• Reference Number: HEY723-2023
• Departments: Gynaecology
• Last Updated: 31 October 2023

Introduction

We are very sorry you have suffered a miscarriage and appreciate this is a distressing time. If you have decided to have medical management to complete your miscarriage, we will explain the procedure to you and what to expect afterwards. Please read this information carefully. You will also be given further information on miscarriage from the staff looking after you.

This leaflet has been produced to give you general information about your treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Although this document refers to the term woman/women, it is applicable to anyone that can become pregnant regardless of whether you identify as a woman or not.

What is medical management of miscarriage?

Sometimes the symptoms (PV) per vaginum bleeding/pain of a miscarriage are not immediately obvious. You may have had a scan that showed that the pregnancy stopped growing some time ago. Instead of waiting for miscarriage to happen naturally, medical management uses medication to speed up the process of miscarriage.

You may have two types of medication, mifepristone, which blocks the hormones to the pregnancy and the second medication, misoprostol, works by making your womb contract to push out the pregnancy tissue.

We may only use one medication called misoprostol, if the pregnancy is less than 10 week size.

Why do I need medical management of miscarriage?

Instead of waiting for miscarriage to happen naturally, medical management is an option which may speed up the process of miscarriage.

This treatment usually involves one or two visits to the unit (48 hours apart if 2 visits are required). You will be seen by medical staff to check your general health before we organise your treatment.

What are the benefits – why should I have medical management?

• You are more in control of your treatment.
• Day Case procedure. It is unlikely an overnight stay will be required unless you experience any complications that require further management as an inpatient.
• Avoids surgery and general anaesthesia.
• The risk of infection is low.
• Medical management is successful in about 80 to 90% of cases.

Are there any other alternatives?

The nurse will have discussed these with you alternative treatments such as:

• Conservative management – letting nature take its course and letting the miscarriage happen naturally, and
• Surgical management – an operation to remove the remains of the pregnancy under local anaesthetic (awake) or general anaesthetic (you are asleep).

Can there be any complications or risks?

Many women worldwide have used this treatment and it is proven to have a very good safety record.

Every form of medical treatment has some risk or side effect and you must consent to the procedure.  With this treatment the main risks, though small, are excessive PV bleeding, incomplete miscarriage and infection. These can be easily treated.

PV bleeding can be heavy and you will pass clots. The process of miscarriage can be painful. Most women have quite strong period-like pain and cramps and some find the process very painful, especially as the pregnancy tissue is expelled. You will be advised what pain relief medication to take.

The tablets do not work for everybody; they failure rate is 10 to 20 women in 100. If the treatment does not completely empty the womb, there is a risk that hospital admission or surgery may be required.

PV bleeding can continue for up to three weeks after the treatment and women may require follow up to monitor their progress.

How do I prepare for the procedure? 

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this procedure.

If you have children at home we recommend that you organise some childcare help during/after the treatment.

It is important to have somebody with you for support whilst you are miscarrying.

Ensure you have a good supply of large sanitary pads. Do not use tampons as this may increase the risk of infection.

Ensure you have an adequate supply of pain relief medication, which is available without prescription from your local pharmacy or supermarket (we advise paracetamol and ibuprofen to take at home following your treatment).  A hot water bottle or heat pack may be helpful too. Pain relief will be provided on the day of your procedure whilst you are receiving care as an inpatient.

You can eat and drink normally on the day(s) of your treatment.

It is advisable to wear loose, comfy clothing and to bring a change of clothing to hospital with you. You are welcome to bring one person with you to support you. We will provide meals and drinks for you whilst you are on the ward. There is a cafeteria and vending machines on the ground floor of the hospital for anyone who accompanies you.

What will happen?

You will be admitted to the ward at a pre-arranged time on the day of your procedure. You will be introduced to the nurse taking care of you and shown your bed and the toilet facilities. You will have your blood pressure, pulse and temperature checked prior to being given the medication.

You will be given tablets this may be vaginally or orally.

Pain relief medication will be prescribed for you, please let the staff know if you are beginning to experience any pain, as the sooner we can give you some pain relief medication, the quicker it will take effect.  The tablets cause the uterus to contract to expel the pregnancy tissues, rather like contractions in labour.

