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Medical Management of Miscarriage (non-surgical means)

Medical Management of Miscarriage
by Dr Spouse

Why You May Use Medications to Bring About Miscarriage (rather than waiting for a natural miscarriage or using surgical means)

If you’ve had an incomplete miscarriage or if a loss is imminent, a third option (after natural miscarriage or a D&C) is to use medications to enable the uterus to push out an remaining tissue. Medications given include RU 486 and misoprostol. Methergine may also be given.

What to Expect (My Experience)

In my 10th week of pregnancy, I noticed some spotting. I called my GP and he put me into the end-of-the-day emergency slot and booked me in for a scan later in the week. He tried to reassure me it was nothing to worry about. The next morning, I had more spotting but it was brown, so I didn’t worry. By the afternoon I’d had some red spots and was starting to panic so I took myself to A&E (emergency room).

They asked me how much blood I thought I had passed, and what it was like – I now know they were trying to work out whether I’d had a complete miscarriage. The A&E doctor told me my cervix was open, but then they took me up to the gynecological ward. The gynecologist told me the other doctor didn’t know what he was talking about–my cervix was closed and it could be a threatened miscarriage. We were booked for an earlier scan the following morning (Wednesday) and went home.

At the scan, we had the news that you can never forget. The sac was empty. They sent us upstairs to the ward to consider our options. They asked me when was the last time I ate and a female gynecologist came and discussed the options with us. She asked us if we’d like a little time to consider them, but it didn’t take us long. They were willing to let me go away for a week to try and miscarry naturally, or to offer us medical or surgical management.

The doctor explained the “evacuation” procedure and the medical procedure. I was also told that if I chose expectant management (natural miscarriage), they would probably ask me to have surgery if it didn’t work. As my cervix had been closed and the spotting hadn’t gotten any worse, I didn’t want to wait and possibly miscarry at work or hang around at home waiting for it to happen. I wanted some kind of connection to what was happening. So that was why we chose medical management. We were also told that, in the days before scans, women like me with a threatened, but incomplete, miscarriage would not have been able to have any confirmation of the embryo’s death and could have clots travelling round their bodies etc.

The bed I’d been put in at the hospital was reserved for me; if I’d needed to come back earlier it would have been there for me. At my current stage of pregnancy (10 weeks), I was given some tablets orally, told to go home for 48 hours, then given more as vaginal pessaries. I know that it changes depending on how far along you are, so other people’s treatment may be different.

The intervening 48 hours (between first dose and second dose – I believe they are different drugs but I’m not too sure) was pretty uneventful though my husband took the Thursday off to be with me at home, and take me in to hospital if necessary – it can happen pretty quickly at home before you go back. Friday morning, he took me in and went to work. My anaesthetist friend told me to take some paracetemol and codeine before going in and I’m very glad I did.

Within a few hours I had very bad cramping, slightly relieved by walking around. Around midday, I had passed the sac. I had a better idea then of what the nurses were trying to get me to look out for earlier in the week. Finally around 3pm the blood flow lessened and although my blood pressure was pretty low I started to feel a little better. Basically I had been through a very short labour.

My husband came to pick me up about 5 but they got me to stay in overnight, partly because it had only been a couple of hours since the bleeding had begun to ease off, and it had by no means stopped. I was asked to use horrible non-absorbent hospital pads, and to use a cardboard bedpan every time I went to the loo, so they could check what I had passed.

It took about a week for me to stop feeling sick and my breasts to go down. I gather that can be even longer if you have surgery. I have since had natural miscarriages as well, but at a much earlier stage.

Problems That May Arise and Ways to Troubleshoot

There are two reasons why I’m not sure I’d have this treatment again. One is that having had more miscarriages, I know they’d now offer analysis of the embryonic material if they could get any. I’m not sure they could do that if I had medical management.

The other is that I do feel that I’ve had a valuable experience, but you don’t need to have every valuable experience more than once. I’ve also now had surgery (a lap and dye) which I’d never had before the first miscarriage, and so I feel a bit more confident about having a general anaesthetic than I did before.

Personal Tips

I think the worst part was the pretty ineffective pain relief. The nurses seemed to need to keep checking with each other and the doctors and then forgetting they had checked. I am very glad I did choose that method of managing the miscarriage; the only part I’m not sure about is whether I’d do it again. I am glad I did have some sense of what was happening and that it was over.

8 comments

1 Kathy { 02.19.10 at 10:20 am }

This is a very informative blog post. I actually had to go through medical management for my miscarriage due to my hormone levels not decreasing appropriately. It was an early miscarriage and the doctors could not locate the pregnancy on ultrasound.
Part of me wishes I had the D&C so that I would have known if the pregnancy was ectopic or not. Plus, it took more than a month for my hCG level to go down to 5.

2 Tammy { 10.08.10 at 1:57 pm }

I have just gone through this at home and have a few tips if anyone is interested. A few things are briefly mentioned in the post, but I found them so helpful I thought they deserved more emphasis.
First, walking helped me A LOT, all I wanted to do at the most painful point was lay down, but when I tried that it was much more painful.
Second, a friend who has been through this before recommended incontinence pads rather than sanitary napkins due to her severe bleeding. I was glad I had them (and never would have thought of this).
Third, definitely take the painkillers at least an hour before you take the meds to start the miscarriage. I think the miscarriage can start as quickly as 1/2 hour after inserting the meds (although mine took 5 1/2 hours to start) so you want to make sure you have the pain meds on board in advance.
Fourth, it seems simplistic, but deep breathing during the most painful times actually helped a lot too. I was quite tense due to fear and pain, and taking deep breaths lowered both my fear and pain – maybe just a notch, but it was enough to feel a little more in control and make things a little more bearable.
Anyway, I hope this information helps someone.

