Miscarriage – Diagnosis and Treatment
Diagnosis
Diagnosing a miscarriage involves several steps to confirm pregnancy loss and rule out other causes of symptoms such as vaginal bleeding or cramping.
Health professionals use a mix of tests and exams to check the health of both the pregnant person and the pregnancy.
Key Diagnostic Steps:
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Blood Tests:
- The clinic often starts with blood tests to monitor the pregnancy hormone called human chorionic gonadotropin (hCG).
- They check hCG levels, then repeat the test after two days.
- Falling or low hCG levels usually mean the pregnancy may not be viable.
- The beta subunit of hCG helps measure hormone changes during very early pregnancy.
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Pelvic Physical Review:
- A pelvic exam lets the healthcare provider check if the cervix is dilated or open, which makes miscarriage more likely.
- The provider also checks if the uterus matches the expected size for the gestational age.
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Imaging:
- An ultrasound, often by transvaginal ultrasonography, helps visualize the uterus, gestational sac, embryo, and detect fetal heart activity.
- This test shows if the embryo is growing or if there are signs of fetal death.
- If the first ultrasound is unclear, the provider may schedule a follow-up scan within a week.
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Examination of Passed Tissue:
- If tissue passes from the vagina, a lab can confirm whether it is pregnancy tissue.
- This helps distinguish miscarriage from other possible causes of bleeding.
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Chromosomal Testing:
- If someone has more than one miscarriage, chromosomal testing for both parents can identify genetic problems that might contribute to repeated pregnancy loss.
Types of Diagnoses Made:
A health professional may use several terms to describe the type of miscarriage based on test results and physical findings:
Diagnosis | Main Features |
---|---|
Threatened miscarriage | Vaginal bleeding without an open cervix. Pregnancy may continue. |
Inevitable miscarriage | Bleeding, cramping, and an open cervix. Loss cannot be prevented. |
Incomplete miscarriage | Some tissue passed, but some remains in the uterus. |
Missed miscarriage | No symptoms; embryo dies or never forms, but tissue remains in the uterus. |
Complete miscarriage | All pregnancy tissue has left the uterus, more common before 12 weeks’ gestation. |
Septic miscarriage | Infection has developed in the uterus after miscarriage, causing fever and severe illness. |
Other Factors Considered:
- Providers monitor symptoms such as vaginal bleeding, abdominal pain, and pelvic pain.
- Risk factors include maternal age, chronic diseases, viral infections, and conditions like antiphospholipid antibody syndrome.
- The cause is often unknown but sometimes relates to chromosomal problems found by genetic testing.
Health professionals may repeat tests to track progress, especially if early signs are subtle. A clear diagnosis also helps spot rare but serious issues like ectopic pregnancy, which can have similar symptoms but needs different care.
Treatment
Managing Early Signs of Pregnancy Loss
When someone experiences vaginal bleeding early in pregnancy, a health professional may advise resting until the bleeding stops.
Although bed rest and other methods have not been proven to prevent pregnancy loss, providers sometimes recommend them as a precaution.
Precautionary steps:
- Avoid tampons to lower the risk of infection.
- Wait to have sex until bleeding ends.
- Postpone travel, especially to places with limited access to emergency care.
If you are unsure about any activities, ask your medical provider. Each case is different, so a tailored plan is best.
Options for Pregnancy Loss Management
If a miscarriage is confirmed or expected, several treatment options may be available.
The main goal is to prevent complications such as heavy bleeding or infection and to support emotional well-being.
Main Treatment Approaches:
Approach | Description | When Used |
---|---|---|
Expectant management | Waiting for the body to pass pregnancy tissue naturally | Common in early pregnancy |
Medicine-based treatment | Using uterine evacuation medications to help clear pregnancy tissue | When quicker management is needed |
Surgical procedure (Dilation and Curettage) | Removing tissue with a gentle procedure called suction dilation and curettage | If heavy bleeding or infection occurs |
Expectant Management
This approach means waiting while the body passes the tissue. It can take from a few days to eight weeks.
If the tissue does not pass or if there are signs of infection, providers may suggest medical or surgical options.
Medication-Based Care
Uterine evacuation medicines, such as those that soften the cervix and trigger contractions, help the uterus pass any remaining tissue. Using two medicines together works better than using just one alone.
