Miscarriage

Treatment Overview

There is no treatment that can stop a miscarriage. As long as you do not have heavy blood loss, fever, weakness, or other signs of infection, you can let a miscarriage follow its own course. This can take several days.

If you have an Rh-negative blood type, you will need a shot of low-dose Rhogam. This prevents problems in future pregnancies. Your doctor can do a blood test to see if you are Rh negative.

If a miscarriage is causing intense pain or bleeding or is taking longer than you are comfortable with, talk to your health professional about using medicine or surgery (such as a procedure called dilation and curettage, or D&C) to clear the uterus.

An obstetrician, a family medicine doctor, or a certified nurse-midwife can manage a miscarriage.

Should I have medical, surgical, or no treatment to complete a miscarriage?

Threatened miscarriage

If you have vaginal bleeding, but tests suggest that your pregnancy is still progressing, your health professional may recommend:

• Resting. You will be advised to temporarily avoid sexual intercourse (pelvic rest) and heavy activity. Your health professional may recommend bed rest. But most research shows that bed rest does not prevent miscarriage.¹¹
• Taking progesterone. You may be treated with the hormone progesterone to help maintain the pregnancy. However, this treatment may serve only to delay a miscarriage and has not been proven effective for preventing a miscarriage.¹² (Progesterone has only shown promise for preventing preterm birth later in a high-risk pregnancy.¹³)
• Avoiding NSAIDs. You will be advised to avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Use only acetaminophen, such as Tylenol, for nonprescription pain relief.

Incomplete miscarriage

Sometimes all or some of the fetal tissue stays in the uterus after a pregnancy miscarries. This is called an incomplete miscarriage (incomplete or missed spontaneous abortion). If your health professional determines that you have had an incomplete miscarriage, you will have one or more treatment options:

• Watchful waiting. This period of waiting, called expectant management, allows the miscarriage to end naturally while your health professional watches for and treats any complications.
• Medicine.Mifepristone and/or misoprostol cause the uterus to empty.
• Dilation and curettage (D&C). This surgical procedure clears the uterus of tissue. A D&C offers the quickest treatment for a miscarriage.

Should I have medical, surgical, or no treatment to complete a miscarriage?

Additional treatment concerns

If you are bleeding heavily, you will be tested for anemia and treated if necessary.

If your blood is Rh-negative, you will need Rh immune globulin (RhoGAM) after the miscarriage. This protects a future pregnancy against Rh sensitization. For more information, see the topic Rh Sensitization During Pregnancy.

In very rare cases, removal of the uterus (hysterectomy) is needed for women who have severe, uncontrollable bleeding or a severe infection that is not cured with antibiotics.

After a miscarriage

If you plan to become pregnant again, check with your health professional. Most doctors and nurse-midwives recommend waiting until you have had at least one normal menstrual period before attempting to become pregnant.

Your chances of having a successful pregnancy are good, even if you've had one or two miscarriages.

If you have had three or more miscarriages (recurrent miscarriage), your health professional may suggest further testing to help find the cause. In up to 75% of couples who are tested, no obvious cause is found for recurrent miscarriage. But studies have shown that up to 70% of couples with unexplained recurrent miscarriages go on to have a baby without treatment.¹⁰

What To Think About

Researchers suspect that a small number of miscarriages are related to a woman's immune system response against the pregnancy. But experimental immunotherapies used to prevent this have no proven benefit.¹⁴

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Author:	Kathe Gallagher, MSW	Last Updated: May 9, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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