«Information to support you through your experience of a miscarriage Content Page No(s) Introduction 2 What is a Miscarriage? 2 Medical Terms you may ...»
Early Pregnancy Loss
Information to support you through your
experience of a miscarriage
Content Page No(s)
What is a Miscarriage? 2
Medical Terms you may hear to describe a 2
How will your Miscarriage be managed? 2-3
Expectant Management 3
- Does it hurt?
- Are there any risks?
- Care after expectant management Surgical Management: ERPC 3-4
- Are there any risks?
- Care after surgery Medical Management 5
- Does it hurt?
- Are there any risks?
- Care after Medical Management What Happens to the Miscarried Baby/Tissue? 6 Making the Decision for a Post Mortem 7 Examination After the Post Mortem Examination 7 Remembering your Loss 7 Follow-Up 8 Getting Pregnant Again? 8 Your Feelings 8 Sources of Support 9 - 10 Acknowledgements 10 Introduction If you are reading this leaflet you may have been told that you are having or have had a miscarriage.
We would like to say how sorry we are that you are having this experience and we will do everything possible to support you.
We hope that this leaflet will help to explain what options there are for treating a miscarriage. It will give you information to help you make decisions at a difficult and distressing time.
What is a Miscarriage?
A miscarriage is the early end to a pregnancy. Sometimes an ultrasound scan will show that a baby has died or not developed in the womb or uterus.
Sometimes there are signs that a miscarriage has happened e.g. there is bleeding from the vagina.
In most cases there is no obvious reason why it should happen.
Medical Terms you may hear to describe a Miscarriage Incomplete Miscarriage This is where the pregnancy is partially lost and not all of the pregnancy tissue in the womb comes away. You may have symptoms of pain and bleeding.
Silent, Delayed or Missed Miscarriage These are terms used to describe when a baby dies in the early stages of pregnancy, most commonly between 6-8 weeks. It may not be discovered until there is a small amount of bleeding or during a routine dating scan, which is usually carried out around 10-12 weeks.
2 How will your Miscarriage be managed?
It may be possible to wait and let the miscarriage happen naturally, known as expectant management or it may be managed medically or surgically. How your miscarriage is managed may be a personal choice but if your doctor feels that one option is better for you, they will explain why.
The doctors and nurses looking after you will understand it is an upsetting experience for you and your family. If at any time there is something you do not understand, please ask a member of staff.
Your partner may stay with you throughout your time in hospital if you wish.
Expectant management: letting nature take
You may prefer to wait and let the miscarriage happen naturally, especially if the pregnancy was at an early stage. The process of a natural miscarriage will vary depending on the size of the pregnancy and the findings of the ultrasound scan.
It may take days or several weeks before the miscarriage begins. You may be invited back for another scan or scans over the next few weeks to monitor progress and ensure that the womb has emptied.
Does it hurt?
Most women will experience abdominal cramps, possibly quite severe and painful, especially as the pregnancy tissue is expelled. You are also likely to have heavy bleeding and pass blood clots. You may see the pregnancy sac and it maybe larger (or smaller) than you expect. The doctors and nurses looking after you will give you some guidance as to what to expect and recommend pain-relief.
Are there any risks?
The risk of infection is low, but if you have any signs of infection such as a raised temperature, flu like symptoms, abdominal pain or a vaginal discharge that looks and smells offensive, you should contact your GP or out of hours service for advice
While you are bleeding it would be best to use pads rather than tampons and avoid intercourse until the bleeding has stopped There is a small risk that not all of the pregnancy tissue will be expelled and when this happens surgical management (ERPC) may be required.
An operation, where the remains of the pregnancy are removed, is called an “Evacuation of Retained Products of Conception” or ERPC. You will be admitted to the Gynae Ward and, as you need to have an anaesthetic for the procedure, you will be asked not to eat or drink anything for a few hours before coming to the hospital.
During the operation a doctor will place instruments into your womb through your vagina. Before the procedure, you may be given tablets to take by mouth and/or a pessary may be placed in your vagina. The medication softens the neck of the womb making the operation safer and easier.
When you are admitted to hospital you will be asked to sign a consent form for the anaesthetic and the operation.
Are there any risks?
The health care team will try to make your operation as safe as possible, however complications can happen. You should ask your doctor if there is anything you do not understand.
Complications of anesthesia: Before your operation the anesthetist will discuss with you the possible complications of having an anesthetic.
Pain: You may experience some pain following the operation. The health care team will try to assess and reduce your pain. Pain following ERPC is similar to period pain and can usually be controlled with simple painkillers, such as Paracetamol.
Bleeding: You will bleed from the vagina; it is usually like a period and settles after about 7 days. If the bleeding is heavy, a blood transfusion or a further operation may be needed (risk 1 in 2000)
Care after surgery After the operation you will be transferred to the Recovery Ward and then to the Gynae Ward. You should be able to go home the same day but may need to stay overnight depending what time you have your operation and whether you have any complications or are feeling unwell. If you do go home the same day a responsible adult should drive you home or accompany you in a taxi, and stay with you for at least 24 hours.
If you feel unwell or have any concerns when you go home please contact your GP or out of hours service who will be able to reassure you or identify and treat any complications.
If your blood group is Rhesus Negative you will be given an injection of Anti-D to prevent problems in a new pregnancy.
