Expectant management of miscarriage

Miscarriage is when you lose a pregnancy before 20 weeks.

There are different treatments for miscarriage, including:

• expectant management — where you wait for your body to miscarry naturally
• medical management — where you take medicines to help the pregnancy tissue leave your body
• surgical management — where you have a minor operation

Natural management of miscarriage is when you choose to wait for your body to miscarry naturally. This is also called 'expectant management'.

Natural or expectant management may be offered if you have had an incomplete miscarriage. This is when some pregnancy tissue has passed, but some remains in your uterus (womb).

You may prefer natural or expectant management because it may:

• feel more natural
• help with the grieving process
• give you more of a sense of control

Usually, natural or expectant management takes longer than other miscarriage treatments. Sometimes, medical or surgical treatment is needed to avoid heavy vaginal bleeding and to prevent infection.

You should discuss the different options with your doctor or midwife.

Vaginal bleeding and cramping will usually start within 7 to 14 days of your pregnancy ending. It may start with some light spotting and cramping. This will increase to heavy bleeding and more painful cramps or contractions.

Depending on how far along you are in your pregnancy, you may pass large clots of tissue.

The pain and vaginal bleeding should reduce within 1 to 2 days. Some bleeding or spotting may continue for about 2 weeks.

You may find that waiting for the bleeding to start and then stop can be emotionally draining.

You should contact your doctor if you have any concerns or worries during expectant management of a miscarriage.

See your doctor or go to the nearest emergency department if you:

• have pain that's worse than period pain (Opens in new tab)
• are soaking 1 to 2 sanitary pads per hour
• are passing large blood clots (golf-ball size)
• have unusual or smelly vaginal discharge (Opens in new tab)
• have a fever (Opens in new tab) (a temperature of 38°C or higher) or chills
• feel dizzy (Opens in new tab), lightheaded or faint (Opens in new tab)
• have heavy bleeding for more than 2 weeks

During expectant management of a miscarriage, you may want to take pain-relief medicines (Opens in new tab) and anti-sickness medicines to help manage your symptoms.

For most women, over-the-counter (Opens in new tab) pain medicine such as paracetamol and ibuprofen are enough to control the pain.

It's a good idea to have the following at home:

• sanitary pads — you may need a few packs
• over-the-counter pain-relief medicines, such as paracetamol (Opens in new tab) or ibuprofen (Opens in new tab)
• time to rest
• a support person

If you have had an incomplete miscarriage, you will often pass the remaining pregnancy tissue within days.

Once the miscarriage begins, the pain should improve within 1 to 2 days. Your vaginal bleeding will also start to reduce.

It can take up to 2 to 4 weeks before your bleeding stops completely.

It's normal to have pain and bleeding after a miscarriage. It may feel like a period and usually stops within 2 weeks.

Until your bleeding stops, you should:

• use sanitary pads instead of tampons
• not have sex
• not swim
• not take a bath

You should have a general follow-up appointment with your doctor 4 to 6 weeks after your miscarriage.

Your next period will usually come 4 to 6 weeks after a miscarriage.

Sometimes, expectant management of a miscarriage only partially works. If this happens, some pregnancy tissue may be left in your uterus.

It's important to see your doctor if you have a fever, which may mean you have an infection, or heavy bleeding for more than 2 weeks.

Your doctor will organise tests to work out what is causing your vaginal bleeding or pain.

If you haven't fully miscarried, they will discuss your options with you. These will depend on your situation and preferences. They may include:

• continuing with the expectant management of miscarriage
• medical management of miscarriage
• surgical management of miscarriage

If you have experienced a miscarriage or pregnancy loss, there are many support services available to help you, your partner and your family.