Am Fam Physician. 2011;84(1):85-86
See related article on early pregnancy loss.
What is a miscarriage?
A miscarriage is something that happens when a pregnancy stops growing. It is sometimes found when women have bleeding in early pregnancy, or it may be found during routine tests.
Miscarriage happens in a pregnancy that would not have been healthy for reasons beyond your control. It is not caused by stress or regular activities like playing sports or having sex.
What happens during a miscarriage?
If you are having a miscarriage and the pregnancy tissue hasn't fully come out, there are three treatment options:
Watch and wait: wait for the miscarriage to happen on its own.
Medicine: use pills called misoprostol (brand name: Cytotec) to make the miscarriage happen sooner.
Suction procedure: have a doctor remove the pregnancy tissue using a simple office procedure.
All three treatment options are safe and will not affect your ability to get pregnant.
Which treatment should I choose?
The most effective treatment for you may depend on the type of miscarriage you have:
Incomplete miscarriage is when the pregnancy tissue begins to pass on its own. Using the watch-and-wait option, it will pass on its own more than 90 percent of the time, but this can take weeks. Using misoprostol, the tissue passes more than 90 percent of the time within one week.
Fetal or embryonic [EM-bree-ON-ik] demise is when the pregnancy has stopped growing but is not passing on its own. Using the watch-and-wait option, this type of miscarriage will pass on its own about 75 percent of the time, but it can take weeks. Using misoprostol, the tissue passes almost 90 percent of the time within one week.
Anembryonic [AN-EM-bree-ON-ik] pregnancy or “empty sac” is when the pregnancy stopped growing before the fetus developed. Using the watch-and-wait option, this type of miscarriage will pass on its own only 66 percent of the time, and may take many weeks. Using misoprostol, the tissue passes about 80 percent of the time within one week.
Many women choose to watch and wait as their first option. If this takes too long, you can come back to the doctor at any time to try another option. If medicine doesn't work, you may come back for a suction procedure. A suction procedure works 100 percent of the time with any type of miscarriage.
Once I choose my treatment, what should I expect to happen?
What to expect if you choose to watch and wait:
Cramping and bleeding can start at any time. Usually the cramping is worse and the bleeding is heavier than during a period. The heavy bleeding is not dangerous and usually lasts from three to five hours. Lighter bleeding often lasts one to two weeks and it may stop and start a few times. Taking ibuprofen (up to 800 mg every eight hours) and using a heating pad can help ease painful cramps.
What to expect if you choose to use medicine:
Misoprostol pills are placed in the vagina at a time chosen by you. Cramps and bleeding usually start two to six hours after placing the pills and last for three to five hours. A heating pad, ibuprofen, and/or a prescription pain medicine may be used to help ease cramps.
Some women get nausea, diarrhea, or chills soon after using misoprostol. This should get better in a few hours. Taking ibuprofen before using misoprostol helps prevent some of the side effects. The bleeding may be much heavier than a period. This heavy bleeding is not risky; it means the treatment is working. Lighter bleeding often lasts one to two weeks and may stop and start a few times.
What to expect if you have a suction procedure:
Taking pain medicine before the procedure helps to ease cramps. The start of the procedure is like a Pap smear or a routine pelvic exam. To numb pain, local anesthesia is injected around the opening of your uterus, called the cervix. Next, the cervix is gently stretched and the pregnancy tissue is removed with a small plastic device.
The procedure usually takes less than 10 minutes. After resting for 15 to 30 minutes, you will then be able to go home. Most women are able to return to their usual activities the next day. It is normal to have mild cramping and bleeding for a few days after the procedure.
What happens after a miscarriage?
You will be given take-home instructions. Call your doctor if you have any of the following:
Bleeding that soaks more than two maxi pads per hour for two hours in a row.
Fever greater than 102°F (a slight fever of 102°F or less is common with misoprostol use).
Feeling very ill, with lower abdominal pain after the heavy cramping and bleeding are over.
At your follow-up visit, your doctor will make sure the miscarriage is over using ultrasonography, a blood test, or both. This visit is also a chance to talk about any emotional issues you may have after the miscarriage.
Once the miscarriage is over, you can try to get pregnant again as soon as you and your partner feel ready. If you do not want to become pregnant right away, be sure to use birth control.
Where can I get more information?
AAFP's Patient Education Resource
Web site: https://familydoctor.org/miscarriage/
National Institutes of Health: Medline Plus