Miscarriage and Treatment Options

When a woman discovers she is pregnant it can be a time of fluctuating emotions. But, once the reality settles in, most women are happy to be pregnant. However, if she experiences first trimester bleeding, worry ensues. Communication with a healthcare professional at this time is very important. Until she has been evaluated by a health professional to understand the source of bleeding, anxiety is normal.

It is very important for women to discuss bleeding during pregnancy with their health care provider as this may be a sign of a more serious condition such as an ectopic pregnancy (a pregnancy somewhere other than in the uterus, usually in the fallopian tube) or a miscarriage. (Fifteen percent of all pregnancies result in miscarriage.) A physical exam, laboratory evaluation and a pelvic ultrasound are all a part of evaluating early pregnancy bleeding. Thirty percent of all pregnancies are complicated by bleeding in the first trimester. Fifty percent of women experiencing bleeding will go on to miscarry.

If a miscarriage is identified and there are not other medical concerns, we may proceed in one of three directions:
1. Allow spontaneous passage of the products of conception (POC).
2. Surgical intervention (i.e. dilation and curretage).
3. Medical treatment with misoprostol.

More about the use of misoprostol: In a number of randomized trials comparing the three methods, 85% of women with retained tissue (after a miscarriage is identified) can expect complete passage of products of conception after one or two doses of misoprostol without the need of surgery. Serious complications are rare. Women choosing this method may expect moderate pain and bleeding up to 2 weeks. Side effects of misoprostol consist of nausea, vomiting, diarrhea and fever. Nonsteroidal anti-inflammatories and other analgesics are often used for pain management. She may also experience exceptionally heavy bleeding prompting medical evaluation and potentially resulting in the need for surgery. 1% of women will need a blood transfusion, less than 1% will experience infection and 3% will need emergency treatment. According to a large study by Zhang and others, these numbers are similar to surgical intervention.

Regardless of the decision a woman makes in conjunction with her health care provider when experiencing a miscarriage, whether conservative management, D&C or misoprostol, this is a time for open communication, garnering support from those she loves and trusts and taking care of herself mind, body and spirit.