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decision pointShould I have medical, surgical, or no treatment to complete a miscarriage?

There is no treatment that can reverse a miscarriage after it has started. The main goal of miscarriage treatment is to prevent infection and excessive blood loss. These complications are most likely to develop when the uterus does not completely empty (an incomplete miscarriage).

For decades, incomplete miscarriages were routinely treated surgically with a dilation and curettage (D&C), which quickly clears the uterus of its contents. Women now have more choices. Many women miscarrying in the first trimester who are otherwise stable (with no fever or excessive bleeding) can now also choose to have nonsurgical treatment.

If you are medically stable and are miscarrying, you may have more than one option for completing the miscarriage. Consider the following when you make your decision:

  • For many women, the body completes the miscarriage process on its own. During this time the doctor will watch closely for any problems (expectant management).
  • Surgical treatment quickly clears the uterus. If you develop heavy bleeding or infection during a miscarriage, surgical treatment will be needed.
  • Medicine causes the uterus to contract and empty. This treatment is called medical management. Medicine takes longer than a surgical treatment and can cause pain and unpleasant side effects. But it does not require surgery or anesthesia, both of which have risks.
  • Nonsurgical treatment is not always effective in clearing the uterus. If medicine, watchful waiting, or a combination of the two do not clear the uterus after several weeks, surgical treatment is the next course of treatment.

What is a miscarriage?

A miscarriage is the loss of a pregnancy during the first 20 weeks. (After 20 weeks, pregnancy loss is known as a stillbirth.)

See a table that shows how miscarriage risk increases as a woman ages camera.gif.

The natural miscarriage process can take days to weeks. Common signs of a miscarriage can include vaginal bleeding; pain in the abdomen, lower back, or pelvis; or passing fetal tissue from the vagina. Bleeding may be light or heavy and constant or irregular. It can sometimes be hard to know whether light bleeding is a sign of miscarriage. When bleeding is accompanied by pain, though, the likelihood of a miscarriage is high.

What should I do if I am or might be miscarrying? What are the risks of not calling a doctor?

If you have miscarriage symptoms, call your doctor or nurse-midwife immediately. Going without medical care or advice increases your risk of complications. Your doctor or nurse-midwife will want to be sure that you:

  • Are not losing too much blood or getting an infection.
  • Do not have signs of an ectopic pregnancy, which can be life-threatening and requires emergency surgery to remove the embryo or fetus.
  • Are not at risk of Rh sensitization, which may be dangerous to a fetus in your next pregnancy. If your blood type is Rh-negative and your partner's is Rh-positive, you will need preventive treatment. For more information, see the topic Rh Sensitization During Pregnancy.

How is a miscarriage treated?

Although there is no treatment to reverse a miscarriage, there are several treatment options for preventing complications. Depending on your condition, you may be able to choose:

  • Watchful waiting and close medical observation, known as expectant management, as the miscarriage progresses over several days or weeks.
  • Medicine to complete the miscarriage process, known as medical management.
  • Surgical treatment with dilation and curettage (D&C) or vacuum aspiration to complete the miscarriage process.

If your doctor or nurse-midwife has confirmed that your first-trimester or early second-trimester miscarriage is complete and all tissue has passed from your uterus, expect the bleeding to taper off within a week or so. Unless you develop a fever or heavy bleeding, you will not need follow-up treatment. Your doctor or nurse-midwife may want to see you sometime during the next month, though.

If you are miscarrying and do not have signs of infection or severe bleeding, there is little risk involved in medically supervised watching and waiting (expectant management).

If you are miscarrying, are bleeding heavily (using one or more sanitary pads in an hour), have severe pain, or have a fever of about 100F or higher, you are at significant risk of life-threatening blood loss or infection if you are not treated. See a doctor immediately.

If you need more information, see the topic Miscarriage.

Your choices are:

  • Try watching and waiting (expectant management) for up to 4 weeks, to see whether the miscarriage resolves naturally over time.
  • Use medicine that is likely to cause the uterus to empty.
  • Have a surgical procedure that clears the uterus.

The decision about whether to have treatment to complete a miscarriage takes into account your personal feelings and the medical facts.

Deciding about treatment
Reasons to try watchful waiting (expectant management) Reasons not to try watchful waiting (expectant management)
  • You are stable and have no fever or heavy bleeding.
  • You are miscarrying in the first trimester.
  • You have ready access to emergency health care services.

Are there other reasons that you might want to try watchful waiting?

  • You are not comfortable with the idea of waiting for days or weeks until the miscarriage ends on its own.
  • You are bleeding severely.
  • You have signs of infection, such as:
    • A fever of around 100F or higher.
    • Moderate to severe abdominal pain or cramping.
    • Smelly vaginal discharge.

Are there other reasons that you might not want to try watchful waiting?

 

Comparison of miscarriage treatment options
Reasons to have treatment Reasons not to have treatment

Watchful waiting (expectant management):

  • Allows the body to take its natural course.
  • May be less emotionally stressful than medicine or surgery.

Watchful waiting (expectant management):

  • Allows bleeding to run its course, if not heavy. Bleeding can last for days to weeks.
  • May not succeed in clearing the uterus (after several weeks, and surgical treatment is considered the next course of treatment).
  • May result in infection or heavy bleeding.

Medicine (medical management):

  • Does not require surgery.
  • Is as effective as surgical treatment for early first-trimester miscarriage.1

Medicine (medical management):

  • Fails to resolve about 50% of later first-trimester miscarriages. Surgery then becomes necessary.1
  • Is not an effective treatment for second-trimester miscarriages.1
  • Can cause unpleasant side effects.

Surgery (D&C or vacuum aspiration):

  • Most quickly ends an incomplete miscarriage.

Surgery (D&C or vacuum aspiration):

  • Causes pain, although shorter-term than with medicine.
  • Carries a slight risk of needing a repeat D&C (2% in one study).1
  • Carries a slight risk of uterine or cervical injury, which can cause heavy bleeding or infection.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about treating a miscarriage. Discuss the worksheet with your doctor or nurse-midwife.

Circle the answer that best applies to you. Consider your options in terms of what feels right for you:

I am waiting for obvious signs of this miscarriage. My doctor says that the fetus isn't alive, but I have no symptoms. Yes No Unsure
A prolonged miscarriage would be the most difficult for me. Yes No Unsure
I do not tolerate pain well. Yes No Unsure
I prefer to let my body take its natural course. Yes No Unsure
A surgery would be the most difficult for me. Yes No Unsure
I would like this miscarriage to end quickly, so I prefer surgery. Yes No Unsure
Compared with surgery, I prefer the idea of using medicine to complete a miscarriage. Yes No Unsure
I am concerned about the pain and side effects of medicine for miscarriage. Yes No Unsure
I understand that watchful waiting or medicine may not work and I would then need a D&C or vacuum aspiration. Yes No Unsure

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use treatment to complete a miscarriage.

Check the box below that represents your overall impression about your decision.

Leaning toward watchful waiting (expectant management)

 

Leaning toward NOT trying watchful waiting (expectant management)

         

Leaning toward medicine for miscarriage

 

Leaning toward surgery for miscarriage

         

Citations

  1. Ankum WM, et al. (2001). Management of spontaneous miscarriage in the first trimester: An example of putting informed shared decision-making into practice. BMJ, 322(7298): 1343-1346.

Author Sandy Jocoy, RN
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Last Updated May 7, 2009

WebMD Medical Reference from Healthwise

Last Updated: May 07, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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