The options for managing miscarriage are outlined in Figure 12.1. If miscarriage is threatened, you will usually be advised to rest for a few days and a repeat scan will confirm whether the pregnancy is continuing. There have been several important developments in the management of miscarriage in recent years. The combination of highly sensitive pregnancy tests and ultrasound will usually assist in providing an accurate diagnosis. Many hospitals now have an early pregnancy assessment unit that specialise in these problems. This should allow you to see an expert in a dedicated area where you can receive sympathetic assistance away from busy, and often fraught, accident and emergency departments.

Figure 12.1

At one time, we believed that if you miscarried between seven and thirteen weeks, there were likely to be retained products of pregnancy and an ERPC (evacuation of retained products of conception) was indicated to reduced the risk of infection and bleeding. In the days before legal termination of pregnancy (Chapter 19) infection with induced abortion was relatively common. These septic abortions could be life threatening. Current opinion is that the risk of infection and bleeding has been overstated and a conservative approach now seems safe. From your point of view, this means that you may not need an operation which, as always, carries an element of risk (surgery risks) and furthermore delays waiting for an operation slot are avoided. A repeat scan about ten days after the diagnosis of incomplete abortion will usually confirm that nature has solved the problem for you and the womb has completely emptied itself. If a miscarriage is incomplete, oral misoprostol 600 micrograms may be as safe as surgical evacuation.

If you are Rhesus negative you should be offered an injection of Anti-D to reduce the chance of rhesus problems in a future pregnancy. Guidelines for the administration of Anti-D are currently under review.

The emotional aspects of miscarriage can be difficult to deal with particularly if you have had difficulty conceiving or if this is not your first miscarriage. There is inevitably a time of grieving. A trained counsellor with a special interest in miscarriage can provide support and help you come to terms with your loss.

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