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Miscarriage Information
Miscarriage is the unexpected loss of an early pregnancy (less than 20
weeks) and happens when the fetus (baby) is not developing. About 1 in 4
pregnancies end in miscarriage.
Causes
Routine activities like exercise, lifting, sexual intercourse, travel, work, and
stress do not cause miscarriage. Miscarriage is most commonly caused by a
genetic abnormality and may be caused by uncontrolled diabetes,
uncontrolled thyroid disease, uterine abnormalities, or blood clotting
abnormalities. Genetic testing to help determine the cause of a miscarriage
is not always done but may be done where a woman has a history of
infertility or had more than 2 miscarriages in a row. Talk to your health care
provider for more information about testing.
No activities or treatments (bed rest, for example) have been proven to
prevent or reduce the chance of miscarriage.
Bleeding in Early Pregnancy
Bleeding in early pregnancy does not always mean that a miscarriage will
occur. Bleeding can be a result of:
abnormalities of the vagina or cervix
bleeding between the pregnancy sac and the uterus
ectopic pregnancy - where the pregnancy is developing outside of the
uterus, which is a medical emergency.
Sometimes there is no explanation for bleeding in early pregnancy.
After a Miscarriage
It is normal to have bleeding for up to 3 weeks after a miscarriage. If you
are still bleeding after 3 weeks call the Early Pregnancy Assessment Clinic
(EPAC). It is normal to feel sad or upset about your miscarriage. It is
important to care for yourself during this time. If you would like to speak to
a counsellor or social worker please tell one of the EPAC nurses.
Pregnant After Miscarriage
After a miscarriage it is suggested that you wait until you have 1 normal
period before you try to get pregnant. Most women have a normal period
after 4 to 8 weeks. If your period does not return after 8 weeks, contact
your health care provider.
If you do not want to become pregnant again or at this time, talk to your
health care provider about using birth control. Options include the birth
control pill, condoms, patch, ring, or intrauterine device (IUD).
Go to the Regina
General Hospital
Emergency Department
if you:
have sudden severe
abdominal pain
suddenly feel faint or
feel like passing out
save heavy bleeding
(soaking more than 2
maxi pads per hour for
more than 2 hours)
have a fever greater
than 38° C (100.4° F).
To speak to a nurse at the
Early Pregnancy
Assessment Clinic (EPAC)
call:
(306) 766-4123
CEAC 1296
June 2020
Page 1 of 2
Regina Area
Treatment Options for a Miscarriage
Once an ultrasound has determined if a miscarriage
will occur you have three options. All options are safe.
The outcome of future pregnancies are not affected
by how the miscarriage is managed. The risk of
hemorrhage needing transfusion is less than 1%, and
of infection is 1 to 2%. Treatment options include:
expectant management
medical management
dilation and curettage (D&C).
1. Expectant Management
This is when you wait for the miscarriage to occur
naturally. The wait takes an average of 2 weeks to
occur. Sometimes it takes up to 3 or 4 weeks and 80%
of women have complete expulsion of the pregnancy
by 8 weeks. Expectant management may be an option
for you if you are early in pregnancy.
Most women experience moderate to severe
cramping and bleeding which can be quite heavy for 2
to 3 hours. Some women have nausea. You may take
ibuprofen or acetaminophen for pain. After the heavy
bleeding you can expect bleeding like your period for
the following week and then light bleeding or spotting
for up to 3 weeks.
To reduce your risk of infection while bleeding after a
miscarriage:
do not use tampons
do not have sexual intercourse.
Most women who choose expectant management
have a complete miscarriage given time but some
need to have the surgical D&C procedure if there is
pregnancy tissue left in the uterus.
A follow-up phone is arranged after your Clinic visit
with the EPAC nurse.
You can call the EPAC for advice or to arrange a
follow-up visit.
2. Medical Management with Misoprostol
Is when the medication misoprostol is used to help
the cervix open up and the uterus to start the
miscarriage. We give you misoprostol tablets to take
home to insert into your vagina at an agreed upon
time. The miscarriage usually happens within 12
hours of insertion of the tablets. If it does not occur
within 24 hours you may be advised to insert more
misoprostol tablets into your vagina.
1 in 6 women who use medical management may still
need a D&C to remove tissue from the uterus.
Most women experience moderate to severe
cramping and bleeding which can be quite heavy for
2 to 3 hours. The misoprostol may cause side effects
including vomiting, diarrhea, shivering, and fever
which can last from 2 to 3 hours to 1 day. You may
take ibuprofen or acetaminophen for pain or fever
and dimenhydrinate can be used for nausea.
The EPAC nurse calls you within 72 hours of taking
the misoprostol.
You can call the EPAC for advice or to arrange a
follow-up visit.
3. Dilation and Curettage (D&C)
A D&C may be recommended if you are bleeding
heavily, have an infection, anemia, a bleeding
disorder, or cardiovascular disease. A D&C is a
minor surgical procedure where the cervix is opened
(dilation) and the pregnancy is removed using suction
(curettage) that takes about 15 minutes. A D&C may
be done in an operating room under general
anesthetic or in the EPAC under sedation with local
anesthetic. The wait for a D&C may be up to 1 week,
depending on your situation.
After a D&C, you may bleed for about a week. A
small amount of bleeding may be normal for up to 4
weeks after the D&C. Mild cramping is normal for 1
to 2 days. Risks of a D&C are rare but include
perforation (making a hole) in the uterus, tearing of
the cervix, developing scar tissue, infection
needing antibiotics and hemorrhaging.
CEAC 1296
June 2020
Page 2 of 2
Regina Area
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