Miscarriage
Risk and Signs of Miscarriage
- Miscarriages are fairly common. Statistically they occur once in every 4 pregnancies. Most occur in the first trimester (less than 12 weeks gestation.)
- The risk of miscarriage decreases significantly once a baby's heartbeat is seen/heard.
- Miscarriages are often signaled by bleeding and cramping, but it is important to note that not all bleeding or cramping will result in a miscarriage. Bleeding can sometimes be attributed to implantation bleeding and cramping can sometimes indicate the normal "growing pains" of a new pregnancy.
- Notify your doctor immediately if you have any spotting/bleeding or moderate cramping. Mild cramping can be quite normal.
- You will likely be asked to have your blood drawn if a miscarriage is suspected. Your blood will be examined for the level of your pregnancy hormone (BHcg) and sometimes for your progesterone level. Many times you will be asked to have your BHcg rechecked. If the level doubles every 48 hours, your risk of miscarriage is decreased, but if it does not, then an impending miscarriage is more certain. The doctors will follow your BHcg level until it returns to zero, indicating that your miscarriage is complete. Your doctor will advise you how often you will need to have your blood drawn.
- You may be asked to have a sonogram to confirm that you are indeed miscarrying. The sonogram will also verify that the pregnancy was in the uterus as opposed to being ectopic. Special precautions will be taken if an ectopic pregnancy is identified.
If you have a miscarriage…
- During the time of impending miscarriage/miscarriage, do not use any tampons. You should also abstain from relations until after your normal menses return. This usually occurs 4-6 weeks after completion of a miscarriage.
- Bleeding from a miscarriage can be very heavy. However, notify the doctor immediately if you are passing clots the size of the palm of your hand or if you are soaking through a super absorbency pad (like an overnight pad) every half hour.
- The length of time that you bleed during a miscarriage will vary. Typically you will experience very heavy bleeding and cramping for a few hours to a few days. The bleeding and cramping will ease, but you will likely continue to have some kind of bleeding/spotting for the next few weeks. If you increase your activity level, you will notice that the bleeding may increase. Many people report that their bleeding "was practically gone and suddenly returned heavier again." In most cases this is due to the patient having increased her activity levels now that she is feeling better. This is very common. Listen to your body. If you start bleeding heavily again, reduce your activities. As your bleeding decreases, gradually increase your activities. Again should you notice very heavy bleeding, as described above, call the doctor immediately.
- At any point, you can request to have a dilation and curettage (D&C). A D&C is a procedure done at the hospital as an outpatient whereby the fetal and placental tissue is removed. Sometimes your doctor will advise that this is best for you—especially if you are not miscarrying on your own after a week or two, if you start developing signs of hemorrhage or infection, or if your miscarriage is occurring a little later in your pregnancy. Once you are past 12 weeks gestation, however, a D & C is no longer an option. You will have to be induced and deliver.
- Please call the doctor at any point that you experience very heavy bleeding (as defined above), fever, chills, or severe pain. These could be signs of hemorrhage or infection and should be addressed immediately.
- You can expect to follow-up in the office 2-3 weeks after a miscarriage.
- We usually recommend that you wait at least one regular menstrual cycle, but preferably 2-3 cycles before attempting pregnancy again.
Burial options for a miscarried child
- We grieve with you for the loss of your child. Especially when the miscarriage has occurred late in a pregnancy, it is certainly appropriate to consider burial – either by interment or cremation – for the repose of your child. Your pastor or parish priest will be a good resource for guiding you through locating a burial site and potential sources for financial help.
If you have additional questions, please ask to speak with a nurse. Our triage nurse phone number is 703-273-9440 ext. 118. If it is after hours, call the on-call doctor at 1-888-724-3845.