You may start to develop some PV bleeding within a few hours.  This usually starts off like a period and may progress to heavier loss with clots quite quickly. It is expected that you may soak through pads quickly in the first stages of a miscarriage.

Sometimes PV bleeding or pain may not develop within a short time of commencing the treatment. If you are feeling well, we will discharge you, knowing that the miscarriage may start to happen in the next few hours or even days.

Please be aware that the miscarriage may not happen whilst you are on the ward. It may happen soon after treatment or a few days later. The majority of women are able to cope with a miscarriage at home and do not require admission to hospital.

Misoprostol may have some side effects; these include chills or hot sweats, nausea and vomiting, diarrhoea, and skin rashes. These usually settle within a day or so of the treatment.

What happens afterwards?

You may be discharged home before or after the miscarriage has happened.

If the miscarriage has not happened on the ward you will be asked to perform a urine pregnancy test in 3 weeks and you will be given a follow up appointment in the Early Pregnancy Assessment Unit for review.  PV bleeding is likely to continue for 2 to 3 weeks after the procedure and should gradually decrease.

You are likely to feel quite tired and exhausted after the procedure/miscarriage. Most women start to feel better within a few days however it may take a few weeks until you feel fully recovered.

You may need time off work to recover. Your GP can provide you with a sick certificate.

When do I need to worry or contact a nurse?

• If you have very heavy PV bleeding and it does not seem as though it is getting better
• If you feel light-headed or dizzy
• If the pain relief medication you are taking is not working and you are still in significant pain
• You have signs of infection;  which are a raised temperature, flu-like symptoms or a vaginal discharge that looks or smells offensive

General Advice

• We advise you not to have sexual intercourse until your PV bleeding has stopped. Please talk to your GP or Family Planning Clinic about contraception if you need it.
• You can shower as normal but we advise using plain water instead of scented products or antiseptics.
• Be aware that lying in a hot bath may make you feel faint, so it may be better to avoid this.

When can I try to get pregnant again?

We advise you to wait for at least one period before trying for a new pregnancy. Some people prefer to wait longer as miscarriage can be a very upsetting time and they feel they need longer to recover. If you are planning a pregnancy after your first period, we advise you to take folic acid (400 micrograms daily). This is available from your local pharmacy.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the: 

Early Pregnancy Assessment Unit/Emergency Gynaecology Unit, Women and Children’s Hospital – (01482) 608767

Gynaecology Ward, Women and Children’s Hospital – (01482) 604387

If you have any questions or concerns about the medical management of miscarriage, contact the Early Pregnancy Assessment Unit and ask to speak to a nurse (Monday to Friday 8am to 5pm, Saturday and Sunday 8am to 2pm).

Further information

The Miscarriage Association provides information and support for women that have had a miscarriage – 01924 200799 (Mon-Fri 9am-4pm)  – www.miscarriageassociation.org.uk

Information on Gynaecology Services at Hull University Teaching Hospitals NHS Trust can be found at: www.hey.nhs.uk/gynaecology

Pregnancy remains:

These are the choices available to you:

1. The hospital will arrange a shared cremation with your consent; this is carried out at the crematorium in a sensitive and respectful manner.  If you would like details of when this will happen this information can be given to you.
2. However, if you wish to have an individual cremation/burial you may of course make your own arrangements but the hospital is unable to contribute to the costs.
3. If you are unsure of your wishes you can contact the hospital within 4 weeks of your procedure.  The date that you must let us know by will be documented on your consent form, the contact telephone numbers are Gynaecology Outpatients (01482) 607829, Cedar Ward (01482) 604387 and EPAU (01482) 608767.  Your pregnancy remains are stored for 12 to 16 weeks before going for cremation.
4. In all cases the staff will ensure that your cultural and/or religious needs are respected.
5. You are also legally allowed to take your pregnancy remains home to bury yourself.  There are certain legal requirements that must be adhered to if you wish to do this, which are as follows:

• • The burial must not cause any danger to others.
  • It must not interfere with any rights other people may have on the land.
  • There must be no danger to water supplies or watercourses.
  • There must be no chance of bodily fluids leaking onto adjoining land.
  • The remains must be buried to a depth of at least 18 inches (45cm).
  • Permission must be obtained from the landowner if you do not own the land.
  • Careful thought needs to be given when considering burial in a garden, taking into account what would happen if you choose to move.