MISCARRIAGE
RESOURCES
We would like to express our sincere sympathy to you and your family.
This information resource has been designed to include a range of information that may be of use to you. It is intended to help guide you through some of the decisions and emotions you may be feeling at this time.
Why did my miscarriage happen?
It can be difficult to give a definite answer as to what caused a miscarriage. Women and their partners often blame themselves for a miscarriage. In reality, it is very seldom anything they have done, or not done that is to blame. At least two-thirds of all miscarriages occur because of a random chromosome imbalance. This usually occurs by chance and does not necessarily mean that there are any problems with the parents’ DNA.
What happens now?
Some miscarriages are resolved as bleeding begins naturally. In some cases, all of the pregnancy tissue may pass easily and nothing further needs to be done. Some blood loss, like a period, may continue for up to two weeks, until the lining of the uterus (known as the pregnancy decidua) has completely shed.
Retained Products of Conception:
Sometimes, following a miscarriage, some pregnancy tissue can remain inside the uterus. Given time, nature may take its course and all tissue may pass naturally. However, there are other options like using medicines or surgery to help resolve the miscarriage more quickly.
What is a missed miscarriage?
This means that a gestational sac, and sometimes a baby remains inside the womb despite the fact that sadly the baby has died and the pregnancy has stopped growing. The BHCG pregnancy hormone levels can continue to be present for some time and it can take several weeks before the body realises that the pregnancy is not ok.
If you have been diagnosed with a missed miscarriage, it is safe to wait up to 2 weeks for pregnancy hormone levels to fall and for a natural miscarriage to occur. However there are also options to resolve your miscarriage earlier if you do not wish to wait.
For some women, the pregnancy will not pass naturally and some form of treatment will be needed.
What are the options for management of my miscarriage?
In summary the options are:
Expectant (natural) miscarriage management
Medical management of miscarriage (using medication)
Surgical management of miscarriage (suction curettage procedure)
Option A: Expectant (natural) management
If you prefer to avoid other options, it is reasonable to wait 2 weeks to see it your miscarriage will happen naturally.
If you have a heavy bleed which gradually decreases and stops, then the miscarriage is most likely complete. If you choose the option of expectant management, we ask that you keep in touch with our clinic and let us know when this occurs. We will arrange an ultrasound assessment as your bleeding settles to ensure your miscarriage has completely resolved by making sure there is no retained pregnancy tissue in your uterus. It is important to recognise any retained products of conception beyond the two week point to avoid the complication of a uterine infection (endometritis).
A significant amount of pain, heavy bleeding or other suspicion of infection (fever, bad smelling discharge) should prompt you to immediately contact Women’s Health Melbourne for further advice. If you require urgent advice or assistance after hours, contact the Royal Women’s Hospital (03 9835 2000).
Important note: Use only pads and do not use tampons or menstrual cups during the miscarriage as they can increase your risk of an infection (endometritis).
Is expectant management dangerous?
All miscarriages can potentially be complicated by heavy bleeding and significant pain. Miscarriages managed with a wait-and-see approach carry a small risk of infection and this approach is not always successful. If your miscarriage does not resolve naturally, you will eventually be advised to consider surgical or medical management for your miscarriage.
If, at any time, you change your mind about this management option, you should feel welcome to call us and discuss one of the other management options.
Option B: Medical Management using Misoprostol
Medical management involves taking a medication called misoprostol to help facilitate a complete miscarriage, often avoiding the need for surgery. Misoprostol management is effective for 80–85% of women whose miscarriage occurs before 13 weeks of pregnancy.
Occasionally, a second drug called mifepristone can also be given 1–2 days prior to the misoprostol.
There is strong evidence for the use of misoprostol in the treatment of miscarriage, which is endorsed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
How to use misoprostol
Misoprostol can be administered either under the tongue or in the cheek (dissolve, do not swallow) or in the vagina. You will be given the medication to take home and administer over two days, with the two doses being given at least 8 hours apart.
On each occasion use 2 tablets (400 mcg in total)
What should I expect after taking misoprostol?
Bleeding and pain may start soon after the first dose of misoprostol is given (approximately two to four hours).
Symptoms may persist for up to 24–72 hours before the miscarriage is completely resolved. Period-like bleeding will continue for 1-2 weeks.
Up to 10% of women who use misoprostol may experience excessive pain or bleeding. If this occurs, a visit to your doctor or the hospital, and possibly surgery, may be recommended. It is safe to use simple pain medicines such as paracetamol or non-steroidal anti-inflammatory drugs ibuprofen for the treatment of pelvic pain with miscarriage.
A significant amount of pain or heavy bleeding should prompt you to immediately contact Women’s Health Melbourne for further advice. If you require urgent advice or assistance after hours, contact the Royal Women’s Hospital (03 9835 2000).
Important note: Use only pads and do not use tampons or menstrual cups during the miscarriage as they can increase your risk of an infection (endometritis).
What are the risks and side effects of misoprostol?
Misoprostol is usually well tolerated. Side effects can include nausea, vomiting, diarrhoea and fever. Allergy to misoprostol is uncommon. Misoprostol should not be used by women with a history of severe asthma or porphyria (a rare metabolic disorder). Should you have any concerns, please do not hesitate to ask for further clarification from us.
Your follow up appointments
A sample of your blood will have been taken to assess your pregnancy hormone level (HCG). You will be given a request form to have a repeat blood test a week after commencing misoprostol management to track the resolution of your miscarriage. Our fertility nurse is available Monday/Wednesday/Friday at Women’s Health Melbourne and will routinely contact you to follow up on how you are feeling. However, you should feel free to contact us any time during working hours if you require further support.
For most women, all bleeding will stop within two weeks from the initial heavy bleeding. We will routinely arrange an ultrasound scan assessment at Women’s Health Melbourne to document that your miscarriage is complete.
If your miscarriage has not been completed, you will then have the option to either give it more time, have another two doses of misoprostol, or to have a surgical procedure called a curette. Regardless of which option you choose, our team will continue to follow up with you until we are certain the miscarriage is complete.