You may not need any treatment if an ultrasound scan shows that no pregnancy tissue remains in your womb.
Your doctor or midwife will talk to you about your emotional and physical recovery.
When all the tissue is gone from your womb, it is called a complete miscarriage.
If some pregnancy tissue remains, it is called an incomplete miscarriage. You may need treatment for this.
Managing an early miscarriage (up to 12 weeks)
If there is still some pregnancy tissue in your womb, your options are:
- wait for the tissue to pass out of your womb naturally - conservative (expectant) management
- take medicine that causes the tissue to pass out of your womb - medical management
- have the tissue surgically removed - surgical management
If you are between 12 and 24 weeks you may need medical management. This is to induce labour.
Managing a late miscarriage (12 to 24 weeks)
Your doctor or midwife will talk to you about what to expect and the risks and benefits of each option.
They may recommend 1 form of management over another based on:
- the stage of your pregnancy
- if you had a previous miscarriage
- findings from the ultrasound scan
- your medical history
- how far you live from the hospital
- the support you have
Take your time making this decision. Ask your doctor and midwife to explain anything you're unsure about. Ask them for information you can read in your own time. Together you can decide which option is best for you.
Conservative (expectant) management
Conservative management means waiting and allowing the remains of the pregnancy to leave your body naturally through bleeding. It is sometimes called expectant management.
Conservative management does not always work. It often depends on the stage of your miscarriage and the type of miscarriage you have. If it is not successful, you will be offered another type of treatment.
When you might have conservative management
Your doctor or midwife may recommend this treatment if you:
- have no signs of infection
- do not have excessive bleeding
- do not have a high temperature
- do not have abdominal pain or the pain is mild
- are early on in your pregnancy - usually under 10 weeks, sometimes under 8 weeks
- do not live too far from your maternity unit or hospital
- have transport and childcare, if you have other children
How conservative management works
After the ultrasound scan confirms a miscarriage, you go home. This is to allow the natural process of miscarriage to happen.
Bleeding will usually start within a few days. But it can take up to 3 weeks to start, particularly if you've had a missed miscarriage. Bleeding can last for up to 2 weeks.
You may have a lot of cramp-like pain. Your doctor or midwife will tell you what medicine to take for pain.
If you still have pain and bleeding 2 weeks after these symptoms start, you may be offered another ultrasound scan to check if any of the pregnancy tissue is still in your body.
If bleeding does not start within 2 weeks
Contact the early pregnancy unit if you have no bleeding within 2 weeks.
You may be offered a follow-up appointment. If conservative management is not working for you, you may decide to have medical or surgical management.
When bleeding and pain stops
If the bleeding and pain stop after 2 weeks, the pregnancy tissue has probably left your body. You will be asked to do a pregnancy test about 2 weeks later.
This is to make sure all the pregnancy tissue has gone. Contact your doctor or midwife if this test is positive. You may need a blood test or a follow-up ultrasound scan.
Risks with conservative management
Conservative management of miscarriage is generally safe. But there is a small risk of something going wrong.
Possible complications include:
- feeling faint
- heavy bleeding - sometimes a blood transfusion is needed, but this is rare
- incomplete emptying of the womb - sometimes a different treatment is needed
- infection
These complications are not common - most affect between 1 and 3 in every 100 women.
Urgent advice: Contact your maternity hospital or unit immediately if:
- the bleeding is very heavy - you are changing sanitary towels with blood clots every 15 minutes for more than 1 hour
- the pain is severe and is not relieved by painkillers
- you have a temperature of 38 degrees Celsius or higher
- you feel very unwell
You may need antibiotics or emergency surgery if the pain and bleeding continues.
Medical management
Medical management is the most common way of treating miscarriage.
You usually get 2 medicines:
- mifepristone
- misoprostol
If you are told you need 2 medicines, you take mifepristone first. This is at the hospital or maternity unit.
After about 36 hours, you take misoprostol. This completes the miscarriage process.
If you are told you need 1 medicine, you'll just take misoprostol.
Your doctor or midwife will tell you how to take misoprostol. It works best when absorbed through the cheek of your mouth. You can also take it vaginally.
How medical management works
This medicine helps the neck of the womb (the cervix) to open and the miscarriage to happen.
About 9 in 10 women will pass all the pregnancy tissue (complete miscarriage).
Often you can have this treatment at home. But sometimes your doctor or midwife will recommend you stay in hospital until the miscarriage happens.
They may recommend this if you:
- are more than 10 weeks pregnant
- live far away from the hospital
- have another medical condition
- have limited support at home
- prefer to stay in hospital
After taking the medicine
After you take the medicine you may have stomach pain and vaginal bleeding.
The bleeding is heavier than a period and can last up to 10 days. You may feel large clots passing.
Use sanitary towels rather than tampons. This reduces the risk of infection.
The pain is usually worse than period pain. Take paracetamol and ibuprofen to ease the pain, unless there is a medical reason not to.
Follow-up after taking medicine
You will usually be asked to do a pregnancy test 3 weeks after taking the medicine. Or you may have a follow-up ultrasound scan 2 weeks after taking the medicine.
This is to make sure the miscarriage is complete.
