Miscarriage Care Instructions–Expectant Management

What is a miscarriage?

It is the spontaneous loss of a pregnancy before the 20^th week. This can be physically and emotionally painful. They often happen before 12 weeks. 10 to 20 percent of known pregnancies end in a miscarriage. Some studies show it may be closer to 30%. The fact miscarriage is common does not make it feel better. We want to reassure you that there is likely nothing wrong with your body. Future pregnancies can and should go well. 

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 fetus stops growing 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 may cause a miscarriage?

We often cannot find an answer for why a pregnancy stops developing. It is important to know you did not cause the miscarriage. Many happen because the fetus did not grow normally. 

They are not caused by:

• Normal activity
• Sex
• Exercise
• Working

You may be at higher risk of miscarriage due to.

• Age
  • A person age 35 has a 20% chance of miscarrying.
  • A person age 40 has a 40% chance of miscarrying.
  • A person age 45 has an 80% 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.

How is miscarriage treated?

there are 3 ways to treat a miscarriage

1. Expectant Management

The body is given time to recognize the pregnancy stopped developing. It can pass the pregnancy without medicine or a procedure. This results in passing the pregnancy about 70 to 80% of the time over 3 weeks. 1 in 5 to 1 in 3 people need more intervention, such as a procedure. This is needed if the pregnancy does not pass on its own. Fewer people need intervention if already bleeding when miscarriage is diagnosed. 

2. Medication management

Medicines are given to cause the body to pass the pregnancy. Mifepristone is given in the clinic. Misoprostol is taken at home.These increase the chance that the body will pass the pregnancy without needing a procedure. It works 80 to 85% of the time. 

3. Procedural management

A procedure called a uterine aspiration can be done in clinic with IV sedation. Suction is used to remove pregnancy tissue from the uterus. The procedure takes about 10 minutes. 

What are the signs of a miscarriage?

Vaginal bleeding or spotting

• May be like a period. 
  • You may bleed for a few days, or on and off for a few weeks.
  • Call your care team or go to the Emergency Room if you:
    • Soak 1 maxi pad in 1 hour, for 2 to 3 hours.
    • Feel lightheaded or dizzy.
• When you lie down blood collects in the vagina.  When you stand up, blood may pass:
  • In a large gush.
  • As a large clot.
• Small clots, no larger than a golf ball are normal. 
• Bleeding will change from red to pink to brown.
• Discharge should not be foul smelling.
• Use maxi pads for the first two weeks.
  • After 2 weeks, tampons can be used.

Tissue passing from your vagina

After you have passed all the tissue your bleeding should slow to like a light period.

Pain or cramps in your abdomen or lower back

You may take acetaminophen and ibuprofen.

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

• Call your care team if you do not know your blood type or you are Rh negative.
• You may need Rh D immune globulin (Rhogam^®) within 72 hours after you miscarry.

G​et a blood pregnancy test 2 weeks after your miscarriage

Take a home pregnancy test if you cannot come to the lab.

• Call your care team if it is positive after 2 weeks.
• You may need more testing.

Sexuality

• No sex, tampons, or douching for 2 weeks.
  • Pregnancy can happen with unprotected sex.
  • Start birth control as discussed with your care team.
• Wait at least 1 normal period before you try to get pregnancy.
• You may feel that sex will never be the same due to fatigue, physical discomfort, or anxiety.
  • 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 1 week.

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.

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.
  • Do not let hot water fall on 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.

 

Certificate of nonviable birth:

You may ask for a certificate of nonviable birth from the Iowa Department of Public Health pursuant to Iowa Code section 144.31B. Your care team will give you a letter certifying the nonviable birth, if requested. 

Call:

• The Obstetrics Gynecology Clinic at 319-356-2294 Monday through Friday from 8 a.m. to 4:30 a.m.
• For urgent question or concerns
  • Call the Hospital Operator at 319-356-1616 on nights, weekends, and holidays. 
  • Ask for the gynecology resident on call. 
• Toll-free at 800-777-8442, 24 hours a day
  • ​​​​​​​Ask for the gynecology resident on call. 
  • You may be asked some questions when using the toll-free number. 

Send a MyChart message for non-urgent questions or concerns.