Medical Management of Miscarriages

In medical terms, there are three methods for "managing" miscarriage: Expectant, Medical, and Surgical management. Expectant management is the term used for "letting nature take its course," waiting for the process of miscarriage to begin on its own. This article will address the medical and surgical aspects of treating miscarriage.¹

In early miscarriages, the medical treatment may involve the use of the drugs mifepristone and/or misoprostol. These are more often employed in first-trimester induced abortions, but their function in treating a miscarriage is essentially the same-to cause the uterus to empty completely.² In miscarriage this is important because anything left in the uterus could allow infection to set in. Both of these drugs can have side effects, including pain and cramping, nausea, vomiting, and diarrhea. Misoprostol can also cause fever or chills, or both.³ Later in pregnancy labor may be induced if it is determined that the baby is no longer alive in the womb. These treatments do have the benefit of cutting short the waiting time for a miscarriage, which can be very hard on some women. However, the side effects and possibility of pain involved are not negligible and should be considered when deciding on treatment. It should be kept in mind that whether early or late, the physical pain of a miscarriage can equal that of a full-term delivery, because the uterus is in fact contracting and "laboring," just far too early for a baby to survive, or because the baby has not survived.

Surgical management is another method of dealing with a miscarriage. It involves dilating the cervix, and surgically scraping out the uterus, making sure that the miscarriage is completed and nothing is left within that might cause infection.⁴ For some women the relief of having the miscarriage over and done with makes the D&C the desired option. For others it can be a scary or traumatic experience though, particularly if the woman is not under general anesthesia during the procedure. Having a D&C for miscarriage is usually an outpatient procedure but it can still mean quite a few hours in the hospital. Usually several of those hours are spent in recovery, especially if IV antibiotics are indicated. A woman who has undergone surgical management of miscarriage may be sent home with a prescription for a short course of antibiotics as well as heavy-duty pain relief.

Regardless of how the miscarriage was managed, mild cramping is common for some time afterward, and is often combined with light bleeding or "spotting". A woman recovering from miscarriage should keep in close contact with her doctor or midwife, and call if she has any doubts about whether the pain or bleeding she has is normal. If pain is severe or bleeding is heavy, or if fever and chills occur, the call to the doctor should be immediate. Regardless of the management of the miscarriage, most women will get their period back 4-6 weeks afterward. How long they should wait to try to conceive again depends on their feelings and on the recommendation of the doctor who knows the woman's state of health.⁵

¹Miscarriage: Treatments and Drugs, staff writers, Mayoclinic.com

² Miscarriage-Treatment Overview, staff writers, WebMD.com

³Medication For Treating An Incomplete Miscarriage, staff writers, WebMD.com

⁴Dilation and curettage (D&C), staff writers, Mayoclinic.com

⁵Miscarriage: Lifestyle and Home Remedies, staff writers, Mayoclinic.com