Miscarriage Care Options

When we have gathered all necessary clinical information and you are diagnosed with a miscarriage, you will have a few options to discuss with our care team.

• You can wait and see if the pregnancy will pass on its own. This is called expectant management.
• You can use medications called misoprostol and mifepristone, prescribed here at Oula. This is called medical management that is used to actively pass the products of conception.
• You can have a surgical procedure done with one of our clinical partners.

Which option is best for you depends on your individual situation and is highly personal. We can talk about any of these options with you in more detail and help you feel safe and supported whatever you decide to do. No matter which option is best for you, we will be here to support you every step of the way.

Expectant Management

This option allows for a period to wait and see if the pregnancy passes on its own. How long it takes can vary, but it can take up to 1-2 weeks or more, depending on the details of your situation. We recommend intervention (with medication or a surgical procedure) if you have not passed the pregnancy four weeks after diagnosis of a miscarriage. Some people opt to take a mixed approach and will try expectant management for a week or two before opting into active management. We support your option to change your mind at any time.

Pros

This is the least interventive approach and allows you space and time to process the loss and see how things would evolve on their own timeline.

Cons

Waiting can be mentally and emotionally challenging – knowing the pregnancy will not continue to develop but also being uncertain of when the process of passing the embryo will begin and be complete. Sometimes expectant management results in an incomplete miscarriage and medical or procedural follow up will be necessary.

Medical Management

This option involves taking medication by mouth to encourage the pregnancy to pass.  Our care team will counsel you, obtain informed consent, and then prescribe medication to begin the miscarriage process.

What medicines will be used to treat my miscarriage?

Two medicines will be used to treat your miscarriage – mifepristone and misoprostol. Mifepristone is the first pill you will take to start the process of detaching the embryo from the uterine wall. The second medicine, misoprostol, works by opening the cervix and making the uterus contract to expel the pregnancy tissue.

How does a medical miscarriage differ from a spontaneous one?

With a medical miscarriage, you’ll start to have strong cramps and bleeding when the pregnancy begins to pass, usually within 1 to 4 hours after taking the misoprostol. The overall process can last for several hours, with symptoms peaking when the pregnancy is passed.

Pros

You are able to better control the timing and overall experience of your miscarriage and to prepare yourself, both physically and mentally, to go through the process in a safe space with a support person when possible. The overall parameters of what to expect is more predictable than a spontaneous miscarriage and the process is complete more quickly.

Cons

Medication induced cramps can be stronger than those that occur spontaneously. In rare instances, not all parts of the pregnancy tissue will be expelled and procedural care would be recommended. We provide follow up care to ensure that your medical miscarriage is complete or appropriate next steps are taken.

Procedure-based Management 

If you prefer, you can have a procedure to clear the pregnancy out of the uterus.

Options for procedures include a suction procedure called vacuum aspiration, done as an outpatient at a GYN provider’s office with one of our clinical partners. This procedure empties the uterus with gentle suction and is done by a doctor, midwife or advanced practice clinician skilled in early pregnancy care. Vacuum aspiration is an option in early pregnancy, usually up until ten or twelve weeks gestation.

An additional procedural option is a Dilation & Curettage, also known as a D&C.  This procedure can be done in an outpatient surgicenter or in a hospital’s operating room setting.  You will be offered anesthesia or sedation during the procedure. D&C is done by a OB/GYN doctor and involves gently sweeping the pregnancy out of the uterus with suction and instruments. D&C procedures are safe and would be recommended for pregnancies during the first or early second trimester.

Pros

This is the quickest and most efficient way to complete the miscarriage. You have the option for anesthesia or sedation to help cope with the discomfort of the procedure.  Procedural care allows for genetic testing of the embryo.

Cons

Oula does not currently provide surgical procedures in our clinics or with our hospital partner, so this would require a transfer of care to one of our trusted clinical partners. While these procedures have an overall low risk profile, all interventions carry some increased risk of infection, pain, bleeding, damage to your uterus, or retained pregnancy tissue.

How will I know what’s the best treatment for me?

It depends on your personal preferences and your specific situation. Each option has different benefits and risks. Our care team will provide options counseling to you to review the details of your clinical care and the risks, benefits and alternatives of each management pathway. We will talk with you about all the options and give you more information to help you choose and follow up with you after your miscarriage is complete.

Why do I need follow up?

Follow up is important so we can make sure that the miscarriage is complete, and that you are physically and mentally well after experiencing a miscarriage. We will make sure you have instructions on when and how to follow up with our care team at every step along the way.

Warning Signs and When to Call Us

If you have:

• a fever of 100.4°F or higher more than 24 hours after you’ve taken the misoprostol
• abdominal pain or cramps that don’t get better with pain medicine or you are unable to manage at home
• Bleeding that is heavy, soaks 2 maxi pads an hour for more than 2 hours, any clots larger than the size of a lemon passed for more than 2 hours, moderate or heavy bleeding that does not abate, or any bleeding associated with feelings of dizziness, shortness of breath, fainting or loss of consciousness
• If you are weak or have nausea, vomiting or diarrhea for more than 24 hours after taking misoprostol
• All of these could be signs of serious infection or complication and need immediate medical care in an emergency room
• Have feelings that overwhelm your ability to undertake the normal activities of your day, or if you have thoughts of doing harm to yourself or others.