Treatment options for miscarriage include: waiting for the body to pass the tissue on its own, using a medication called Cytotec, and having a procedure called a D&C. For most women D&C is preferred.
One of the options when you have an impending miscarriage is to do nothing and wait for the body to pass it on its own. This can be safe depending on how far along you are when the miscarriage happens. When the body passes the tissue, it will start with mild bleeding and progress to heavier bleeding. There is typically an hour or two when the bleeding peaks and can get fairly heavy. Cramps will accompany the bleeding and can get pretty strong during the peak. Tissue will then pass that will look different than the blood and clots. It will typically appear tan and may look like meat. The bleeding and cramps will then slow down after the tissue passes and be more like period bleeding. Sometimes all the tissue does not pass and the bleeding continues to be very heavy. If this happens, you should go to the emergency room as a D&C may be necessary.
People often ask me how long it will take after being diagnosed with an impending miscarriage until the miscarriage actually happens. There is no way to predict this; it could be days or even weeks. It can be very difficult emotionally to wait for the miscarriage to actually happen. For this reason, most people choose to have an interventional technique to treat the miscarriage.
Cytotec is a pill that can be used to help the body pass the miscarriage. It can be used either orally or vaginally. It is safe and effective but can be quite uncomfortable and emotionally difficult. Women who use this method can have significant cramping and bleeding. About one third of women who use cytotec for this purpose still end up needing a D&C. This can be because of heavy bleeding, severe pain, or no effect from the cytotec. In my opinion, this is a poor choice for most people. This is mostly used in very busy clinics which don’t have time to do D&Cs on all the patients who miscarry or in remote locations where access to a D&C is difficult.
D&C stands for dilatation and curettage. It is most commonly done in the operating room under general anesthesia but can be performed in the office with sedation and local anesthesia. I prefer to do this procedure in the operating room because that way I can be sure there is no pain for the patient. When general anesthesia is used it will feel like closing your eyes and opening them and you are in another room.
The procedure involves placing a speculum in the vagina like for a pap smear. An instrument is then placed through the cervix and the pregnancy tissue is removed. This tissue is sent to pathology to confirm that pregnancy tissue was obtained. The patient is then awakened and allowed to go home after observation of about two hours. Most people do not experience much pain, just menstrual type cramping. Bleeding may be minimal although for some people it can be like a period and last for several weeks.
The D&C is very safe; complications are rare. In my opinion, this is the preferred method of treatment for most people.
Most people return to work a week or two after a miscarriage. Physically most people could return to work sooner, but emotionally most people need some time off. It is important to eventually return back to normal life. If too long is spent isolated, depression could be an issue.
It is safe to attempt pregnancy as early as two weeks after a miscarriage. We used to ask patients to wait 3-6 months before getting pregnant. Recent studies have shown this is not necessary.
There is no increased risk of miscarrying a second time after one miscarriage. It is not until a women has three or more miscarriages in a row that we start to consider that there could be an underlying problem.