Miscarriage – medical management
Read our guide below about the natural management of a miscarriage for women under 13 weeks of pregnancy.
You can also download a PDF version of this patient information by following the link on the right.
We’re very sorry that you or someone close to you has had a miscarriage. This guide will help to explain what will happen next and how we will manage the miscarriage by medical treatment. This information will guide you so that you can make an informed decision.
Research comparing the medical management of miscarriage using medication with surgical intervention, or natural miscarriage found that:
- the risks of infection or other harm are very small with all three methods
- your chances of having a healthy pregnancy next time are equally good whichever method you choose
- women cope better when given clear information, good support and a choice of management methods.
What is medical management of miscarriage?
Vaginal tablets (pessaries) called Misoprostol help start or speed up the process of a miscarriage. This treatment is unsuitable for women with some health problems, including severe asthma or anaemia.
What happens?
Misoprostol softens the neck of the womb (cervix) and causes the muscles of the womb (uterus) to contract. Misoprostol doesn’t have a UK licence for use in pregnancy but is a recognised and approved drug of choice, very commonly used to help with the management of miscarriage.
You’ll have a blood test and we’ll ask you to sign a consent form. We’ll then give you an appointment to come for your treatment.
During your appointment
We’ll give you the Misoprostol will to insert into your vagina. This can be done by yourself or by the nurse. The Misoprostol makes your uterus contract to push out the pregnancy. If you don’t want to insert the pessaries into your vagina, you can put the tablets under your tongue.
You can go home 15 to 30 minutes after you have inserted/taken the pessaries. The miscarriage will take place at home. We’ll organise a call with you in the following few days. If the miscarriage hasn’t started within a week, you may need to return for a second dose.
What are the side effects of the medication?
The medication may make you feel sick and can cause diarrhoea and flu-like symptoms. This may be worse if you’ve taken oral tablets.
What should I expect?
You can lead life as ‘normal’, but we recommend that you’re prepared for the miscarriage process.
Most women will miscarry within 48 hours of having the Misoprostol but it could take up to a week to happen.
Pain and bleeding
Most women have period-like cramps that can be very painful, especially when the pregnancy tissue is being pushed out. This is because the uterus is tightly squeezing to push its contents out, much like it does in labour.
You’ll need pain relief such as paracetamol and ibuprofen. We can also provide you with codeine-based pain relief and anti-sickness medication. Sometimes using hot water bottles (not too hot) on the tummy can help ease the pain. If you’re still having pain, contact us (see below).
The amount of bleeding can vary. It might be more than with a normal period and you may pass clots. These can be as big as the palm of your hand. You may see the pregnancy sac which might look different from what you expected. You may, especially after 10 weeks, also see a tiny baby (fetus).
Generally, if you soak more than 2 sanitary towels per hour for more than 4 hours, you’re losing too much blood. Although this depends on how you’re feeling as well.
We understand that bleeding at home can be very frightening. Call us for advice on 01296 316469 8am to 1pm, Monday to Friday.
At all other times call Ward 15 on 01296 316500 or 01296 316365.
Once you’ve miscarried (passed blood clots) the bleeding should ease and become lighter. Although you may see some further clots, the bleeding should become lighter and the cramping should ease.
You may bleed for 10 to 14 days after the miscarriage. This should become lighter over time and will become dark red or brown (but it should be lighter, more like a period).
What are the risks?
The main risks are infection (about 1 to 4 women in every 100) or haemorrhage (heavy blood loss, about 2 in 100) – the same as for natural miscarriage.
Signs that you may have an infection include:
- fever or shivering
- vaginal discharge that smells foul or looks infected
- tummy pain or tenderness that continues after you have taken pain relief.
Medical management is effective in 80% (8 out of 10) of cases. If it’s not, or if you have an infection, you may need surgical management to complete the miscarriage.
What are the benefits of medical management of miscarriage?
The main benefit is avoiding an operation and anaesthetic. Some women see medical management as more natural than having an operation, but more controllable than waiting for nature to take its course.
As with natural management, you may prefer to be fully aware of what is happening, to see the pregnancy tissue and maybe the baby.
How you may feel
You may find the process painful and frightening, although good information about what to expect can help.
You may be anxious about how you will cope with pain and bleeding, especially if you’re not in hospital at the time.
You may also be frightened about seeing the remains of the pregnancy.
Bleeding can continue for up to 3 weeks after the treatment and you may need follow-up scans to check on progress. Some women may ultimately need surgical treatment.
Hygiene
Your cervix is slightly opened to allow blood to drain. We want to avoid the risk of infection getting in.
