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Diagnoses of Miscarriage
If you have signs and symptoms of early pregnancy loss, you must likely will have a physical exam. Your obstetrician will ask you questions about when the bleeding started, how much you are bleeding, and whether you have pain or cramping. An ultrasound exam may be done to check whether the embryo is still growing in the uterus or to detect the presence of a heartbeat. You may have a test to measure the level of human chorionic gonadotropin (hCG) in your blood. This substance is made by the developing placenta. A low or decreasing level of hCG can mean loss of the pregnancy. Several ultrasound exams and hCG tests may be necessary to confirm that pregnancy loss has occurred.
treatment Options
When a pregnancy is lost, some of the pregnancy tissue may remain in the uterus. This tissue needs to be removed. There are several ways this can be done. If the situation is not an emergency, you can help choose the type of treatment. The available options have similar risks, which include infection and heavy bleeding. The risk of serious complication, regardless of the type of treatment is very small. If your blood type is Rh negative, you also likely will receive a shot of Rh immunoglobulin after an early pregnancy loss. Problems can arise in a future pregnancy if you are Rh negative and the fetus is Rh positive. These problems can be prevented by giving Rh immunoglobulin after a pregnancy loss.
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Nonsurgical Option
If you do not show any signs of an infection, one option is to wait and let the tissue pass naturally. This usually takes up to 2 weeks, but it may take longer in some cases. Another option is to take medication that helps expel the tissue. Bleeding will occur and it will be heavier than a menstrual period and lasts for a longer time. Cramping pain, diarrhea, and nausea also can occur. Your ob-gyn may prescribe pain medication. You may pass tissue in addition to bleeding. With an early pregnancy loss, the pregnancy tissue resembles a blood clot. It does not look like a baby. An ultrasound exam or blood tests for hCG usually are done afterward to confirm that all of the tissue has been expelled. If it has not, you may need to have surgical treatment.
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Surgical Option
Surgery is recommended if you have signs of an infection, heavy bleeding, other medical conditions. One surgical option is called vacuum aspiration. In this procedure, a thin tube attached to a suction device is inserted into the uterus to remove the tissue. The procedure may be preformed in your doctor’s office. Local anesthesia is used. You also may be given medication to help you relax. Another option is called dilation and curettage (D&C). In a D&C, the cervix is dilated (opened), and an instrument is used to remove the pregnancy tissue. A D&C usually is done in an operating room or surgical center. General anesthesia or regional anesthesia may be used.
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Recovery
You may be advised not to put anything into your vagina (such as using tampons or having sexual intercourse) for 1-2 weeks after an early pregnancy loss. This is to help prevent infection. Call your ob-gyn right away if you have any of the following symptoms:
- Heavy bleeding (soaking more than two maxi pads per hour for more than 2 hours in a row)
- Fever
- Chills
- Severe pain
Pregnancy loss in the first trimester usually is a one-time event. Most women go on to have successful pregnancies. Repeated pregnancy losses are rare. Testing and evaluation can be done to try to find a cause if you have several pregnancy losses. Even if no cause is found, most couples will go to have successful pregnancies.
You can ovulate and become pregnant as soon as 2 weeks after an early pregnancy loss. If you do not wish to become pregnant again right away, be sure to use a birth control method. You can use any contraceptive method, including having an intrauterine device inserted, immediately after an early pregnancy loss. If you do wish to become pregnancy, there is no medical reason to wait to begin trying again. You may want to wait until after you have had a menstrual period so that calculating the due date of your next pregnancy is easier.
You can ovulate and become pregnant as soon as 2 weeks after an early pregnancy loss. If you do not wish to become pregnant again right away, be sure to use a birth control method. You can use any contraceptive method, including having an intrauterine device inserted, immediately after an early pregnancy loss. If you do wish to become pregnancy, there is no medical reason to wait to begin trying again. You may want to wait until after you have had a menstrual period so that calculating the due date of your next pregnancy is easier.