Miscarriage Care & Treatment: Early to Late Pregnancy
Miscarriage Care & Treatment: Early to Late Pregnancy
Understand the distinct care and treatment approaches for miscarriages in early and late pregnancy stages.
Dr Veena H
At a Glance
Early Pregnancy (First Trimester)
Options include expectant management, medical management with misoprostol, and surgical management such as a Dilation and Curettage (D&C).
Late Pregnancy (Second Trimester)
Often involves hospital care; the process may feel similar to labour, with medical or sometimes surgical options needed.
General Considerations
All methods present low infection risks and maintain good prospects for future healthy pregnancies.
Post-Miscarriage Care
Follow-up care is crucial. Avoid certain activities for a week to prevent infection, with the first period returning typically in 2-3 months.
Emotional Recovery
Physical recovery is swift, but emotional healing varies; support and understanding are key.
In this article
Early Pregnancy Miscarriage: Symptoms and Care
First Trimester Miscarriage Treatment Options
Medical management and Surgical Treatment of Miscarriages - In Depth
Second Trimester Miscarriage: Causes and Care
Natural Ways to Heal the Uterus After a Miscarriage
Coping Through it All
Miscarriage is a difficult topic, but it's an important part of the pregnancy journey that every woman should be informed about. It's something no one expects, but with the right understanding and support, you don’t have to go through it alone. Whether you're early in your pregnancy or further along, knowing about the different types of miscarriages and the care options available can help you navigate this challenging time with more clarity and compassion.
Early Pregnancy Miscarriage: Symptoms and Care
In the first few weeks of pregnancy, it’s important to be aware of the signs of a possible miscarriage so you can seek the right care. Symptoms of an early miscarriage can include:
Vaginal bleeding or spotting
Period-like pain and cramps
Passing of tissue or clots
Reduced pregnancy symptoms, such as morning sickness or breast tenderness
Experiencing these symptoms within the first 2 weeks of your missed period may indicate an earlymiscarriage. In such cases, care or treatment could include:
Expectant management: A natural approach where you allow your body time to complete the process on its own, as long as there are no signs of infection or heavy bleeding. Though it may take a few weeks, this approach can give you time to process your experience gently.
Medical treatment: Medications, such as misoprostol, can help your body complete the process of passing the pregnancy tissue, with a success rate of 80-90%. You may experience the passage of tissue within a few hours to a week, allowing you the comfort of managing this step at home if you choose.
Surgical treatment: A procedure known as dilation and curettage (D&C) or suction aspiration may be recommended, which removes the pregnancy tissue. This is highly effective (95-100%) and often recommended for incomplete miscarriages or if medical treatment fails.
Your doctor will guide you through these options and help you make the best choice for your physical and emotional well-being.
Missed Miscarriage: Signs and Management
A missed miscarriage is a type of early pregnancy loss where the embryo or foetus stops developing, but the body has not yet recognised or expelled the tissue. Unlike other types of miscarriage, there may be no obvious symptoms, such as vaginal bleeding or cramping. Instead, signs might include:
Absence of fetal heartbeat during an ultrasound examination
Uterus smaller than expected for the gestational age
Reduced pregnancy symptoms, such as morning sickness or breast tenderness
If a missed miscarriage is diagnosed, your doctor will discuss management options with you. Similar to those for early pregnancy misscarriages, care/treatment for a missed miscarriage may include:
Expectant management: Waiting for the miscarriage to occur naturally, though this method has a lower success rate (about 50%) and may take several weeks.
Medical management: Using medications like misoprostol to induce the miscarriage process, with a success rate of around 80-90%.
Surgical management: A D&C procedure to remove the pregnancy tissue, which is highly effective (95-100%) and often recommended if expectant or medical management is unsuccessful or if there are signs of infection.
First Trimester Miscarriage Treatment Options
A miscarriage that occurs during the first trimester (the first 12 weeks of pregnancy) is one of the most common types of pregnancy loss. It happens when the embryo or foetus stops developing and is no longer viable. The body may expel the pregnancy tissue naturally, or medical intervention may be necessary. Medical intervention includes using administering medicines to induce tissue expulsion or a surgical procedure like the D&C procedure. The choice of treatment is generally based on how far along in your pregnancy you are, your preferences, and your health condition.
Medical management and Surgical Treatment of Miscarriages - In Depth
Given the two most common treatment options for early-pregnancy miscarriages are medical management and surgical treatment it's important to know what to expect of each.
Medical Management for Early Miscarriage
Medical management is a popular option for many women experiencing an early miscarriage, particularly within the first 10 weeks of pregnancy. This approach involves two medications: mifepristone and misoprostol.
Mifepristone is taken first to block the hormone progesterone, which is essential for maintaining the pregnancy.
Misoprostol is taken 24-48 hours later to induce contractions in the uterus, helping to expel the pregnancy tissue.
This method is effective in expelling the residual pregnancy tissue in about 92% of cases. Many women find that this method offers a more private and less invasive way to manage the miscarriage. If the miscarriage is incomplete, however, additional medication or surgical intervention may be necessary.
Surgical Treatment: D&C Procedure for Miscarriage
Surgical treatment, also known as dilation and curettage (D&C) or suction and evacuation, is another option for managing a first-trimester miscarriage.
During this procedure, the cervix is gently dilated, and a suction device is used to remove the pregnancy tissue from the uterus. The D&C procedure is highly effective for miscarriages, with a success rate of 97-99%. It is usually performed as an outpatient procedure with oral or intravenous pain medication.
What People Want to Know... When do doctors recommend a D&C? If medical management doesn’t work, there’s heavy bleeding, or signs of infection appear, a D&C might be the best option.
