When experiencing a miscarriage, there are emotional, spiritual and physical needs that must be addressed. This page will address the physical treatments of pregnancy loss as well as some prevention recommendations. For information on addressing the short term and long term emotional and spiritual needs during a pregnancy loss, please see What to Do.
Treatment for miscarriage
During a miscarriage, a pregnancy loss occurring before 20 weeks gestation, the most common symptoms are vaginal bleeding, abdominal or back pain, or sudden cessation of pregnancy related symptoms. Fewer than half of pregnancies experiencing vaginal bleeding in the first trimester will miscarry but ALL of these pregnancies should be evaluated. The first step, which requires a pelvic exam, is to determine the extent of bleeding to ensure the safety of the mother. If bleeding is severe and pregnancy loss is confirmed, an urgent procedure may be necessary.
To determine if a miscarriage is occurring or has occurred, blood work to check pregnancy hormone levels will be drawn and an ultrasound will be performed. If very early in the pregnancy, and blood levels are not definitive, you may be asked to return in 48 hours for further testing. The ultrasound will provide information on the presence or absence of a heartbeat (if at least 6-8 weeks along) and will evaluate for the presence of an ectopic pregnancy which occurs when the pregnancy is in the fallopian tubes rather than the uterus. If an ectopic pregnancy is diagnosed, an urgent procedure may be necessary. Lastly, if not already determined, blood typing will be performed to help prevent complications in future pregnancies due to Rh disease.
If a miscarriage is diagnosed, there are various treatment options depending on patient wishes, the extent of patient bleeding, and the location of the pregnancy (ectopic or uterine). For uterine, non-urgent miscarriages, the first option is to let the process resume naturally. This is the least invasive method but usually takes a few days longer to resolve. Furthermore, some women who choose this “expectant management” will still need medical or surgical intervention later if it does not completely resolve on its own.
If a patient desires a quicker recovery, she and her physician may opt for medication given by mouth or vaginally that helps speed the process along. Other patients may have a surgical procedure known as a D&C that removes the pregnancy and placenta. Following all options, bleeding should be expected for a few days to a week. If bleeding persists or increases or you develop fever or abdominal pain, you should contact your health care provider.
Treatment for fetal demise
A fetal demise may also present with vaginal bleeding, abdominal pain or back pain but some women simply notice a decrease in the movements of their baby. Again, the initial work up involves verifying the mother is stable with regard to bleeding or other medical concerns such as high blood pressure or infection. An ultrasound will be performed to look for the baby’s heartbeat. If a fetal demise is diagnosed, the baby should be removed by the labor process or surgically. Some women will go into labor on their own. However, if it does not begin within a few hours, intervention is usually recommended to avoid infection or blood clots. So an induction of labor is usually preferred. An induction begins with a medicine taken by mouth, vaginally or intravenously. Or if the cervix is already dilated, induction may occur by simply rupturing the membranes (“breaking the water”).
Other means to remove the baby include a D&C if early enough in the pregnancy or a D&E (if in the third trimester) which both surgically remove the baby. Both of these procedures are performed vaginally rather than through the abdominal wall.
Pain management can be given through an IV, an epidural or in some cases, general anesthesia will be provided.
Prevention of further pregnancy loss
Many pregnancy losses can not be prevented but there are ways to reduce your risk. This begins before pregnancy by taking folic acid in a prenatal vitamin, eating healthy, and avoiding drugs or excessive alcohol and stress. Exercising often and maintaining a healthy weight are also important. Any medical conditions such as thyroid disorders, diabetes, high blood pressure, obesity or autoimmune diseases should also be addressed before pregnancy whenever possible.
For those who have experienced an early miscarriage but do not know the cause, physicians will often skip a diagnostic work up until a second miscarriage (or even third) has occurred. However, you should ask for a work up after your first if you show any signs or symptoms that would indicate a preventable cause. For example, if your cycles were really short or abnormal before pregnancy, you may have low progesterone so evaluating your hormones before becoming pregnant again might be helpful. Or if you or a close relative were ever told you have bleeding or clotting problems, or if you have symptoms related to hyper- or hypothyroidism, a work up before your next pregnancy is also warranted.
For prevention of a fetal demise, prenatal care by a qualified health care provider results in the best outcomes. Monitoring with ultrasounds, blood work, urine tests, uterine growth charting and blood pressure recordings will reveal complications that put you at risk but can hopefully be addressed and treated before a loss occurs.
For couples experiencing recurrent miscarriage or fetal demise, NaPro Technology is a women’s health science that offers treatment and prevention options by diagnosing the root of the issue and thus more adequately restoring health. For information about NaPro Technology and treatment of recurrent miscarriage, please click here.
If you have a non-emergent, general question about pregnancy loss, please email info@teachmehealme.com. Although our physicians would love to assist everyone, we are unable to provide specific treatment recommendations to patients not under our care. So please remember to discuss any questions or concerns with your primary health provider.
