Having a miscarriage

Stages of a miscarriage

The stages of a miscarriage vary widely from person to person, but generally occurs along the following lines:

Initially there is a little blood loss that can last for several days. Subsequently, the miscarriage persists and you will generally start losing a lot of clear-red blood (make sure you carry sanitary napkins). The blood loss varies in amount from a regular menstruation to a very severe menstruation. You can also lose clots. Clots are clumps of blood that can be as large as a fist. In most cases you won’t recognize the amniotic sac as such, but this depends on the term during which the miscarriage occurs.

When the blood loss increases this is often accompanied by painful cramping which resembles strong menstruation pain. The pain comes in waves: it occurs for a few minutes and then goes away. Usually, the pain subsides when blood is released from the uterus. It is possible that you will have several minutes to hours of cramping for it to subside and subsequently return. The contractions of the uterus cause the cramping. Because of this, everything that’s inside the uterus is expelled. In this way your body cleans your uterus.

To counteract the painful cramping you can use paracetamol 1000 mg (max 6 x 500 mg a day – 3 x 2 tablets). We advise against the use of aspirin as it thins the blood. A hot water bottle or shower can also alleviate the pain. Don’t use tampons during the miscarriage.

When the uterus is empty the blood loss will diminish and the cramping will subside to a dull pain. The day after the miscarriage you will lose about as much blood as during a menstruation. The cramping will be over. You can continue to lose clear colored blood for about 5 to 10 days which will then become dark brown blood.

A miscarriage is a natural, but dramatic event. Sadness and disappointment are a natural and logical response. Obviously, we will be there for you during this difficult period.


Treatments concerning a miscarriage

These days, an ultrasound is often done early during the pregnancy. A miscarriage can often be diagnosed before symptoms occur.

If this happens, you will be given three options:

  •  Wait
  •  Induce a miscarriage with medication
  •  Curettage

In general, you can wait for the spontaneous end of the miscarriage. The miscarriage will usually start a few days after the initial blood loss. Sometimes it takes longer, even weeks. The advantages of waiting can be that it provides a spontaneous miscarriage with a more natural path. Also the grief can be experienced at home and possible complications as a result of curettage can be avoided. On the other hand it can be emotionally tasking to wait. Moreover people can find it scary to experience a spontaneous miscarriage at home. And as a result of a large amount of blood loss, pain or an incomplete miscarriage it might still be necessary to resort to curettage. Discuss with us how long you wish to wait.

If the miscarriage doesn’t start by itself you can choose to induce it with medicine (Cytotec) or plan a curettage.
If this case a referral to a gynecologist will be made. The gynecologist will explain all available options. If requested he will prescribe you the medicine (Cytotec) or plan a curettage. If the medicine works as hoped, a curettage is no longer necessary. One of the possible side-effects of Cytotec is nausea and it is possible that Cytotec doesn’t, or only partially, induce a miscarriage. As a result, a curettage might still be necessary.

During a curettage a gynecologist removes the pregnancy-tissue from the uterus. This is done with the use of a thin tube (vacuum-curettage) or scraper (curette) through the vagina and the cervix. The curettage can occur under general anesthesia or sedation through an epidural. This depends on your own wishes and the judgment of the anesthesiologist. Normally, you will be able to go home the same day.

A seldom occurring complication after a curettage is Asherman’s Syndrome: as a result of this, adhesions develop on the inside of your uterus. These can negatively influence your fertility and have to be removed through an operation at a later stage. Sometimes perforation occurs: the tube of the curette goes through the wall of the uterus. Normally, this has no further consequences, but sometimes it is wise to stay in the hospital for an extra night. Often you will get antibiotics. Another complication is an incomplete curettage, in case of which a piece of the miscarriage remains behind. This part can also be expelled spontaneously, but it might be necessary to undergo a second curettage.