Miscarriage Management
A referral is required for this type of appointment.
Please consult with your Physician or Midwife.
Options for Miscarriage Management
Due to early investigations in pregnancy, miscarriages are sometimes identified on ultrasound, prior to the spontaneous passage of tissue and blood. In these situations, there are a few different options for how to proceed.
Our nurse educator and physician will go through the options in detail and answer any questions you have. They can help you decide which option is best for you.
Wait and Watch (Expectant Management)
Miscarriages may not happen right away. It can take time for the body to decide to clear the uterus. It is generally safe to use the “wait and watch” approach for as long as you are comfortable with, though emotionally this can be hard.
The best published statistics have shown that if you wait 2 weeks from your diagnosis, 3 out of 4 people will not need any extra treatment. The others will need medication or surgical management (D&C).
Medical Management
In 2018, research showed that Mifepristone and Misoprostol are the best medications for managing a miscarriage. In Canada, this medication combination is called Mifegymiso and was originally intended for abortions.
These medications will trigger a miscarriage if it has not happened naturally. Within 4 days, it works about 84% of the time, and within 2 weeks it works 93% of the time. The advantage is that you will usually know when the bleeding and cramping will start. We can give you a prescription and walk you through the process.
After medical management, 8-10 % of people will still need an aspiration (sometimes called D&C), 1 % will bleed more heavily than expected and need to attend the ER, and 1 - 2 % will develop an infection requiring antibiotics.
Surgical Management (Uterine Aspiration or D&C)
Some people prefer to have a short surgical procedure to remove the pregnancy tissue. This is done safely in the operating room at Victoria General Hospital by one of our experienced physicians.
You will be given IV sedation to manage the pain and cause a lack of awareness. Because of this, you cannot eat or drink for 8 hours prior to the procedure, and you must have someone drive you home from the hospital, and stay with you overnight afterwards. While the procedure is only 5-10 minutes long, you will be at the hospital for 3-4 hours. You are legally impaired for 24 hours after being sedated, so you are unable to drive.
Our local experience shows that less than 1 % of people choosing this option will need another aspiration or treatment for infection and even less will have intra-operative complications.
Managing Miscarriage at Home
Even if you decide to have a uterine aspiration, the miscarriage could start on its own. If this happens, you will have access to the physician on call. In most situations, we will see you again at the clinic for an ultrasound to re-assess the progress of your miscarriage.
Whether it happens naturally, or is provoked with medication (Mifegymiso), use pads rather than tampons for the bleeding. Avoid sex during this time. Taking ibuprofen 600 - 800 mg every 4 - 6 hours or naproxen 275 - 550 mg every 8 - 12 hours is best for the few hours of pain you will experience. If the pain remains strong, you can add acetaminophen 1000 mg (Tylenol) every 4-6 hours. Arrange a visit to the clinic for an ultrasound about a week after the heaviest bleeding to be sure the miscarriage is completed.