Second Trimester Miscarriage: Causes and Care
A second-trimester miscarriage occurs between 14 and 26 weeks of pregnancy. Although the causes of a second-trimester miscarriage vary, they are often related to factors like maternal health conditions, fetal abnormalities, or issues with the placenta. Let's go over a few of these causes.
Chromosomal abnormalities: About 24% of second-trimester losses are due to chromosomal issues like:
Trisomies 13, 18, and 21 - This is when a foetus has an extra copy of a chromosome, leading to genetic conditions like Down syndrome (trisomy 21).
Sex chromosome polysomies - This means the foetus contains extra X or Y chromosomes. This abnormality can affect development and learning.Such polysomies can contribute to pregnancy loss in some cases.
Placental problems: The placenta plays a vital role in nourishing and supporting the baby during pregnancy. Any disruption to its function can lead to complications that may result in miscarriage:
Placental Abruption: This occurs when the placenta separates from the uterine wall too early, often causing bleeding and depriving the baby of oxygen and nutrients. This can lead to miscarriage or preterm labor.
Acute Chorioamnionitis: An infection in the amniotic sac, which can cause inflammation and affect the baby’s health, sometimes resulting in miscarriage.
Maternal Vascular Malperfusion: When the placenta does not receive enough blood flow, it may fail to provide the necessary nutrients and oxygen to the baby, which can lead to growth restriction or pregnancy loss.
Cervical insufficiency: This is where the cervix is weakened or damaged. As a result, premature dilation and pregnancy loss could occur, especially in the second trimester.
Infections: Infections caused by parvovirus, cytomegalovirus (CMV), and listeria as well as toxoplasmosis can harm the baby or affect the pregnancy, leading to complications or a miscarriage in the second trimester.
Structural abnormalities: Sometimes, physical defects in the baby’s development, such as spina bifida or congenital heart defects, can result in a miscarriage during the second trimester.
Antiphospholipid syndrome (APS): APS is a condition that causes blood to clot more easily. This leads to recurrent miscarriages or complications during pregnancy. It increases the risk of blood clots in the placenta, restricting blood flow to the baby and resulting in loss.
What Happens After a Second Trimester Miscarriage?
In the unfortunate event of a second-trimester miscarriage, your doctors will guide you through understanding the underlying factors that may have contributed to the miscarriage through and through.
The first step often involves a physical examination, followed by tests to gather information for future pregnancies.
Examination of the Baby and Placenta: A detailed examination of the foetus and placenta can help identify any structural issues or abnormalities that may have contributed to the loss.
Chromosomal Analysis: In some cases, genetic testing can provide answers, revealing if chromosomal abnormalities were the cause of the miscarriage.
Once the findings are gathered, your doctor will discuss the results with you and provide recommendations for any next steps. This may include monitoring in future pregnancies or specific treatments to reduce the risk of another loss.
Natural Ways to Heal the Uterus After a Miscarriage
After a miscarriage, allowing your body to heal is essential for both physical and emotional well-being. Here are some natural ways to support uterine healing:
Natural Ways to Support Uterine Healing
How It Helps
Rest
Give your body time to recover by taking it easy and avoiding heavy tasks.
Hydration
Drink plenty of water to flush out toxins and help your body heal.
Nutritious Diet
Focus on fruits, veggies, lean proteins, and whole grains to nourish your body.
Iron-Rich Foods
Include foods like leafy greens, legumes, and lean meats to replenish iron and fight anaemia.
Herbal Teas
Sip on chamomile, ginger, or raspberry leaf tea to relax and support uterine health.
Movement
Gentle activities, like walking or yoga, can boost your mood and circulation.
Emotional Support
Don’t hesitate to reach out for counselling, support groups, or lean on loved ones to heal emotionally.
Coping Through it All
Whether it's a loss early on or later in pregnancy, miscarriage is heartbreaking. If your miscarriage happens after the first trimester, it can feel even more difficult. Give yourself space to grieve, no matter when the loss occurs. Allow yourself to feel what you’re feeling—grief, anger, confusion, or all of it—and know that your emotions are valid.
Talking to a counselor who understands loss can help you make sense of your emotions and begin to heal. Support groups can also be comforting, as they connect you with others who’ve been through something similar. Family and friends are there for a reason—lean on them for emotional support and practical help during this tough time.
And don’t forget to keep up with your follow-up appointments. These are important for checking in on both your physical and emotional well-being. Healing takes time, so be gentle with yourself, and take the support offered when you're ready.
FAQs
What are the symptoms of an early miscarriage?
Common early miscarriage symptoms include vaginal bleeding, abdominal pain or cramping, and the passage of fluid or tissue from the vagina. These symptoms usually occur within the first 12 weeks of pregnancy.
How is a missed miscarriage diagnosed and treated?
A missed miscarriage, also known as a missed abortion, is diagnosed through ultrasound when the embryo has stopped developing but no symptoms are present. Treatment options include expectant management, medication (misoprostol), or surgical intervention (D&C procedure).
What are the differences in treatment for miscarriage at 7 months compared to early pregnancy loss?
Treatment for miscarriage after 5 months, such as a miscarriage at 7 months, typically involves surgical intervention to remove the foetus and placenta, as expectant management carries higher risks. In contrast, early pregnancy loss can often be managed expectantly or with medication.
How long does bleeding typically last after miscarriage, and when can you expect your period to return?
Bleeding after a miscarriage can last for several days to a few weeks, depending on the stage of pregnancy and treatment method. Most women experience a return of their menstrual period within 4-6 weeks after miscarriage.
Are there any natural ways to clean the uterus after a miscarriage and promote healing?
While there are no proven natural methods to clean the uterus after a miscarriage, rest, hydration, and a nutritious diet can support the body's natural healing process. Consult with your healthcare provider for personalised guidance on how to heal the uterus after a miscarriage.