Medical Management Medical management is usually recommended for later miscarriages e.g. 12 weeks or more. Medication to start or speed up the process of miscarriage
tissue passing from the womb can be done in 2 ways:
You may be given a series of pessaries. A pessary will be placed in the vagina every 3 hours until the pregnancy tissue is passed. Alternatively you may be given a series of tablets to take by mouth.
If you choose this option to manage your miscarriage, you will usually stay in hospital until the pregnancy tissue is passed so that staff can check on your progress and offer pain relief if needed.
When a miscarriage starts you may have quite strong period-like pain and cramps, especially as the pregnancy tissue is expelled. The pain is caused by the womb contracting, rather like the contractions of labour and can be particularly distressing as you may have heavy bleeding and pass blood clots.
You may see the pregnancy sac, and if your miscarriage is happening when you are more than 10 weeks pregnant, you may see a tiny baby.
Are there any risks?
The incidence of infection is low, but if you have any signs of infection, such as a raised temperature, flu-like symptoms, abdominal pain or a vaginal discharge that looks and smells offensive, you should contact your General Practitioner or out of hours service for advice.
While you are bleeding, it would be best to use pads rather than tampons and avoid intercourse until the bleeding has stopped.
Sometimes, not all the pregnancy will be expelled and when this happens, surgical management (ERPC) may be required (see Page 3).
Care after Medical Management You should be able to go home when the heath care team looking after you are happy that the miscarriage is complete.
It might be best if someone could drive you home or accompany you in a taxi.
At home if you feel unwell, are worried about anything or concerned about complications please contact your General Practitioner who will be able to reassure you or identify and treat any complications.
What Happens to the Miscarried Baby/Tissue?
Whilst in many cases the cause of the miscarriage will remain unknown, it is important for the tissue from the pregnancy to be examined to confirm that the tissue passed is pregnancy tissue and to rule out a rare type of miscarriage, called a Molar pregnancy.
There is usually just a small amount of tissue, and occasionally fetal parts can be seen.
You will be asked to sign a consent form so we know your wishes regarding the examination and disposal of the tissue.
You may indicate on this consent form;
That you wish the hospital to sensitively dispose of the tissue, which will be by cremation or That you would like the tissue to be returned to you to make your own arrangements. If you chose this option, when the examination is complete a member of the laboratory/mortuary services team will contact you to arrange a time with you to collect the tissue. This may take a number of days
Making the Decision for a Post Mortem Examination
If a baby miscarries after 12 weeks gestation, it may be developed enough for a post mortem examination. If a post mortem examination is possible it will be discussed with you. It can provide valuable information about your baby, the pregnancy and possibly a cause for the miscarriage, although this may not always be the case.
You will be provided with more detailed information by the doctors and nurses looking after you about this option so that you can make a decision that is right for you.
You will be asked to give written consent for the examination. Your baby will be taken to the Paediatric Pathology Department at the Royal Victoria Hospital, Belfast where the examination will take place.
After the post mortem examination it may take several months before you can be given the results as it can take some time for all the test results to be gathered and a report completed.
When the post mortem examination is complete your baby will be returned to the hospital mortuary.
When completing the consent form you will have been asked your wishes about what should happen to your baby’s remains.
If you choose to have your baby’s remains returned to you for family burial or cremation, the mortuary technician will contact you to arrange a time for you to collect your baby.
If you chose for the hospital to undertake cremation of your baby, this will be done with dignity and sensitivity at Roselawn Cemetery where ashes will be scattered in the “Garden of Remembrance for Babies” which all parents can visit.
Remembering your Loss The healthcare team will do all they can to help you cope with your loss.
The hospital chaplain may be a good source of support, whether or not you have any religious beliefs. They are also happy to provide a “naming service” for your baby. The ward staff will contact the chaplaincy team on your behalf if you wish.
The mortuary team are also available to explain options for taking your baby home.
The ward team can help you find other ways to acknowledge the loss of your baby. With your approval, you can be helped to make mementos, such as a hand or footprint, if this is possible and by taking a picture etc.
The hospital also has a “Book of Remembrance”. You can choose to have your baby’s name written in this book. The team will provide you with information about how to do this if you wish.
Annual Remembrance Services are held and these are advertised in the local press.
You will not usually have a review appointment at the hospital.
You may seek follow-up and support from your General Practitioner who can provide you with a certificate for your employer should you need some time off work.
Getting Pregnant Again?
It is understandable that you may be anxious about a future pregnancy in light of this experience.
Having a miscarriage does not normally affect your chances of having a successful pregnancy in the future.
Following a miscarriage your periods should return to normal, however it is normal for the first period to be delayed.
Your Feelings A miscarriage is a difficult and unhappy experience to go through. Feelings after a miscarriage vary from person to person and people express their emotions in different ways. Feelings of grief and loss are very common and natural. You may also feel angry about what has happened.
Your partner may also have sad and difficult feelings to cope with. If you have another child or children who knew you were pregnant, they may also be affected by the miscarriage.
While most people find their feelings of grief and loss ease over time, there is support available to help you cope.
A health visitor can give you support and advice following a miscarriage and will arrange to visit you at home. The ward staff will ask you about this and make a referral if you wish.
Sometimes talking to people who have had a similar experience can be a great source of support. The following organisations are here to help and be contacted by telephone, e-mail or by visiting their websites.
Provide information booklets and a confidential telephone support line for those in need of a listening ear. If you would like to talk to someone confidentially,