MM-TI
Miscarriage Management
Training Initiative
MISCARRIAGE – Patient Education
We’ve learned that you are having, or are threatening to have, a miscarriage. Here is some
information to help you and your clinician decide how to manage it. Before treating your
miscarriage, you need to know the options for treatment and their possible benefits and risks.
We have listed them here for you. We are happy to answer any questions you have.
What is a miscarriage?
Miscarriage is the loss of pregnancy before the embryo or fetus can live on its own outside the
uterus. It is also called early pregnancy loss or spontaneous abortion. Miscarriage is fairly
common. Ten to 20 percent of all pregnancies end in miscarriage.
How is a miscarriage diagnosed?
Women having a miscarriage usually have cramps and bleeding. As it goes on, they may pass
tissue from the pregnancy. The tissue is usually solid. It is lighter in color than a blood clot —
often tan colored. If you think you have passed pregnancy tissue be sure to save it for us to
inspect.
A pelvic exam is usually needed. This is to see if your cervix is dilated or if you are passing
pregnancy tissue. An ultrasound may also be done. This is to tell if the pregnancy is still able to
go on or if it has passed out of the uterus. Sometimes a series of blood hormone tests are done
at several-day intervals.
What causes miscarriage?
We don’t know what causes most miscarriages. We know some of the possible causes:
 In many cases the number of chromosomes is abnormal because the fertilized egg didn’t
divide normally.
 Women with severe chronic illnesses such as poorly controlled diabetes are more likely to
have a miscarriage.
 Severe trauma and very serious infections may cause miscarriage.
 Late miscarriages —after three months — may be caused by abnormalities in the uterus such
as those caused by fibroid tumors.
Women who have had more than two miscarriages in a row are also at higher risk of miscarriage.
Miscarriage is almost never caused by something you did. Having sex, mild trauma such as
falling, and most medications do not affect a normal pregnancy, and they do not cause
miscarriage.
How is miscarriage treated?
If miscarriage is threatening with only light to moderate bleeding, we usually do nothing. The
bleeding will stop and the pregnancy will goes on normally in over half the cases.
A miscarriage is certain if your cervix starts to dilate and bleeding increases. There are three
Miscarriage Management-Training Initiative
Prager, Valley Medical Center Clinic Network
ways to manage miscarriage.
1. We can do nothing and wait for the pregnancy to pass on its own.
2. We can use medications to make the pregnancy pass.
3. We can do a procedure to remove the contents of the uterus. (a vacuum aspiration or D&C
dilation and curettage)
Which treatment is best for you depends on how far your miscarriage has gone on and how much
bleeding you have. Your clinician will discuss your choices with you and explain the risks and
benefits of each choice. You may be given additional information depending on the treatment you
choose.
1. Doing Nothing or “Wait and See” — In at least half the cases, an incomplete or inevitable
miscarriage will complete itself on its own within one week. If you have a missed abortion,
however, and choose to wait, there is more risk of needing an emergency procedure than if you
chose to take medication or have a procedure to start with.
The advantage of “wait and see” is that it avoids a procedure or the use of medications. Many
women consider this more natural. The risks of doing nothing are
 bleeding may last a long time or become heavy
 heavy bleeding may make you anemic
 tissue remaining in your uterus may become infected.
These risks increase the likelihood of hospitalization, unplanned procedure, and transfusion with
this option.
2. Medication — A medication called misoprostol is highly effective in completing an inevitable
or incomplete miscarriage. It causes the uterus to contract and expel any remaining pregnancy
tissue. It also decreases bleeding.
Misoprostol is approved by the U.S. Food and Drug Administration (FDA) for two uses
 the prevention of stomach ulcers
 as part as the Mifeprex medication abortion regimen.
The FDA has never been asked to approve misoprostol for treatment of miscarriage. But many
medical studies have proven that it is safe and effective for that use. The advantages are that
misoprostol may complete the miscarriage faster than doing nothing and using it may avoid the
need for procedure.
Taking the Medication — You will be given tablets to place in your vagina. Misoprostol
usually causes cramps shortly after it is taken. The cramps can last for several hours. Bleeding
may increase as the remaining pregnancy tissue is passed. But heavy bleeding should not last
more than two hours. Misoprostol can also cause nausea and vomiting, diarrhea, and a mild fever
or chills. These symptoms are usually gone in 24 hours. We may instruct you to repeat the
misoprostol if we do not think it has worked completely. If you were given any medication to help
with nausea then take this before you use the misoprostol.
Serious bleeding and infection rarely occur, as they do with other options for completing
miscarriage. There are increased risks of hospitalization, unplanned D&C, and transfusion with
this option. If serious complications do occur, or if misoprostol fails to complete the miscarriage,
you may need a procedure.