Therefore, we advise you NOT to wear tampons or to have sexual intercourse whilst you’re bleeding. Do not go swimming or to take long soaks in the bath as these may increase the risk of infection.
It’s safe for you to take showers and short baths in warm but not hot water.
Once you’ve stopped bleeding you can continue living as normal.
Work
Going back to work is an individual decision. It depends on how heavy your bleeding is and how you feel generally. The loss of a pregnancy can be a very distressing event in a woman’s life. You may decide you need to take some time off while the miscarriage happens.
Some women need more time off than others. You can self-certify for the first week off work. After that you’ll need to see your GP for a fitness for work certificate. You can resume exercise and sexual intercourse whenever you feel ready.
After the miscarriage
In hospital
In our hospital, when a baby dies, in accordance with the Human Tissue Act, we bury the gestation sac/fetal remains sensitively along with remains of other miscarried babies. The hospital’s chaplain attends this service held once a month.
Even if you miscarry in hospital you may want to make your own arrangements for burying or cremating the remains of your baby. You can do this through a funeral director or carry out your own burial at home.
If you’re in a rental property you should not bury the remains in the garden. Find out more below.
At home
If you miscarry at home or elsewhere outside a hospital, you’re most likely to pass the remains of the pregnancy into the toilet. This can happen in hospital too. You may look at what has come away and see a pregnancy sac and/or, the baby, or something you think might be the baby.
You may want to simply flush the toilet. Many people do that automatically or you may want to take a closer look. That’s natural too.
You may want to bring the remains to us and we can check it for you. If you want us to, we can send the remains to the laboratory to confirm this was pregnancy tissue. We can also sensitively bury this for you according to the hospital’s policy.
Find out more below about burying your baby at home.
What happens afterwards?
The Early Pregnancy Unit staff will call you after a week to see how things have progressed. If you’re certain you have miscarried, we don’t need to see you again.
We recommend you do a urine pregnancy test 3 weeks after the miscarriage and contact us if it’s still positive. If you’re in any doubt, contact us. You may have little or no vaginal loss. If this is the case, we’ll make arrangements to see you for a urine pregnancy test and possibly arrange another scan.
What if I haven’t miscarried?
If the miscarriage isn’t complete, you can
- repeat the Misoprostol
- waiting for the miscarriage to occur spontaneously
- have surgical management to remove the pregnancy.
Can you change your mind?
Yes, you can change your mind about having medical management. The other options are:
- surgical management of miscarriage (operation) under a general anaesthetic
- expectant management of miscarriage. Waiting for the onset of miscarriage to occur naturally.
Call the Early Pregnancy Unit to talk about your options at any time.
When can I expect a period?
Every woman is different in terms of when they’ll have their next period following a miscarriage. This can range from 3 to 6 weeks. Remember that this can vary as you are experiencing the loss of a pregnancy, and the body and your hormones can take time to return to normal. Often the next period can be different to those you normally experience (heavier or lighter). This is nothing to be concerned about but you should call GP if bleeding is very heavy and prolonged.
Contact your GP if you don’t have a period within 6 weeks of your miscarriage.
Do I need to tell anyone about my miscarriage?
No, the Early Pregnancy Unit will send information to your GP and community midwife. We’ll cancel any ultrasound scan or hospital appointments so you won’t need to worry about doing this.
Unfortunately, we can’t stop appointment letters that have already been sent out.
The future
We recommend you take daily folic acid, preferably for 3 months before a pregnancy, and wait for at least one period before you try again. Once you have a period we know that your hormones are back to normal.
We hope this guide provides the information to help you make informed decisions at what may be a difficult and distressing time.
Please remember that nothing is too trivial to talk about. If you’re worried, we want to help.
Contact us
Call us for advice, if you’re concerned or unsure what to do.
Early Pregnancy Unit
01296 316469 (8am to 5pm, Monday to Friday).
At all other times call Ward 15 on 01296 316500 or 01296 316365
Further information and support
Information about burying your baby at home
If you want to take your baby home for burial, please remember:
- you may not always live at that address
- the baby should not be buried near a water supply
- the baby must be buried at least 90cm deep
- if you do not own the land, permission must be sought from the landowner
- others using the land should be informed of the burial
- keep a note of the exact place of burial with the deeds in case you want to take your baby with you if you move.
You may prefer to bury your baby in a simple casket or box, in case you do want to move.
If you bury your baby in a designated place, for example, the Aylesbury Cemetery or Snowdrop Garden, High Wycombe, you will always be able to visit.
For more contact the Institute of Cemetery and Crematorium Manager (Inc.) on 0208 9894661.