While the majority of miscarriages occur due to genetic abnormalities that are unavoidable, the management and treatment of miscarriage aim to ensure the physical wellbeing of the individual, address any underlying causes, and provide emotional support.
A miscarriage generally occurs for reasons outside your control and nothing can be done to prevent or stop it from happening. Any treatment you have will be aimed at avoiding heavy bleeding and infection. Recurrent miscarriage, also known as recurrent pregnancy loss (RPL), is defined as two or more consecutive pregnancy losses and affects a smaller subset of individuals, presenting additional emotional and medical complexities.
Understanding the causes, treatment options, strategies for prevention, management, and relevant statistical information about miscarriages can provide crucial support and guidance for those affected.
The causes of recurrent miscarriage are diverse, and in many cases, a specific cause may not be identified. Known factors include:
Expectant management of miscarriage, also known as “wait and see” is an approach where medical intervention is delayed, allowing the body to naturally expel pregnancy tissue after a miscarriage has been diagnosed. This option is typically considered for early miscarriages, particularly when the miscarriage is incomplete, but the body is beginning to process the loss naturally.
How it works
When a miscarriage is diagnosed, especially in cases where the miscarriage is incomplete (meaning not all pregnancy tissue has passed from the uterus), expectant management gives the body time to pass the remaining tissue on its own. The process can vary in duration, typically ranging from a few days to a few weeks. Healthcare providers will offer guidelines on monitoring symptoms and recognising signs of complications that would necessitate immediate medical attention.
Advantages of expectant management
Considerations and risks
While expectant management is a viable option for many, it’s not suitable for everyone. Factors influencing the decision may include the duration of the pregnancy, the level of bleeding and discomfort experienced, and individual health considerations. Risks associated with expectant management include:
What to expect
During expectant management, individuals may experience symptoms similar to a heavy menstrual period, including bleeding and cramping. The severity and duration of these symptoms can vary. Healthcare providers will advise on what symptoms to monitor, such as signs of infection (e.g., fever, foul-smelling discharge) or excessive bleeding, which would require prompt medical attention.
Follow-up care
Follow-up care is an essential component of expectant management to ensure that the miscarriage has been completed without complications. This may involve ultrasound scans and/or blood tests to confirm that all pregnancy tissue has passed from the uterus. Healthcare providers will also offer guidance on physical recovery, emotional support resources, and discussions about future pregnancies when the individual is ready to consider this.
Medical management of miscarriage is a treatment option that uses medication to facilitate the expulsion of pregnancy tissue from the uterus after a miscarriage has been diagnosed. This approach is particularly relevant for early miscarriages or when an incomplete miscarriage has occurred, meaning not all pregnancy tissue has naturally passed from the body.
How it works
Medical management typically involves the use of a medication called misoprostol, either alone or in combination with mifepristone. Misoprostol causes the uterus to contract and expel pregnancy tissue through the vagina. It is administered orally or vaginally, and the process of miscarriage usually begins within a few hours to a few days after taking the medication.
Advantages of medical management
Considerations and risks
What to expect
Individuals can expect to experience bleeding and cramping, which may begin within a few hours after taking the medication. The intensity of these symptoms can vary widely. Passing large blood clots or tissue is common during this process. Healthcare providers will offer guidance on managing pain and what symptoms to monitor, such as signs of infection or excessive bleeding that would necessitate medical attention.
Follow-up care
Follow-up care is critical to ensure that the miscarriage has been completed and to address any complications. This typically involves a follow-up visit with a healthcare provider, who may perform an ultrasound or order blood tests to confirm that all pregnancy tissue has been expelled and that the uterus is clear.
Surgical management of miscarriage is a medical intervention used to remove pregnancy tissue from the uterus following a miscarriage. This approach is considered when a miscarriage is incomplete, meaning some pregnancy tissue remains in the uterus, or when there’s a need to expedite the process due to heavy bleeding, infection risk, or for emotional reasons. The primary methods include dilation and curettage (D&C) and vacuum aspiration.
Surgical procedures for miscarriage
Advantages of surgical management
Considerations and risks
While surgical management is generally safe, as with any procedure, there are potential risks:
What to expect
Preparation for surgical management of a miscarriage includes fasting if general anaesthesia is to be used. Post-procedure, patients might experience cramping and light to moderate bleeding for a few days. Pain relief medication can be used to manage discomfort. Most individuals can resume normal activities within a few days, although heavy lifting and inserting anything into the vagina, including tampons, should be avoided for a period to reduce infection risk.
Follow-up care
Follow-up care is crucial after surgical management to ensure complete recovery and address any complications. This usually involves a post-operative visit to check for signs of infection, ensure the uterus is returning to its normal state, and discuss any needed emotional support or planning for future pregnancies.
A very small number of couples experience recurrent miscarriage, which will often require a more thorough investigation.
A thorough evaluation is essential for identifying the cause(s) of recurrent miscarriages. This may include:
Treatment for recurrent miscarriage depends on the identified causes, but may include:
Planning and preconception care
When you are ready to try again, preconception care can help optimise your health for a future pregnancy:
The risk of another miscarriage after a single loss is generally low and similar to the overall miscarriage risk in the general population, which is about 10-20%. However, the risk may be higher in individuals with underlying medical conditions or those who have experienced multiple miscarriages.
Understanding the statistics related to miscarriage and recurrent miscarriage can offer some perspective. While specific success rates for treatments can vary based on the underlying cause, it is encouraging to know that with appropriate intervention, about 60-70% of women with miscarriages go on to have successful pregnancies.
Dr Genia Rozen is a Melbourne gynaecologist and fertility specialist with 10+ years of experience dedicated to fertility medicine.
She holds a PhD in fertility after cancer treatment, and a Masters of Reproductive Medicine (MRMED) degree. She undertook three years of sub-specialising training in Fertility and Reproductive Medicine at the Royal Women’s Hospital in Melbourne as is affiliated with Genea Fertility, who are recognised leaders in advanced reproductive laboratory services.
Please get in touch if you have a question or wish to book an appointment.
