Your treatment plan

Your treatment plan depends on whether you have had a complete or incomplete miscarriage (whether there is any foetal tissue left in your womb).

If you have had a complete miscarriage, no further medical treatment is required.

If you have had an incomplete miscarriage, it will be necessary to remove the foetal tissue as there is a risk that it could become infected. This can be done in three ways:

• surgical treatment, where minor surgery is used to remove the tissue,
• medical treatment, where medication is used to remove the tissue, or
• expectant treatment, where you wait for the tissue to pass naturally out of your womb.

All three treatments are equally effective in preventing infection.

Medical and expectant treatments sometimes fail to remove all the foetal tissue or can cause other complications. This means that there is a slightly higher risk that you will need further unplanned surgery.

Discuss the treatment options with the doctor in charge of your care.

Surgical treatment

Surgery usually takes place within a few days of a miscarriage. However, there are a number of circumstances where you may be advised to have immediate surgery, including:

• if you experience continuous heavy bleeding,
• if there is evidence that the foetal tissue has become infected, or
• if medical and expectant treatments have previously been unsuccessful.

Surgery is usually performed under general anaesthetic. Your cervix will be opened with a small tube, known as a dilator, and the tissue will be removed using a suction device. This type of surgery is known as evacuation of retained products of conception (ERPC).

Before surgery, you may be given medication to soften the cervix and to make it easier to perform the surgery.

ERPCs are usually very safe. However, as with all surgery, there is a small risk of complications.

Complications of ERPC include:

• infection,
• excessive bleeding, and
• the womb being torn during the procedure (which would require surgery to repair it).

In 95% of cases, surgical treatment is successful in removing foetal tissue.

Medical treatment

Medical treatment for miscarriage involves taking tablets that cause the cervix to open, allowing the tissue to pass out. The tablets can either be swallowed or inserted directly into your vagina (pessaries), where they dissolve.

The effects of the tablets usually begin within a few hours. You will experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience some further vaginal bleeding for up to three weeks.

Medical treatment is successful in removing foetal tissue in 85% of cases. However, you will need to have surgery if the treatment is unsuccessful.

Expectant treatment

If you have expectant treatment, it may be some time before you experience vaginal bleeding. The bleeding tends to be heavier than your usual period and you may also experience cramping. Bleeding can last for up to three weeks.

If the bleeding becomes particularly heavy or you experience severe pain, contact your hospital as soon as possible. You should be given a 24-hour helpline number to call in case of emergency.

Expectant treatment is successful in removing foetal tissue in 50% of cases. If treatment is unsuccessful, you will need either medical or surgical treatment.

After your treatment

Once your treatment has finished, you can decide what happens with the remains of your pregnancy. Some women prefer to leave the decision to the hospital staff whereas others prefer to discuss the available options.

It is possible to arrange a memorial and burial service. In some hospitals or clinics, it may be possible to arrange a burial within the grounds. You can also arrange to have a burial at home, although you will need to consult your local authority before doing so.

Cremation is an alternative to burial and can be performed at either the hospital or a local crematorium. However, not all crematoriums provide this service and they have no legal obligation to do so.

The cremation of foetal tissue does not provide any ashes for you to scatter.

Treating recurrent miscarriages

Hughes syndrome

Currently, Hughes syndrome is the only cause of recurrent miscarriage that can be successfully treated.

Research has shown that a combination of aspirin and heparin (a medicine that is used to prevent blood clots) can improve pregnancy outcomes in women with Hughes syndrome. About 74% of women who receive this type of treatment go on to have a successful pregnancy.

Suggested treatments

A number of other suggested treatments for recurrent miscarriages have been studied. These include:

• hormone treatments during pregnancy,
• using specially modified antibodies during pregnancy, and
• taking vitamin supplements during pregnancy.

The results of all these studies have been disappointing and there is no evidence that these treatments can prevent miscarriages.