If you chose this option, we will give you more information to describe the process in detail.
Miscarriage Management-Training Initiative
Prager, Valley Medical Center Clinic Network
3. Having a Vacuum Aspiration — A thin plastic tube is inserted into the uterus to remove the
pregnancy tissue. Pain medication is often used before the procedure, and a local anesthetic may
be injected into the cervix or opening of the uterus to numb it. Sometimes it is necessary to
stretch the cervix open first.
The plastic tube is attached to suction and then moved back and forth inside the uterus for a few
minutes to gently remove the pregnancy tissue. You may feel cramping during and after the
procedure as the uterus shrinks back to its smaller size.
The advantage of vacuum aspiration is that it rapidly removes the pregnancy tissue to complete
the miscarriage. The possible complications are hemorrhage, infection, failure to remove the
pregnancy tissue and, rarely, damage to the uterus. If you chose vacuum aspiration, we will
give you information to describe the procedure and possible complications in more detail.
Risks of Miscarriage — There are risks with all medical procedures, including all of the options
for managing miscarriage. If you choose “wait and see” or medical management, there are more
risks of hospitalization, unplanned vacuum aspiration, and transfusion. Very rarely, a woman will
die during or after a miscarriage — about one in 100,000. The risk of dying carrying a pregnancy
to term is greater — about 10 in 100,000.
What to Expect During a Miscarriage
Bleeding — Don’t be alarmed if the bleeding is quite heavy and you pass large blood clots.
The cramps may also be really strong. The bleeding and cramping can last for several hours.
Blood clots may be the size of a lemon. This is to be expected. The embryo or fetus itself is
very small. It may not be noticed with the bleeding and clots. Occasionally, if the pregnancy
has developed eight weeks or more, a recognizable fetus may be seen. The bleeding usually
begins to ease after the pregnancy tissue has passed.
Cramps — Cramps are a normal part of the process, but some women feel stronger cramps
than other women. Cramping will ease after the pregnancy tissue has passed. If you
experience cramps so strong that you feel you need to take pain medicine, you may take every
four to six hours, acetaminophen (Tylenol), ibuprofen (Motrin), or other medication for cramps
given to you by the clinic. Do not drive or do other things that require concentration if you are
taking Tylenol with codeine or Vicodin for pain. DO NOT take aspirin.
Other things besides medication can provide comfort:
 having back rubs by your support person
 putting a hot water bottle or heating pad on your abdomen
 sitting on the toilet
 standing in the shower
Fever and Chills — Some women experience mild fever (100.4ºF) and chills after taking
misoprostol. Acetaminophen (Tylenol) or ibuprofen (Motrin) should help.
Sadness, Loss --- Some women experience guilt, depression, or sadness after miscarriage.
This is a normal reaction and should go away as you recover. If it doesn’t, or if these
feelings are severe, call or make an appointment to talk with a clinician. The group
SHARE has information that may be very helpful.
1800-821-6819 or
www.nationalshareoffice.com. They also run a local support group.
Miscarriage Management-Training Initiative
Prager, Valley Medical Center Clinic Network
Other Symptoms — Some women experience nausea, vomiting, or diarrhea, especially if
they were given misoprostol.
After the Miscarriage
Daily Activities — You may go back to your usual activities — school, working, driving, as soon
as you feel up to it. Some women feel well enough to do so right after the miscarriage. Most
prefer to rest and relax until the next day. You should not take part in strenuous activity, such
as bicycling, jogging, lifting, heavy exercise, horseback riding, swimming, etc., for several days.
You should not do strenuous activities if you are bleeding more heavily than with a period.
Vaginal Intercourse — It’s best to wait until heavier bleeding has lightened up and you have
chosen a method of birth control. We recommend that you wait to have sex for one week after
miscarriage.
Tampons or Pads? When you use pads, it makes it easier to tell how much you’re bleeding.
However, after the heavier bleeding lets up, you can use tampons if you wish.
Trying to Get Pregnant Again — Talk with your clinician about how long to wait before
attempting pregnancy again. If you have had two or more miscarriages in a row, talk with
your clinician about the possibility of testing for conditions that may cause miscarriage.
Warning Signs — Call the clinic if you
 Bleed and are soak though two maxi pads an hour, for two or more hours in a row.
 Have severe cramps not relieved by medication, especially more than 24 hours after
the miscarriage.
 Have a fever with a temperature higher than 100.4ºF for more than 24 hours after the
miscarriage.
 Have nausea, vomiting, or diarrhea for more than 24 hours after the miscarriage.
 Have overwhelming sadness or depression.
Miscarriage Management-Training Initiative
Prager, Valley Medical Center Clinic Network