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 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 grow.

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 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 a miscarriage due to.

• Age 
• 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. 

What is uterine aspiration?

• It is a procedure to remove the products of pregnancy with suction. No scraping, incisions, cutting, or sutures are used. 
• During the procedure, you are given IV sedation. This helps you feel more relaxed and helps with pain. Numbing medicine will be placed into the cervix. These medicines often do not "put people to sleep." The goal is for you to be more comfortable.
• The cervix is gently stretched enough to pass a small cannula (tube) into the uterus. A gentle suction is then used to remove the pregnancy tissue. 
• The procedure takes 10 to 15 minutes. 
• You will not be bale to eat for hours before your procedure. Your care team will teach more about this. 

After a uterine aspiration you may have:

• Lower abdominal cramps and low back pain. This should lessen quickly.  
• Cramps on and off for a few days. 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 within 4 weeks. It may be lighter or heavier than normal. 

Call your care team if you:

• Have bright red vaginal bleeding for more 2 weeks.
  • Brown discharge is ok and may last longer.
• Soak 1 maxi pad in 1 hour, for 2 or 3 hours.
• Pass clots larger than a golf ball.
• Have severe pain in your abdomen.
• Have foul smelling vaginal blood or discharge.
• 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.
• Wait at least 1 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.
  • 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 with sugar.
• Drink 6 to 8 glasses of fluid each day.
• Limit caffeine and alcohol.

Breast care

• Your breast may feel tender and 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.
  • 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 request a certificate of nonviable birth from the Iowa Department of Public Health pursuant to Iowa Code section 144.31B. Upon your request, your care team will give you a letter certifying a nonviable birth.

Call:

• The Obstetrics and Gynecology Clinic at 319-356-2294 Monday through Friday from 8 a.m. to 4 p.m. 
• For urgent questions 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.