After a miscarriage, the main goals of treatment are to:
- Remove products of conception to prevent the risk of uterine infection and sepsis
- Prevent complications that can damage the uterus, increasing the risk of miscarriages or infertility in the future
- Identify and correct the cause of miscarriage (cervical incompetence, hormonal imbalances, maternal thyroid dysfunction, maternal infections, congenital birth defects, etc.)
Dilation and curettage (D&C) is the most common surgical procedure performed for incomplete miscarriage, involving removing the contents of the fetus and other tissues that develop in the uterus during pregnancy. However, there are other procedures that can be helpful before going for D&C.
What are different treatment options for miscarriage?
If you have symptoms of miscarriage, treatment depends on whether there is pregnancy tissue in the uterus. If your uterus is clear, (all products of conception have been expelled), there is no need for additional treatment. Symptoms such as pain and bleeding subside gradually, and you may start ovulating within a few weeks.
If your uterus has fetal remnants or other pregnancy tissues, you may be treated in the following ways:
Expectant management
If you present with symptoms of miscarriage before 20 weeks, your doctor may advise you to wait for 7-14 days for the tissue to flow out naturally. This is known as expectant management.
If pain and bleeding have diminished or ceased completely within this period, the miscarriage is complete.
After 3 weeks following a miscarriage, your doctor will encourage you to perform a home pregnancy test. If the pregnancy test result is positive, your doctor will perform further tests and scans to analyze the situation and provide treatment accordingly.
Medical treatment
If you do not want to wait or if the tissue does not discharge on its own after 2o weeks, you can take medications that open the cervix, enabling the tissue to flow out.
In most situations, pills called pessaries are given, which are inserted into the vagina and cause dilation of the cervix, allowing the contents of the uterus to empty. You may be given oral pills as well, although the mode of administration depends on the doctor and your test results.
The pills normally start working within a few hours. You may feel symptoms similar to those of heavy menstruation, such as cramps and vaginal bleeding. You may notice vaginal bleeding for up to 3 weeks.
You will be advised to take a home pregnancy test. If it comes out positive, further investigations and treatment may be done.
Surgical management
Surgery involves removing remnants of the pregnancy from the uterus. This is usually done if expectant or medical managements fail or if you present with:
- Severe, persistent bleeding
- Possible infection caused by the remnants
Surgical procedures are done under general anesthesia or local anesthesia, or sometimes both:
- Dilation and curettage: D&C is a small outpatient procedure that is not extremely painful but may cause cramping and discomfort without anesthesia. The procedure involves:
- Dilation of the cervix: A special device is used to dilate the cervix, which dilates naturally during childbirth.
- Curettage: The uterine wall is scraped so that pregnancy tissues that are attached to the uterus can shed.
- Suction evacuation: Similar to D&C, this procedure involves dilating the cervix and inserting a tube that works as a vacuum or suction to pull unwanted tissue from the uterus.
What are the signs and symptoms of a miscarriage?
Miscarriage is the expulsion of the embryo from the uterus. A miscarriage may be complete or incomplete:
- Complete: All contents of the fetus are expelled.
- Incomplete: Some parts of the fetus or other tissues that develop during the pregnancy may be left inside the uterus.
Cramping pain and bleeding during the early stages of the pregnancy may indicate a miscarriage and usually occurs before 20 weeks of gestation.
If you notice these symptoms, seek medical attention immediately to prevent further complications.
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