Medical management is often used when someone prefers not to wait or if the loss is discovered early.
Surgical Care
If strong bleeding, infection, or incomplete tissue passage occurs, providers may recommend a minor surgery called dilation and curettage (D&C). The provider carefully opens the cervix and removes tissue from inside the uterus.
There are risks, such as possible injury to the cervix or uterus, but complications are rare.
Special case: Rh factor
If the person is Rh negative, a shot called Rh immunoglobulin is usually given.
This shot helps prevent problems for future pregnancies by stopping the body from attacking a baby’s blood cells later on.
Healing After Pregnancy Loss
Physical recovery after a miscarriage usually takes from a few hours to several days.
Signs to watch for:
- Soaking more than two pads an hour for over two hours
- High fever or chills
- Stomach pain that does not go away
If any of these signs appear, contact a healthcare provider right away.
Return to Normal Activities
Most people get their period about two weeks after light bleeding or spotting ends. All forms of birth control can start right after a miscarriage if needed.
Avoid sex or putting anything in the vagina, like tampons, for one to two weeks after the event. This helps prevent infection as the body heals.
Planning for Future Pregnancies
After a miscarriage or early pregnancy loss, pregnancy can happen again during the next menstrual cycle. Give both your body and mind enough time to recover.
Discuss the timing of trying for another baby with your healthcare provider to make sure you are ready.
- Only about 2% of people have two consecutive pregnancy losses.
- Fewer than 1% will have three in a row.
If losses happen more than once, health professionals may suggest tests to look for possible reasons.
Possible causes include:
- Structural problems of the uterus
- Chromosome differences in the parents
- Blood clotting disorders
- Immune system issues
Sometimes no clear reason is found, but most people still have a good chance (between 60% and 80%) of having a full-term pregnancy.
Support and medical guidance can help address both physical and emotional needs, especially after multiple losses.
Ways to Handle Grief and Find Support
Coping with miscarriage, stillbirth, or fetal death often brings emotions like sadness, anger, or guilt. Emotional recovery may take weeks or months, sometimes longer than physical healing.
It’s normal for both partners to handle these feelings differently.
Helpful Tips:
- Allow time to grieve.
- Reach out to supportive loved ones.
- Join a miscarriage support group to connect with others who understand.
If sadness or anxiety continues, talking to a healthcare provider can help. Recurrent loss or ongoing emotional stress may point to depression or PTSD.
Counseling and therapy can offer tools for coping and understanding emotions. Getting professional help may also support future healthy pregnancies.
Support Options | Description |
---|---|
Family/Friends | Emotional and practical support |
Counseling | Professional guidance to manage stress |
Support Groups | Shared experiences and encouragement |
Getting Ready for Your Visit
Steps You Can Take
Preparing for a healthcare visit after miscarriage symptoms is important. Patients should contact their healthcare provider right away if they notice any signs.
In some cases, immediate care may be needed, so ask for special instructions if an appointment isn’t soon.
- Limit Activities If Told To Do So: Some people may need to rest more or avoid certain activities until seeing the doctor.
- Arrange Support: Bring a family member or friend for help. Support can be reassuring and help remember information.
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Make a Question List: Write down questions in advance to make sure nothing important is missed. Some sample questions include:
- What kinds of tests will I need?
- Are there options for treatment?
- When should I call the office or go to the hospital?
- Can I keep doing normal activities?
- What are my chances for a healthy pregnancy in the future?
- Do you know what might have caused this?
Having a list helps keep the conversation clear and focused.
Below is a table with things to bring to the appointment:
Item | Why It’s Needed |
---|---|
Personal support (friend/family) | For help remembering information |
Written questions | To make sure all concerns are discussed |
Notes about symptoms | Helps the healthcare provider understand what happened |
List of medications | Important for planning safe treatment |
Questions You May Hear from the Healthcare Team
The healthcare professional will likely ask about your symptoms and medical history.
Some common questions include:
- When did your last period start?
- What birth control did you use before pregnancy, if any?
- When did your symptoms begin, and how often do they happen?
- How does your bleeding compare to your heaviest period before?
- Have you had any past miscarriages or pregnancy problems?
- Do you have any known health conditions?
- What is your blood type?
Try to answer these questions as accurately as possible. The healthcare provider may schedule a follow-up appointment to check your recovery or discuss further care.