Highlights
- Miscarriage is the loss of a pregnancy before 20 weeks.
- Medical management of miscarriage involves taking medication to help expel pregnancy tissue from your body.
- Side effects from the medical management of miscarriage can include fever, nausea, vomiting, and diarrhea.
- It may take up to 2 weeks for your vaginal bleeding to stop completely after a medically managed miscarriage.
- There are support services available to assist you after a miscarriage.
In This Article
- Understanding Miscarriage
- Medical Management of Miscarriage: What Is It?
- What Is Involved in the Treatment?
- How Can I Access This Treatment?
- What to Expect After Medical Management of Miscarriage?
- What Supplies Will I Need at Home?
- How Long Will It Take?
- The Emotional Effects of Miscarriage
- Are There Alternatives to Medical Management of Miscarriage?
- Tools and Assistance
Understanding Miscarriage
Miscarriage refers to the loss of a pregnancy before 20 weeks. This loss can happen at various stages of pregnancy, and it is more common than many realize. Up to 1 in 4 pregnancies end in miscarriage, particularly in the early stages, before the 10th week. While miscarriage can be a physically painful experience, it is also emotionally challenging, and individuals affected by miscarriage often require support and care.
Medical Management of Miscarriage: What Is It?
The medical management of miscarriage is the use of medications to help the body expel pregnancy tissue. The two main medications involved in this process are misoprostol and mifepristone, sometimes used in combination (referred to as MS-2 Step).
The medical approach is often chosen when the miscarriage is incomplete (some tissue remains in the uterus) or missed (when the pregnancy ends without symptoms). It is important to discuss this treatment option with your healthcare provider to ensure it is the right choice based on your situation.
What Is Involved in the Treatment?
The treatment for a medically managed miscarriage involves taking misoprostol and mifepristone. Misoprostol helps open the cervix and causes the uterus to contract, facilitating the passage of pregnancy tissue.
Misoprostol can be taken in several forms:
- Buccally: Placed between your cheek and gums
- Sublingually: Placed under your tongue
- Vaginally: Inserted into the vagina as a pessary
Mifepristone is taken orally, by mouth. Depending on your condition, you may need additional doses of misoprostol after the first round of treatment.
In some cases, this treatment may be administered at home, but in more complex situations, it may be done in a hospital setting, with possible overnight stays.
How Can I Access This Treatment?
If you are experiencing symptoms of miscarriage, it’s essential to contact your doctor or midwife promptly. They can assess your condition and discuss the most appropriate treatment for your specific situation.
If you are pregnant and experience heavy bleeding, severe cramping, or feel unwell, it’s crucial to seek immediate medical attention. Your healthcare team will guide you in the right direction regarding the treatment options.
What to Expect After Medical Management of Miscarriage?
After taking the prescribed medications, you should rest for 3 hours. During this time, your body will begin the process of expelling the pregnancy tissue.
Most women experience heavier bleeding and cramping, similar to period-like pain, which typically begins 4 to 6 hours after the medication. The bleeding may include clots. It’s normal for these symptoms to continue for up to 2 weeks, although the pain should subside within 24 to 48 hours.
You may need pain-relief medications like paracetamol or ibuprofen to manage the cramping. A heat pack may also help with the discomfort. It’s important to note that the bleeding and pain should gradually ease, but if the symptoms persist or worsen, contact your doctor.
What Supplies Will I Need at Home?
To make your recovery as comfortable as possible, it’s helpful to have the following items at home:
- Sanitary pads: To manage the bleeding.
- Pain-relief medications: Such as paracetamol or ibuprofen to manage cramps and discomfort.
- Time to rest: Allow yourself time to rest and recover.
- A support person: A friend, family member, or partner to provide emotional and physical support during this time.
How Long Will It Take?
For most women who have an incomplete miscarriage, the medication works quickly, with the pregnancy tissue passing within a few hours. However, if you have experienced a missed miscarriage, it may take longer for the body to expel the tissue, possibly up to 2 weeks or more.
It’s important to follow your doctor’s instructions and attend any follow-up appointments to monitor your recovery.
When Should I Contact My Doctor After Treatment?
A follow-up appointment with your doctor is crucial to ensure that the miscarriage process is complete. You will likely need a blood test a week after treatment to confirm that the pregnancy tissue has been expelled.
If you experience any of the following symptoms after treatment, seek medical help immediately:
- Severe pain that’s worse than period cramps
- Soaking 1 to 2 sanitary pads per hour
- Passing large blood clots (golf-ball size or larger)
- Unusual or foul-smelling vaginal discharge
- A fever higher than 38°C, chills, or dizziness
- Heavy bleeding for more than 2 weeks
How Long Will My Physical Recovery Take?
Physical recovery after a medically managed miscarriage can take up to 2 weeks for the bleeding to stop completely. During this time, you should avoid:
- Using tampons
- Having sex
- Swimming
- Taking baths
Your first period may return about 4 to 6 weeks after the miscarriage, and it may be heavier than usual. If you have a Rhesus negative blood type, you might be offered an anti-D injection to prevent complications in future pregnancies.
The Emotional Effects of Miscarriage
It’s normal to experience a wide range of emotions after a miscarriage, from sadness and grief to anger and confusion. There is no “right” way to feel during this time, and it’s important to allow yourself the space to process these emotions. Seeking support from a counselor, support group, or healthcare provider can help.
Are There Alternatives to Medical Management of Miscarriage?
Depending on your circumstances, you may have alternative options for managing your miscarriage. These include:
- Waiting for the miscarriage to occur naturally
- Choosing a surgical procedure (D&C) to remove remaining tissue
It’s essential to discuss your preferences and treatment options with your healthcare team to make the best decision for your health and well-being.
Tools and Assistance
- Emotional Support Services: Miscarriage can bring up a range of emotional responses, and accessing emotional support is important. Many hospitals and healthcare providers offer counseling or have connections to support groups that specialize in miscarriage. Talking to a mental health professional or a counselor can help manage feelings of grief, sadness, anger, or guilt. Support groups can offer community and understanding, where others share similar experiences.
- Pain Management: After a medically managed miscarriage, over-the-counter pain relievers such as paracetamol or ibuprofen are usually sufficient to help manage discomfort. If you have more severe pain, your healthcare provider may recommend stronger medications. Applying a heat pack or taking warm baths (once bleeding slows) can also help alleviate cramps.
- Follow-Up Care: Follow-up care with your doctor is crucial to ensure complete recovery. After medical management, it’s important to schedule a follow-up appointment, typically within a week, to check for any complications or remaining pregnancy tissue. Your doctor may also perform a blood test to monitor hormone levels and ensure that the miscarriage is complete. Follow-up appointments at 4-6 weeks are also advised to assess emotional well-being and physical recovery.
- Home Care Essentials: At home, having sanitary pads, pain relief medications, and time to rest can help you recover physically. It’s important to have someone supportive nearby to assist with daily tasks, especially if you need emotional or physical help during your recovery process.
- Support for Partners: While the person who experiences the miscarriage may be physically affected, their partner may also experience emotional distress. Support services for partners, including those who identify as sexually and gender-diverse (LGBTIQA+), can help both partners navigate the grief process together. These services can provide emotional counseling, relationship support, and coping strategies during this challenging time.
- Educational Resources: Understanding the process of miscarriage and the treatment options available can provide clarity during an overwhelming time. There are many trusted educational resources available through healthcare providers, counselors, and online platforms, where you can learn about your options, what to expect, and how to manage the physical and emotional recovery.
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