Miscarriage - What happens if you have a miscarriage

If there is no pregnancy tissue left in your womb, no treatment is required.

However, if there is still some pregnancy tissue in your womb, your options are:

• wait for the tissue to pass naturally out of your womb (expectant management)
• take medication that will cause the tissue to pass out of your womb (medical management)
• have the tissue surgically removed (surgical management)

The risk of complications is very small for all these options. Discuss them with the doctor in charge of your care.

Expectant management

It is usually recommended you wait 7-14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management. 

If the pain and bleeding have lessened or stopped completely during this time, this may mean the miscarriage has finished. You should be advised to take a home pregnancy test after three weeks.

If the test shows you are still pregnant, you may need to have further tests to make sure you don't have a molar pregnancy or an ectopic pregnancy.

If the pain and bleeding haven't started within 7–14 days, or are continuing or getting worse, this could mean the miscarriage hasn't begun or that it hasn't finished. In this case you should be offered another scan. Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever), or you experience severe pain.

After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or to have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.

Medication

You may choose to have medication to remove the tissue if you don't want to wait.

This involves taking tablets that cause the cervix to open, allowing the tissue to pass out. In most cases, you will be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve. However, tablets that you swallow may be available if you prefer. A medication called mifepristone is sometimes used first, followed 48 hours later by a medication called misoprostol.

The effects of misoprostol tablets usually begin within a few hours. You will experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to three weeks.

You should be advised to take a home pregnancy test three weeks after taking this medication. If the pregnancy test shows you are still pregnant, you may need to have further tests to make sure you don't have a molar pregnancy or an ectopic pregnancy.

You may be advised to contact your healthcare professional to discuss your options if bleeding hasn't started within 24 hours of taking the medication.

Surgery

In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:

• you experience continuous heavy bleeding
• there is evidence the pregnancy tissue has become infected
• medication or waiting for the tissue to pass out naturally have been unsuccessful

Surgery involves opening your cervix (neck of the womb) with a small tube known as a dilator, and removing any remaining tissue with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.

This type of surgery is known as evacuation of retained products of conception (ERPC). You may also hear it referred to as surgical management of miscarriage (SMM).

If your blood group is RhD negative, you should be offered injections of a medication called anti-D immunoglobin after ERPC. This is necessary to prevent rhesus disease. Read more about preventing rhesus disease.