Austin Women's Health Center Blog&Inspiration

Miscarriage Management: Knowing Your Options

September 27, 2022
Miscarriage Management

At Austin Women’s Health Center, we offer miscarriage management. Miscarriage means the loss of pregnancy before 20 weeks. There are a few miscarriage options, and depending on the type of miscarriage and your circumstances, a provider can help you decide which option is best for you. 

Miscarriages are relatively common; about 10-20% of known pregnancies end in miscarriage. According to Mayo Clinic, this number may be higher because miscarriages are common before many people know they are pregnant. However, a miscarriage is not your fault! There are myriad reasons why miscarriages occur. 

As part of Austin Women’s Health Center’s Early Pregnancy Assessment Clinic, we offer an early diagnosis of miscarriage or ectopic pregnancy, medical management of early pregnancy loss, in-office surgical management of early pregnancy loss, and in-office surgical management of fetal demise. 

Usually, if there is no indication for surgical treatment of a miscarriage, people may choose between the following options:

  • Expectant management, 
  • Medical management, 
  • Surgical management. 

Miscarriage Management Options

Choosing to wait for a miscarriage to complete on its own is called expectant management. If a miscarriage takes too long and the process has not been completed, meaning you have passed some but not all of the pregnancy tissue, your provider might recommend other miscarriage management options. A provider can detect an incomplete miscarriage through an ultrasound. Which option is best for you may depend on the type of miscarriage you are experiencing. 

Miscarriage Management with Medicine

Your provider may suggest medical management of a miscarriage using the medications Misoprostol and Mifepristone. Medicine can speed up the process of passing tissue. The process usually takes a few hours or up to two days with medication, which can be issued in-office, but you can complete the process at home. 

Depending on your protocol, you might take the medicine orally or vaginally. The combination of these two medications is more effective than Misoprostol alone and is effective at a rate of 84% on day two. Most people who chose medical management for their miscarriage were satisfied with their choice

Misoprostol has side effects, such as nausea, vomiting, and diarrhea, which will likely subside after a day. Bleeding is normal after two to three weeks and should gradually decrease. 

Surgical Management

On the rare chance that medical management of a miscarriage is ineffective or for another reason identified by you or a doctor, your provider might recommend surgical management for a miscarriage. 

Your provider might suggest surgical management if your pregnancy is over ten weeks gestation. Surgical management is a minor procedure known as dilation and curettage (D&C), performed under general anesthesia. If you are bleeding heavily, a provider may also advise a D&C. You may have a D&C in-office, in-hospital, or in a clinic. The procedure usually only lasts 10-15 minutes. During the process, a provider dilates the cervix and then uses a surgical instrument called a curette to either suction or remove the remaining uterine tissue. Surgical management of a miscarriage is successful in 95-100% of cases

Most people are discharged a few hours after the procedure. After a D&C, you may experience painful cramping initially that shouldn’t last longer than a day. You can most likely resume normal activities within a few days. Light cramping and bleeding are expected within two weeks, and you should not insert anything into the vagina during this time. A provider will likely prescribe antibiotics and possibly pain medication to help ease any discomfort. 

Surgical Management of Fetal Demise

When there is a fetal death at or after 20 weeks gestation, it is called fetal demise. Fetal demise can be diagnosed when an ultrasound shows no fetal heart activity. According to the CDC, fetal demise affects 1 in 160 pregnancies yearly. Fetal demise is often referred to as a stillbirth. 

Management for fetal demise up to 24 weeks can entail surgical evacuation. Surgical evacuation is the most common choice for fetal demise; it involves removing the pregnancy through the cervix. Different ways to open the cervix depend on the length of pregnancy and other circumstances. 

After surgical evacuation, a normal recovery includes irregular bleeding or spotting for the first two weeks and cramping for the first two weeks. 

After Your Miscarriage

Miscarriage is a sensitive time. Just as physical pain may vary from person to person, emotional pain may differ between individuals. For some, miscarriage can be heartbreaking with a long-lasting emotional imprint. Help is available for the range of experiences that miscarriages may illicit. 

At AWHC, we offer grief and loss counseling as part of our Early Pregnancy Assessment Clinic because we know it’s common to experience a spectrum of emotions during and after a miscarriage. For example, you might experience shock, sadness, guilt, anger, relief, or grief. However you might be feeling, your emotions are valid. 

We provide our patient’s compassionate care at every step, from diagnosis to grief and loss counseling after a miscarriage.