3 Tiffany { 08.13.11 at 11:22 pm }

I am in the beginning stages of my medical management miscarriage. Should there be this much blood? I feel like a waterfall. When do I know if I should go to the er?

4 heather { 12.23.11 at 8:16 pm }

I had to insert 8 pills, (2doses of four each), i did that 2 days ago and am only now starting to feel a lot of pain. Yesterday i passed a few clots, pretty big ones, but i still am today. How long is the passing of the clots supposed to continue? When should i start toworry?

5 elise { 12.11.12 at 2:34 pm }

I am miscarrying now – second time (the first was a nine and a half natural miscarriage at 11 weeks ending with cytotec and a week of bleeding). This time my cervix is closed but I am bleeding and cramping a lot for 2 days so far. My midwife/obgyn team are monitoring my blood hormone levels over 48 hours. My breast swelling/soreness is gone and I’m sure I’m miscarrying, but they want to be sure it’s not just a threatened miscarriage. The worst part is not knowing when this will be over. I have been told by the ER, OB and midwife that filling a pad with blood every 30 minutes for 2 hours warrants the ER immediately. If you fill 2 in an hour, you might as well go in, especially if you’re on your own at the time – not that this will help for the above person, but for anyone coming across this as I have and wondering…hopefully it helps. Last time I passed clots for 2 days…this time I haven’t had any yet, but I’m sure it’s different for everyone each time.

6 Hilda { 10.28.13 at 4:26 am }

I am on day 7 after having a medically managed miscarriage. I found that the first day was definitely the worst! I found I had vomiting and diarrhoea from about 5 hours after taking the medicine (internally inserted) which made me feel a lot worse but tended to come on just before passing large “clots”. The pain relief of tablets didn’t really help much on the first day but since then I’ve taken them as and when and they have helped. I’m sill bleeding now although its a lot lighter than it was at the beginning, its just like a normal period (although I’m usually very light) and I’m pretty fed up- just want to be back to normal! I’m also tired! I don’t think I would choose this option again, I think if it did happen again I would have the surgery- the pain, vomiting, diarrhoea and dizzy spells the first day were enough to put me off! I had to go back to work on day three and found that quite hard too as I was just so tired and kept getting bouts of cramping. Hopefully over the next week or so the bleeding will stop.

7 Hilda { 11.05.13 at 6:40 pm }

Just an update yesterday (Monday 4th November) I get a call from the hospital asking for the results of my pregnancy test!? What pregnancy test I was never asked to do one? I ask. We need you to do one ASAP so I rush out and buy a clear blue digital test and sure enough it comes back positive (I have still been bleeding since taking the medical management) so the book me in for a scan today which Of course who’s not all the tissue has come away! I explained how sick I was before and opted to have the surgery today. I had to have bloods taken at the path lab and then went straight to pre op. I was then seen by the anaesthetist and the surgeon who explained everything and they then fitted me with a cannula (the tapping needed to find a vein on the back of my hand hurt the most!) I then went under. I woke up in recovery with quite a lot of discomfort like very bad period pain- enough to have me in tears but they gave me some pain which kicked in pretty quick. I was then taken back to the ward where the nurse made me drink some water and have a nibble on a biscuit- I wasn’t feeling very hungry just very tired and a bit woosie. I have come come and taken it very easy but the initial comparison I can give between the surgery and the medical management is vast. Not in any discomfort, not feeling sick obviously I have no idea how I will feel tomorrow but I feel a 100 times better than I did after taking the original medicine. I just wish I had done this two weeks ago. Hopefully I can draw a line under the 8 weeks of hell I’ve been through and start to feel normal again. I am still bleeding but it is very light and hopefully might stop in a couple of days. I can’t recommend having the surgery enough to anyone choosing what to do when facing a miscarriage.

8 Bobs { 06.10.14 at 4:23 am }

Hi,
I avoided googling medical evacuations before I had mine in fear I would hear horror stories. I chose to be admitted to hospital for the day 5 days ago. I am so glad I opted to stay in hospital as I don’t know how I would’ve have known what should be happening and what was ‘normal.’ I had 4 pessaries around 8am and by lunch I was getting mild period pains. I had some lunch and at 12.30 I had two tablets orally. I had already begun not feel sickly not long after eating but immediately after taking the second 2 stablest I was sick for the first time. Things seemed to escalate quickly then. Having not been through labour before I could only presume what I was experiencing were contractions. I had a constant, painful ache then severe cramping at intervals. Between contractions I was being sick therefore could not take any painkillers. Around 3.30 I was taken to the bathroom (with the lovely bedpans) and told to push. Nothing happened. Feeling faint, exhausted and still in pain I was out back in bed. Some time later I felt the need to push and the sac came away. All pain stopped. Since then, I have had some bleeding and feel a little like I have had the worst gym session of my life. Each day I feel a little better. My advice would definitely to go into hospital for your medevac and I wish I had known to take painkillers before. As for bleeding afterwards, I was told that if I passed clots as large as my palm, bled do heavily that you drowned a sanitary towel every twenty minutes for over an hour or if I experienced pain I couldn’t control with painkillers to seek medical attention.

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