I Have Had a Miscarriage -- What Happens Next?

What Treatments Are Available?

In most cases, women who have a miscarriage in the first trimester do not require any treatment. However, there are three ways a miscarriage can be treated:
 
  • Watch and wait: In most cases of an early miscarriage, the uterus will start contracting and will pass the tissue on its own, similar to having a heavy menstrual period. The heavy bleeding usually lasts from three to five hours, and lighter bleeding tends to lasts one to two weeks. Nonprescription pain medications (such as ibuprofen) and a heating pad can help relieve any painful cramping you experience.
  • Medication: This treatment involves a medication called misoprostol that causes uterine contractions. The misoprostol pills are inserted in the vagina at a certain time. About two to six hours later, cramping will usually start and can last for three to five hours. Your healthcare provider may prescribe a narcotic pain medication to help relieve cramps, or ibuprofen can be used. A heating pad can also help minimize the cramping.
In some cases, misoprostol can cause nausea, diarrhea, or chills. These symptoms should improve after a few hours. Taking ibuprofen before using the misoprostol may help prevent some of the side effects of the drug. You can expect that bleeding will be quite heavy -- heavier than a period. Most women will pass the pregnancy within 24 hours of taking the medication. If miscarriage doesn't occur, a surgical treatment is necessary and may include vacuum aspiration, dilation and curettage (D&C), or dilation and evacuation (D&E).
  • Surgical procedure: If there is tissue left in the uterus after the miscarriage and it does not pass on its own, a surgical procedure is necessary. This involves having a healthcare provider remove the pregnancy tissue using an office procedure, an outpatient procedure, or a regular hospital surgery, depending mostly on how far along you were (the earlier and smaller the baby, the easier the procedure). Depending on the type of procedure, how far along you were, your preferences, and your doctor's preferences, you may be given a local anesthetic or you may be "put under" for the procedure. This process may involve the following:
    • Vacuum aspiration: A medical pump is used to suction the remaining tissue from the uterus (used mainly for very early miscarriages).
    • Dilation and curettage (D&C): This is a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument removes the tissue from inside the uterus (curettage).
    • Dilation and evacuation (D&E): This is a more complicated surgical procedure used for second-trimester miscarriages. Sometimes, people use the term D&E in a more general way to describe a first-trimester vacuum aspiration, although usually the term refers specifically to the second-trimester procedure.
 
If you choose to watch and wait and it is taking too long, you can talk to your healthcare provider about doing one of the other treatments. Also, the same is true if you have chosen to take the medication and it hasn't worked; you can choose to have the suction procedure done.
 
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Miscarriage Information

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