Treatment Options for Miscarriage
Learning that you are having a miscarriage or that your pregnancy will not continue to develop is difficult. There are many options to consider, but first, it is important to take time for yourself. This is a sad time. If you feel that you need time off work, please discuss this with your care provider. You need to consider both your emotional and your physical health during this difficult time.
Your doctor has likely outlined several different treatment options for you, however, we realize that this decision is one that you will want to consider and possibly discuss with your family or other support persons. There is no need to make a decision right away. The options below are available to help you with the physical aspect of a miscarriage.
Expectant Management
Technology today allows us to identify early on that miscarriage will take place. Your own body will also eventually identify this and begin the process of miscarrying. This may start in only a day or two, or it may take over a month. Bleeding and cramping usually come with miscarriage, and either symptom may come first. You do not have to go to the Emergency Room if you feel you are okay at home, but if you are bleeding too heavily you may need to have a procedure performed to complete the miscarriage (see below). If you have your miscarriage at home please call our office for a follow-up appointment with your doctor to make sure the miscarriage is complete. We can prescribe pain medication to have at home if you feel that you may need it.
Medical Management
Many women like the idea of having a natural miscarriage but don’t like the idea of waiting for it to happen. Not knowing when it will happen can be stressful as well. Medical management involves prescribing medication that will start the natural miscarriage. There is a medication that can be given (usually Cytotec or Misoprostol) which will make the uterus contract and expel the pregnancy tissue. The miscarriage will usually occur within 48 hours of taking the medication and will follow a similar pattern as described above. A follow-up appointment will be scheduled for you to come back and see your doctor after the miscarriage. Occasionally the tablets don’t work as we would hope and you either need to use a second dose or have a procedure done to complete the process (see below).
Manual Vacuum Extraction
This is a procedure done in the office. No anesthesia is needed. You will be given pain medication as well as medication to help soften and open the cervix. A suction tube is then passed through the cervix and used to remove the pregnancy tissue. Since you don’t have to be asleep for the procedure, an IV is not needed and you can eat a light meal beforehand. The entire procedure usually takes less than five minutes, but you might be kept in the office for observation and pain management for a while longer.
Suction D&C
Suction dilation and curettage (D&C) is a minor surgical procedure used to complete a miscarriage. Suction D&C is performed in the hospital under anesthesia. During a suction D&C, instruments are used to open the cervix and remove the pregnancy tissue. Starting at midnight the night before your D&C, you cannot have anything to eat or drink. You will need to be at the hospital a couple of hours before the procedure starts for labs, consent forms, and to have an IV started. You will be kept in the hospital for a couple of hours after the D&C for observation and pain control.
