Expectant management of miscarriage

What is expectant management of miscarriage?

Expectant management means waiting for the miscarriage to happen naturally, without treatment.

It is successful in approximately 50 out of 100 women (50%) who choose this option.

This option is suitable for you if:

• You have been diagnosed with a delayed or incomplete miscarriage
• You general health is good and your condition is currently stable
• You would like to avoid medical or surgical intervention at this time

What can I expect with expectant management of miscarriage?

The process of a miscarriage will vary considerably depending on many factors, such as the size of the pregnancy and other findings on the ultrasound. It can also be very difficult to predict what will happen. It may take several days or even weeks for the process to start. Once the process starts you will experience:

• Pain: You are likely to experience strong crampy abdominal pain, similar to strong period pain. This will be most severe as the pregnancy tissue is being passed. It is advisable to buy simple pain relief to take as required. We recommend the following pain relief:
  
  
  • Paracetamol (2 Tablets (1g) every 4–6 hours (Maximum 4 times per 24 hours)
  • Ibuprofen (2 tablets (400mg) every 8 hours (maximum 3 times per 24 hours)
• Bleeding: When a miscarriage happens the pregnancy tissue and lining of the womb will pass out through the neck of the womb and vagina. The bleeding is likely to be heavier than a period initially and you may pass clots. Your bleeding should then should become lighter and stop over the next 2-3 weeks.

Please ensure you have enough sanitary protection. You should use pads only (not tampons) to reduce the risk of infection. You should also avoid sexual intercourse until your bleeding has stopped.

If the bleeding is continuously very heavy (soaking through a pad every hour for 4 hours or more) or you feel dizzy, unwell or have a fever you should attend Accident and Emergency.

What are the risks of expectant management of miscarriage?

Infection

This occurs in 2-3 in 100 women (2-3%) and is usually treated with antibiotics.  The risk of infection is similar with medical, surgical and expectant management of miscarriage.

Failure

50 in 100 women (50%) will require another treatment option  (medical or surgical management) because expectant management does not work

Heavy bleeding

A small number of women (2 in 100) will have bleeding heavy enough to require admission to hospital and need a blood transfusion. An emergency operation may also be required to stop the bleeding.

Unpredictable

It is difficult to predict when you miscarriage will happen and how bad the symptoms will be for you.  Everybody is different.

Do I require follow up?

We advise you to take a urinary pregnancy test 3 weeks after your bleeding has stopped. Please contact EPU by  e-mail or phone (WM) or phone only (CW) with your pregnancy test result.  If the pregnancy test result is positive we will invite you in for a scan and review.  If you would prefer to have a telephone appointment booked in for 3 weeks’ time please let us know and we will arrange that for you.

You should also contact EPU in the following circumstances:

• If you experience no bleeding or very light bleeding only in the 2 weeks after your scan
• If you experience offensive discharge, worsening abdominal pain, have a high temperature or feel generally unwell. If EPU is closed you should attend Accident and Emergency.

• If you experience bleeding that continues for more than 3 weeks

When can I expect my next period?

Once your bleeding has stopped and your pregnancy test is negative, you should expect your next period approximately 4-6 weeks later. This period may be heavier or lighter than your normal period.

When can I try to conceive again?

We recommend you wait for at least one period, prior to conceiving again. You should therefore avoid unprotected sexual intercourse until after your next period.  If you are planning to conceive in the next few months you should continue to take folic acid.

Useful contacts

West Middlesex University Hospital
(Early Pregnancy Unit)
2nd floor, East Wing

T: 020 8321 (6070) or (6506)
M: 07920 020 800
E: caw-tr.westmidepu@nhs.net

Chelsea and Westminster Hospital
(Early Pregnancy and Acute Gynaecology Unit)
The Elizabeth Suite
4th Floor 
Chelsea and Westminster Hospital 
369 Fulham Road London 
SW10 9NH 

The Miscarriage Association
T: 019 2420 0799
W: www.miscarriageassociation.org.uk

Crossway Pregnancy Crisis Centre
T: 0208 892 8483
M: 07776482350
W: www.crosswaypregnancy.org.uk