Miscarriage Management for Early Pregnancy Loss
Dr. Cousins offers miscarriage management for early pregnancy loss. This article includes causes, symptoms, and treatment for miscarriage.
Early Pregnancy Loss (Under 12 weeks)
Am I Having A Miscarriage?
A miscarriage, also called a spontaneous abortion, means that the pregnancy has failed and is no longer growing normally. You may have a “threatened miscarriage” which means the doctor is not sure whether you have started to miscarry or not. Early pregnancy loss happens in up to 1/3 of all pregnancies and 1/4 of all pregnant patients.*
What are the signs that I might be miscarrying?
You may have spotting, light or heavy bleeding during early pregnancy. This may include passing blood clots.
You may have abdominal pain or cramping, usually with bleeding.
If you had nausea or other pregnancy symptoms, you may notice a decrease in symptoms.
Why Do Miscarriages Occur?
In the early stages of pregnancy cells divide rapidly as the gestational sac and embryo form. Errors in this cell duplication are the most common cause of miscarriages. Unless there are repeated miscarriages, most often there is no concern about an underlying fertility problem. It is usually a random event that is not likely to happen again. It is generally NOT caused by anything you did or did not do. It is unlikely that it could have been prevented.
Miscarriage is quite common—some estimates are as high as 20-30% of all pregnancies. If you have had 3 or 4 miscarriages, and want to have a successful pregnancy, you should see a gynecologist who specializes in infertility. More information here.
How can I know if I am having a miscarriage?
Pregnancy tests can be helpful in evaluating an early pregnancy loss. Urine tests may be enough or a series of blood tests may be required. An ultrasound in our office can often tell if the pregnancy is in trouble. Dr. Cousins can also evaluate the cervix and uterus with an exam. Sometimes an evaluation over a week or two will be needed to conclusively determine whether or not you are losing the pregnancy.
What are my treatment options?
Based on the testing and the exam Dr. Cousins may offer different treatment options.
1. Aspiration. The most effective treatment for early miscarriage is an aspiration of the uterus, which returns the lining to a non pregnant state. This simple procedure uses a gentle suctioning to remove the pregnancy and can be completed in 3-5 minutes in our office. (The whole process in our office will take longer.) If you need something to relax or pain medication we offer that at no extra charge. You will be able to resume your normal activities quickly.
2. Medication. There is a medication that causes the uterus to contract, which assists your body’s natural process of expelling the pregnancy tissue. You are likely to experience cramping and heavy bleeding. Medication may not work and it is important to return to be checked out in a week or two. If it doesn’t work, an aspiration may be needed to complete the miscarriage.
3. Wait and see approach, also called "expectant management" You can choose to have the miscarriage occur naturally. Generally, this option works best in pregnancies under 7 weeks. At this stage, the experience of a miscarriage can be similar to having a heavy period with strong menstrual cramps. Some miscarriages will not complete on their own. There is a danger of prolonged bleeding (up to several weeks), retained pregnancy tissue, or the risk of too much bleeding (hemorrhage). You should be checked a week or two after you start bleeding to be sure the miscarriage is complete.
A recent study* found that the kind of care found in an outpatient facility such as Dr. Cousins' office is preferable to most women and also costs less. The study did not take into account lost time at work, repeat visits to the doctors, and expenses like childcare, fuel costs, etc. which would make a quick resolution even more desirable for some women.
IMPORTANT: If you are unsure of your blood type we can test it here. If your blood type is Rh negative, you will need a shot of Rhogam within 72 hours, which we can do for you. This is very important for women whose blood type is Rh negative.
No matter what treatment you have, this should not cause a problem for future pregnancies.
*reference "Beyond Usual Care" AJOG Feb. 2015, p 177-179, Vanessa Dalton Md, et al.