnancy sac, and may be able to see a tiny fetus, depending on how advanced your pregnancy was. The medical team should tell you what to expect. You’ll probably be asked to take a pregnancy test afterwards, to check there your hormones have dropped back to normal and confirm you’ve miscarried properly. Around two in 100 women have uncontrolled bleeding – a haemorrhage – and around one in 100 develop an infection (the hospital may give you pre-emptive antibiotics).

Some advantages:

  • Some women prefer to let nature take its course and avoid any medical interventions. It can feel more ‘complete’ and some women find it helps them accept the situation more fully. Seeing the pregnancy tissue and the fetus or baby can sometimes help with this. 
  • The pain can be intense but can usually be managed well with painkillers – your doctor can advise. 
  • Some women find it more comfortable to go through a miscarriage in their own home, rather than a hospital setting.

Some disadvantages:

  • It can be difficult to get on with life not knowing when you may start bleeding. And some women find it distressing to wait once they know the developing baby has died. 
  • You may find it very upsetting to see the pregnancy tissue and the baby when it passes – everyone’s different with this. 
  • Sometimes, you may still end up needing medical intervention anyway if the pregnancy doesn’t pass fully.

Medical management

This involves being given medication in the form of pills and/or pessaries, tablets you put into your vagina. What happens varies between hospitals – and some don’t offer it at all. You might be given pills that start breaking down the lining of your uterus. Then the pessaries encourage your uterus to start contracting and pushing out the pregnancy tissue. You may go back to hospital to have the pessaries there or you may be given both lots of medication to take at home. Sometimes, the initial pills aren’t thought necessary and you may go straight to the pessary stage. You’re likely to start bleeding heavily and may pass clots, including the pregnancy sac. You’re also likely to experience very painful cramps. The risk of infection and haemorrhage are around the same as for natural management.

Some advantages:

  • It gives you some control over when you miscarry, while still allowing the process to happen as naturally as possible, and letting you avoid hospital treatment.
  • As with natural management, some women find the process of passing the pregnancy tissue and fetus helps them accept what’s happened.

Some disadvantages:

  • The medicine may make you feel sick and can give you other symptoms, including diarrhoea and flu-like symptoms. 
  • The experience of passing pregnancy tissue and the baby may be very distressing. 
  • Medical management is effective in 80 to 90 per cent of cases, but there’s still a risk you won’t have a complete miscarriage and you may need surgical management. 

Surgical management

In surgical management, the cervix is stretched gently, and a thin tube inserted to draw out the pregnancy tissue. It’s usually done under general anaesthetic, although sometimes it’s carried out under a local anaesthetic (sometimes called manual vacuum aspiration or MVA). The procedure is short and simple and you’ll normally be able to go home the same day. As there’s a small risk of infection, you may be given antibiotics to go home with. You may experience cramps afterwards, and you can expect some bleeding, which should tail off within two or three weeks. Surgical management may be recommended if you have a later miscarriage, which can involve a lot of bleeding and pain if left to happen naturally, or if the pregnancy ended some weeks before and you’re not miscarrying naturally. However, be aware that during the coronavirus crisis many hospitals haven’t been offering it. 

Some advantages:

  • You know when it’s all going to happen and can plan your life around it, which may be particularly important if you have children to look after, or other responsibilities. 
  • Surgical management can feel a good option if you want to move forward emotionally from the miscarriage as soon as possible. 
  • You won’t have to see the pregnancy tissue passing, which some women find distressing. And you won’t need to cope with heavy bleeding and pain. 

Some disadvantages:

  • You usually have to have a general anaesthetic, which can leave you feeling groggy for a few days afterwards. 
  • Some women prefer to be aware of the whole miscarriage process. 
  • There’s a small risk of infection and, very rarely, there can be other complications, including scarring to the lining of the uterus. 

 

What you need to know

Your medical team can give you support to make an informed choice, but ultimately it’s your decision. You can ask about anything you want – it’s important you have the information you need and it’s very likely lots of women have asked the same questions in the past, so don’t be embarrassed. The doctors and nurses should tell you what to look out for afterwards and how to know if there’s a problem. But if anything’s concerning you before or after the miscarriage, get in touch with the hospital.