Miscarriage care instruction–procedural management

What is a miscarriage?

It is the spontaneous loss of a pregnancy before the 20^th week.

• This can be both physically and emotionally painful.
• They often happen before 12 weeks.

10 to 20 percent of known pregnancies end in a miscarriage.

Terms:

Chemical pregnancy

A pregnancy loss before it can be found on ultrasound. It is found only with a hormone test.

Blighted ovum

Early in pregnancy, a fertilized egg attaches to the uterus wall. No embryo will develop.

Intrauterine fetal demise

The baby stops developing and dies in early pregnancy.

Molar or partial molar pregnancy

Is not viable. There is an extra set of chromosomes, abnormal placenta, and abnormal fetus.

What is uterine aspiration?

It is a procedure to remove the products of pregnancy with suction. 

After a uterine aspiration

You may expect:

• Lower abdominal cramps and low back pain. 
  • This should lessen quickly.  
• Cramps on and off for a few days.  
  • You may take medicine as needed.  

Spotting or light bleeding for a few days. 

• It should not be heavier than your normal period.  
• Some people have no bleeding after the procedure.

Your bleeding should slowly fade in color.   

Your next period should:

• Start at its normal time or within 4 weeks.  
• It may be lighter or heavier than normal.

Call your care team if you:

• Have vaginal bleeding for more 2 weeks.
  • Brown discharge is ok and may last longer.
• Soak one maxi pad, in one hour, for 2 or 3 hours.
• Pass clots larger than a golf ball.
• Have severe pain in your abdomen.
• Have foul smelling vaginal discharge or bleeding.
• Temperature above 100.4 Degrees F.

How do I take care of myself after a miscarriage?

Blood type

You may need Rh D immune globulin (Rhogam^®) after the procedure if you are Rh negative.

Sexuality

• No sex, tampons or douching for 2 weeks.
  • Pregnancy can happen with unprotected sex.
  • Start birth control as discussed with your care team.
• We suggest that you wait for 2 normal periods before you try to get pregnant.
• You may feel that sex will never be the same due to fatigue, physical discomfort, or anxiety.
  • You should tell your partner how you feel.

Temperature

Take your temperature each day between 4 and 8 p.m. for 1 week.

Rest and exercise

• Slowly start normal activity.
  • No strenuous exercise (such as running or aerobics) for 2 or 3 days.
• Your energy level may be low for the first week.
• Naps may be helpful.
• You may return to work as told by your care team.

Bathing

• You may shower and wash hair.
• You may have a tub bath.
• No swimming pools, hot tubs, lakes, or rivers for at least 2 weeks.

Diet

• Take your prenatal vitamin.
• Eat a balanced healthy diet.
  • Cut down on food and drinks containing sugar.
• Drink 6 to 8 glasses of fluid each day.
• Limit caffeine and alcohol intake.

Breast care

• Your breast may be tender or feel full.
• They may leak milk. Use breast pads to protect your clothing.
• Wear a bra that gives good support.
• Use ice packs under your arms and on breasts for 20 minutes every 2 hours if they are sore.
• Take acetaminophen and ibuprofen as needed.
• Do not stimulate or pump your breasts.
  • Avoid hot water directly hitting your breasts in the shower.
• Cabbage leaves can help with breast pain and swelling.
  • Place green or red cabbage leaves in the refrigerator.
  • Rinse the leaves with cold water and pat dry if desired.
  • Place cold leaf in your bra on your breast.
  • Leave in place for 20 minutes or until warm.
  • Repeat with a fresh leaf as needed.

Emotions

• Each person will feel different.
  • It may help to talk about your feelings.
• A support group or grief and loss website may be helpful.

What may cause a miscarriage:

You did not cause the miscarriage.  Most miscarriages happen because the fetus has not developed normally.

They are not caused by:

• Normal activity
• Sex
• Exercise
• Working

Conditions that may increase the risk of a miscarriage:

• Age
  • A person age 35 has a 20 in 100 chance of miscarrying.
  • A person age 40 has a 40 in 100 chance of miscarrying.
  • A person age 45 has an 80 in 100 chance of miscarrying.
• History of 2 or more miscarriages in a row
• Uncontrolled diabetes
• Uncontrolled thyroid disease
• Problems with your uterus or cervix
• Infection
• Hormonal problems
• Smoking, heavy alcohol use, or illicit drug use

See your care team if you are worried before trying to get pregnant.