Miscarriage
Miscarriages are common, but this does not make them any easier. They can be sad and frightening, but when we work together, they are usually without complication.
Women often worry and feel guilty that they have done something to cause the miscarriage. This is not the case. Common concerns are that stress, sex or hard physical work has been the cause. This is simply not true. Most commonly, an early random genetic error is to blame.
Women with three or more miscarriages are statistically more likely to have an underlying condition which predisposes them to miscarriage. We call this recurrent spontaneous abortion, or RSA for short. Such women should obtain consultation with a Board Certified Ob/Gyn and an evaluation should take place. However, one or two miscarriages carries no prognostic significance. This means these patients are as likely as anyone else to have a successful pregnancy the next time.
Most miscarriages are early, as in the first trimester. If this is the case, you may deliver in one of three different ways:
Natural Delivery
This means you begin contractions and expel the pregnancy on your own.
Cytotec induction
This means that you are given a medication called Cytotec, to induce cramps and separation of the placenta. This should result in passage of the pregnancy.
Either of these two methods can result in excess bleeding, excess pain, or incomplete passage of the products of conception. If any of these happen, the next step is D and C. You may also choose D and C from the beginning.
Many women will want to be delivered the instant the diagnosis of miscarriage is made. However, in certain cases, there is some advantage to letting the pregnancy involute or shrink a bit, as it will naturally do .This results in easier dilation and less blood loss at the time of D and C.
D and C
This stands for dilation of the cervix and curettage. This requires anesthesia. It requires dilation of the cervix, followed by curettage; this is when the lining of the uterus is gently cleaned out with an instrument called a curette, which is much like a spoon.
Since D and C is a surgery, it has the risks common to all surgeries such as infection bleeding or damage to nearby structures, intraoperative or postoperative complications, anesthesia reactions, drug reactions, or thromboembolic phenomenon such as clots in the legs or the lungs. There are also rarer risks of over scraping the lining of the uterus making infertility more likely, or perforating the wall of the uterus which may require extra treatment. The big picture is that D and C is a short relatively low risk operation which usually goes well.
Regardless of how you come to deliver, you will need to know the following:
1. Activity- Afterwards you will be a bit crampy and will have normally lost some blood. You will recover most quickly if you rest at home the first two days. If you overdo it early on you will be more likely to have excess bleeding and discomfort. When you are evaluated at your post partum appointment, you will receive new tailored recommendations about advancing your activity.
2. Prevention of abnormal clotting – Any time after a pregnancy or surgery the clotting system is activated. Examples of abnormal clotting would be a stroke, deep vein thrombosis in the leg, or a pulmonary embolus, which is a clot in the lung. While recovering, is necessary to have enough mobility to maintain good circulation even while maintaining a reduced activity level as recommended above. It is best to alternate rest and activity, and to increase physical activity as tolerated.
3. Pain management- It is best to rely on a base of regularly scheduled anti-inflammatory, such as ibuprofen, with narcotic pain pills added in “ on top” as needed. Narcotic pain pills can cause constipation, which can be a major cause of post op pain. Please use healthy diet, good hydration and stool softeners such as Colace and Milk of Magnesia to prevent this.
4. Bathing-You may shower right away, and bathe after the first day.
5. Dietary intake should be normal healthy. However you should be especially attentive about eating lots of fruits, vegetables and protein. Plain probiotic yogurt is also a good addition. Make sure to stay extremely well hydrated. Continue your Prenatal Vitamin.
6. Abstain from intercourse, tampons or anything in the vagina until you are evaluated at your 2 week follow up appointment.
7. Precautions - Call with a fever greater than 100.0 degrees, chills, body aches, nausea, vomiting, diarrhea, uncontrolled pain or vaginal bleeding greater than a light menstrual period. It is important that if you pass any solid tissue please collect it, place it in a Ziploc bag, refrigerate it and bring it in within a day. This helps us determine if you have completed the miscarriage. Call us if you experience abnormalities of mood. To protect yourself , it is best to stay in a reasonable routine of contact with family, eating, sleeping and gentle activity.
Click here to get a printable information and precaution sheet.
On a personal note...
Miscarriages are most difficult, of course, for the patient herself. But they are also difficult for those around her such as family and friends. It is important to realize that everybody reacts individually to this type of loss. Patients often notice that their husbands do not respond in a way that makes sense to them. Sometimes women are disappointed with their husband's lack of feelings for the early pregnancy. I think it is important, under these circumstances, to realize that men do not experience miscarriage at all similarly to women. It is not possible for them to experience it as we do. We should accept that they still care about us and the family even if they cannot relate to our experience of the miscarriage.
Similarly, well-meaning friends and acquaintances will try to console us with phrases that do not make sense or are even sometimes downright irritating. For example, they will imply that we caused the problem.They will say " You shouldn't have been working so hard " . They will also often say" you can try again." What they might not understand is this pregnancy is it's own pregnancy and that while another would be welcomed, another cannot replace this one. Regardless of all this, it is best to simply best to say thank you for the condolences and understand that they mean well. Try not to get in the weeds about this. You're sensitive right now because your hormones are fluctuating.
Patients should let others help with things such as housework and meals. Patients should be encouraged that they will feel better but the process will go in stages and take its own time.