Gynaecology - Medical Management of Miscarriage

Medical management

You have discussed your treatment options with your doctor or nurse and together you have decided that the best treatment for you is medical management of your miscarriage. If there aren't any contraindications, medical management can be offered in hospital or at home. If you have any questions, please do not hesitate to ask the doctors or nursing staff for advice.

What is medical management?

Instead of waiting for the miscarriage to happen naturally, medical management uses a medication called Misoprostol to start or speed up the process.

What are the benefits?

• It avoids you having an operation under general anaesthetic
• Medical management is seen by some women as being more natural than having surgery, but more suitable than letting nature take its course
• You may feel more comfortable in your own surroundings
• Medical management is effective in around 80 - 90 percent of cases

What are the risks?

• This treatment may not work and in some case surgery may still be needed to complete treatment
• There is a risk of haemorrhage which happens to around 2 women in 100
• There is a risk of infection. This is around 1 - 4 women in 1003
• Sometimes a miscarriage doesn’t complete itself fully and some tissue remains in the womb. If this happens you may still need to discuss further treatment

What is Misoprostol?

Misoprostol is a medication that is used to help the uterus (womb) contract. This enables the products of pregnancy to be expelled from the womb. As with all medication there can be side effects.

Side effects of Misoprostol can include and are not limited to diarrhoea, abdominal pain, indigestion, flatulence, nausea, vomiting, rashes and dizziness.

You may need more than one treatment before the miscarriage is complete.

What happens during the procedure?

Once you have decided that medical treatment is the right option for you, you will be asked to sign a consent form. Your blood pressure pulse and temperature will be checked, and blood samples obtained to check your blood levels and blood group.

Four small tablets need to be inserted inside your vagina. This can be done by either you or a nurse. These tablets may be given orally if you are having vaginal bleeding. The medication may make you feel sick and can cause diarrhoea and flu-like symptoms; you will be given an anti-sickness medication at the same time to try and prevent this.

If you are rhesus negative then an anti D injection will also be required.

Following the medication, you will be observed for 30 minutes. Providing you are well you may be discharged home with advice and a follow-up appointment.

What can I expect when I go home?

You must always have somebody with you or within easy contact. Most women have period-like cramps that can be extremely painful. This is because the uterus is tightly squeezing, much like it does in labour. You are also likely to bleed very heavily – more than with a normal period – and pass clots.

These can be as big as the palm of your hand. You may need to use extra-absorbent pads, even more than one. Please make sure that you only use sanitary towels and do not use tampons as they increase the risk of infection. You may see the pregnancy sac, which might look different from what you expected. You may, especially after 10 weeks see an intact foetus that looks like a tiny baby. If you do see a recognisable foetus, if you wish, the hospital can offer a hospital cremation. Please contact Gynaecology Assessment Unit (GAU) for advice.

If you would like a private funeral you may contact a funeral director of your choice, (this would normally incur a cost). You may wish to bury the remains at home, however certain requirements need to be met. Please contact the GAU for advice.

What pain relief can I take?

You can take paracetamol and codeine. Do not take aspirin, diclofenac or ibuprofen as these may make your treatment less effective. If you do not have appropriate pain killers at home a prescription will be given for you to take with you.

How long will it take?

This is different in every woman. Bleeding and cramping can start within an hour, but some may take two days after you go home. If no bleeding has occurred after 48 hours you will need to contact Gynae Assessment Unit (GAU) and attend for a further dose of Misoprostol.

Your bleeding may last for up to 3-4 weeks after the start of treatment.

How do I know everything has passed?

Usually, when the procedure is complete, your pain will decrease, and vaginal bleeding will slow down and become lighter. You may also see pregnancy tissue or a recognisable foetus.

When to contact GAU

Please contact GAU at Oldham if:

• You have not started bleeding after 48 hours. You will need to attend for a further dose of Misoprostol
• You have prolonged very heavy vaginal bleeding with large clots i.e. your sanitary towel is soaked, and you are changing it 2-3 times an hour
• You have severe abdominal pain
• You have a fever or raised temperature
• You are feeling dizzy or lightheaded
• You have an offensive smelling discharge
• You have any symptoms you are concerned about
• You need advice about cremation/burial arrangements

You should call 999 or go to the Accident and Emergency Department if you feel very unwell, collapse or have severe heavy bleeding.

When will my next period be?

You may have bleeding for up to 3 to 4 weeks. When this has stopped, the average time for the first period to arrive is 4 weeks, but it could arrive any time between 2 and 10 weeks. This period may be lighter or heavier than you are used to and may be more or less painful. Periods may also be a little irregular in the early cycles after treatment and can occur between 23 and 42 days. If this irregularity persists after 3 cycles, you should speak to your doctor.

What follow-up will I have?

Three weeks after your miscarriage you need to perform a urine pregnancy test.
If this urine test is positive, you will need to contact the Gynaecology Assessment Unit and have an ultrasound scan, depending on the result you may require further treatment. If the pregnancy test is negative you will be discharged.
To ensure that your miscarriage is complete it is important that you perform this pregnancy test.

When can I try to get pregnant again?

Physically, you may feel able to try again for a baby, but emotionally you may wish to wait for longer before trying again. For dating reasons, there is an advantage in waiting until your next period, however, if you conceive before your next normal period, there is no increased risk of miscarriage.

If you are planning to get pregnant again, we recommend that you take folic acid tablets (400 micrograms per day) whilst you are trying to conceive and continue to take them until the 12th week of the pregnancy. This helps to reduce the risk of spina- bifida, an abnormality of the baby’s spine. You can buy tablets at your local chemist or supermarket or alternatively you can obtain them from your General Practitioner (GP).

Advice and support

A miscarriage can be a very traumatic experience, both physically and emotionally. Many women grieve but come to terms with their loss quite quickly, whilst others find it difficult to cope.

Feelings of loss, disappointment, guilt, anger and sometimes relief will pass with time and good support. There is plenty of support available to help you, your partner, and your family deal with your loss.

Your GP

Gynaecology Assessment Unit - Royal Oldham Hospital - 0161 627 8855 (Open 24 hours)

Women and Children’s Counselling Service - 0161 720 2969

Spiritual & Emotional Team - 0161 778 5259

Charity groups such as the Miscarriage Association
info@miscarriageassociation.org.uk
01924 200799

NHS Choices www.nhs.uk