Non-urgent advice: Contact your maternity hospital or unit if:
- your pregnancy test is positive
- you are still bleeding after 2 weeks - there may be pregnancy tissue remaining or you may have an infection
Risks with medical management
Medical management is safe. But there are some small risks.
Possible complications include:
- feeling faint
- heavy bleeding - sometimes a blood transfusion is needed, but this is rare
- incomplete emptying of the womb
- infection
These complications are not common - most affect between 1 and 3 in every 100 women.
Urgent advice: Contact your maternity hospital or unit immediately if:
- the bleeding is very heavy - you are changing sanitary towels with blood clots every 15 minutes for more than 1 hour
- the pain is severe and is not relieved by painkillers
- you have a temperature of 38 degrees Celsius or higher
- you feel very unwell
Surgical management
You may be offered surgery to remove the pregnancy tissue from the womb.
The operation can be done:
- electrically - evacuation of retained products of conception (ERPC), sometimes called dilatation and curettage (D and C)
- manually - manual vacuum aspiration (MVA)
The operation is safe, but like any surgery, there are some risks. Your doctor or midwife will talk to you about this. They will also discuss your options with you. You can ask them questions you may have. They will ask you to sign a consent form for the surgery.
How an ERPC works
In an ERPC, your surgeon gently widens the neck of the womb and removes the pregnancy tissue. The procedure takes about 30 minutes.
You will usually have a general anaesthetic so you are asleep during the procedure. You will be asked to fast (not eat or drink) from the night before.
Make sure you have a lift home after the procedure as you should not drive for 48 hours after a general anaesthetic.
How a MVA works
You will have a local anaesthetic for a MVA so you are awake during the procedure.
You get an injection to numb the neck of your womb. The doctor gently opens the neck of your womb and passes a small suction tube into the womb. The tube is used to remove the contents of the womb.
Sometimes, an ultrasound scan machine is used to make sure the womb is completely empty.
You may feel some discomfort and cramping pain during the procedure.
After surgery
You can usually go home 2 to 4 hours after the procedure.
You may have some cramps and pain similar to period pain. Take ibuprofen or paracetamol. You can take these medicines together for better pain relief.
You will also have bleeding that is a lot like your period. It will last for about 7 to 10 days.
During this time, use sanitary towels, not tampons. Avoid having sex until the bleeding has stopped.
Usually there is no need for follow-up at the hospital or early pregnancy unit.
The physical recovery time after surgical management of miscarriage is short. You can usually go back to work after a few days, if that is what you want to do.
Non-urgent advice: Contact your GP if you have:
- heavy vaginal bleeding
- vaginal discharge with a bad smell
- abdominal pain that is not relieved with painkillers
- a positive pregnancy test 2 weeks after you stop bleeding
Risks with surgical management
The risks from surgical management of a miscarriage are low, but they can happen.
Possible complications include:
- scar tissue in the womb
- cervical injury
- feeling faint - only if awake during surgery
- heavy bleeding - sometimes a blood transfusion is needed, but this is rare
- infection
These complications are not common - most affect between 1 and 2 in every 100 women.
In rare instances (around 1 in 1,000) you can have:
- problems related to the anaesthetic
- injury to the womb and the need for more surgery
What happens to the pregnancy tissue
In most early miscarriages the fetal tissue is too small to see when it leaves your body. But if fetal tissue is identified at the hospital, the team will guide you on your options. For example, they can help arrange a hospital burial. Or you may choose to take the remains home to bury them privately.
Managing a late miscarriage (12 to 24 weeks)
If you have a late miscarriage, sometimes:
- you go into labour and deliver at home - you will need hospital care
- you go into hospital with pain or bleeding and deliver in hospital
- your baby dies in your womb and you need to have labour induced
Having labour induced means you are given medicine to speed up the process of passing the pregnancy tissue.
How induction works
You get 2 medicines:
- mifepristone
- misoprostol
You take mifepristone first. You must take this tablet at the hospital or maternity unit.
About 24 to 48 hours later you get misoprostol. This starts labour.
Your doctor or midwife will tell you how to take it. It works best when absorbed through the cheek of your mouth.
The medicine works quickly for some people but not for others. It can take several hours for labour to begin.
You will get misoprostol every few hours until you have regular contractions and your baby is born.
The contractions may cause a lot of pain. Your doctor or midwife will give you medicine to help control the pain.
This is often a distressing time. You will need someone with you for support.
After the birth
When your baby is born, you may decide to see and hold them or you may prefer not to. Take time to make these decisions. There is no right or wrong thing to do.
If you deliver at home, you will need to go to hospital for medical help and support. Take your baby's remains with you.
It can be difficult to make decisions about what happens to the remains. A midwife trained in bereavement care and pregnancy loss will talk to you about your options. Usually your baby can be buried at the hospital or you can take them home for a private burial.
You will be offered a postmortem examination of your baby.
Your doctor or midwife may offer you other tests as well.
Support for you and your partner
This can be a very emotional time for you, and your partner. You may find it helps to talk about your loss. A bereavement specialist team at the hospital or maternity unit will support you.
In the days and weeks after your loss, you are likely to feel physically and emotionally exhausted. Give yourself time to grieve and recover.
For some people, the loss can be overwhelming. It may affect your mental health. Talk to your GP if you feel you are not coping. They may refer you for counselling.
