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Treatments and drugs
By Mayo Clinic staffIf you're having a threatened miscarriage, your doctor may recommend resting until the bleeding or pain subsides. You may be asked to avoid exercise and sex as well. It's also a good idea to avoid traveling — especially to areas where it would be difficult to receive prompt medical care.
With the expansion of the use of ultrasound, it is now much easier to determine whether the embryo has died or was never formed — and that a miscarriage will definitely occur. In this situation there are several choices to consider:
- Expectant management. Before the use of ultrasound in early pregnancy, most women did not know they were destined to have a miscarriage until it was already in process. We know from this experience that you may choose to let the miscarriage progress naturally. Usually this happens within a couple of weeks of determining that the embryo has died. Unfortunately it may take up to three to four weeks. This can be an emotionally difficult time.
- Medical treatment. If after a diagnosis of certain pregnancy loss you'd prefer to speed the process, medication can cause your body to expel the pregnancy tissue and placenta. Although you can take the medication by mouth, your doctor may recommend applying the medication vaginally to increase its effectiveness and minimize side effects, such as nausea, stomach pain and diarrhea. The miscarriage will likely happen at home. The specific timing may vary. And you may need more than one dose of the medication. For about 70 percent of women, the treatment works within 24 hours. If treatment doesn't work within 24 hours, you may experience the miscarriage within several days to weeks.
- Surgical treatment. Another option is a minor surgical procedure called suction dilation and curettage (D and C). During this procedure, the doctor dilates your cervix and gently suctions the tissue out of your uterus. Sometimes a long metal instrument with a loop on the end (curet) is used after the suction to scrape the uterine walls. Complications are rare, but may include damage to the connective tissue of your cervix or the uterine wall.
In the case of an inevitable miscarriage, surgical treatment may be necessary to stop the bleeding.
- Tulandi T, et al. Spontaneous abortion: Risk factors, etiology, clinical manifestations, and diagnostic evaluation. http://www.uptodate.com/home/index.html. Accessed Aug. 13, 2008.
- Tulandi T. Patient information: Miscarriage. http://www.uptodate.com/home/index.html. Accessed Aug. 13, 2008.
- Miscarriage. March of Dimes. http://www.marchofdimes.com/printableArticles/681_1192.asp?printable=true. Accessed Aug. 13, 2008.
- Early pregnancy loss: Miscarriage and molar pregnancy. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp090.cfm. Accessed Aug. 14, 2008.
- Blighted ovum. American Pregnancy Association. http://www.americanpregnancy.org/pregnancycomplications/blightedovum.html. Accessed Aug. 14, 2008.
- Puscheck EE, et al. The impact of male factor on recurrent pregnancy loss. Current Opinions in Obstetrics and Gynecology. 2007;19(3):222-228.
- Tulandi T, et al. Spontaneous abortion: Management. http://www.uptodate.com/home/index.html. Accessed Aug. 13, 2008.
- Cytotec (prescribing information). New York, N.Y.: Pfizer; 2006.
- Cunningham, FG. First-trimester abortion. In: Schorge JO, et al. Williams Gynecology. 1st ed. New York, N.Y.: The McGraw Hill Companies; 2008. http://accessmedicine.com/resourceTOC.aspx?resourceID=514. Accessed Aug. 13, 2008.
- Misoprostol: Drugdex DrugPoint Summary. Micromedex Healthcare Series. http://www.micromedex.com/. Accessed Sept. 19, 2008.
- Sifakis S, et al. High-dose misoprostol used in outpatient management of first trimester spontaneous abortion, Archives of Gynecology and Obstetrics. 2005;272(3):183-186.
- Blum J, et al. Treatment of incomplete abortion and miscarriage with misoprostol. International Journal of Gynecology and Obstetrics. 2007;99(2)(suppl):S186-S189.
- Stephenson M, et al. Evaluation and management of recurrent early pregnancy loss. Clinical Obstetrics and Gynecology. 2007;50(1):132-45.
- Patient's fact sheet: Recurrent pregnancy loss. www.asrm.org/Patients/FactSheets/recurrent_preg_loss.pdf. Accessed Sept. 25, 2008.
