What Is the Difference Between a Natural and Medical Miscarriage?

If you have lost your pregnancy, you may be able to choose how you miscarry

Worried Mature Couple with Female Doctor
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If you have lost your pregnancy, your doctor may offer you several choices of miscarriage treatment. These options include waiting for a natural miscarriage, having a D&C, or using medication to induce bleeding.

If your pregnancy loss involved a medical emergency such as a ruptured ectopic pregnancy or a hemorrhage, you may have had no choice but to have surgery. If you do have a choice in your treatment, each of your options has possible pros and cons depending on your situation and personal outlook.

Waiting for Natural Miscarriage

Early in pregnancy, a miscarriage will be very similar to a heavy, crampy menstrual period. It may start with brown spotting that changes to heavier bleeding, sometimes with large blood clots. The bleeding may last up to two weeks, but it should not be heavy for that entire time. The general rule is that if you are soaking through a menstrual pad in under an hour that you should go to the emergency room.

The cramps in a natural miscarriage can range from mild to very strong. Your doctor can recommend painkillers to help you handle the cramping.

Some women prefer nonsurgical miscarriage because they want to avoid the ordeal of checking into the hospital, or they may feel that dilation and curettage (D&C) is too invasive. Women may also want to avoid the minor risks of complications from a D&C or they may want to collect the tissue for burial. (However, during the earlier stages of pregnancy the baby will most likely not be recognizable).

If a doctor diagnoses a miscarriage before any bleeding has started, a miscarriage may take days or even weeks to happen without intervention. This can be a drawn out and emotionally difficult waiting process. Most women, 80 to 90 percent, will miscarry within two to six weeks without complications.

If bleeding has started and the woman chooses to wait, she should be sure to follow her practitioner’s recommendations and probably check in for a follow-up appointment to make sure that everything has cleared and hCG levels have returned to zero.

Medication to Expedite an Inevitable Miscarriage

If miscarriage bleeding has not started and you prefer to avoid a D&C, your doctor may prescribe you a prostaglandin medication, such as misoprostol, to speed the process along. With these medications, a miscarriage will happen in the same manner as a nonsurgical loss without medication. The only difference is that the medication speeds up the process.

Sometimes doctors will use medication to treat confirmed or probable ectopic pregnancies that are not at immediate risk of rupturing. For an ectopic pregnancy, the standard medical treatment is methotrexate.

Although these medications are safe for most women, they do carry risks of hemorrhage and severe cramping. If you choose this option, your doctor will go over any warning signs that require medical attention.

You should remain at home or in your doctor's care while taking the medication. Avoid traveling until your doctor evaluates you again to make sure your miscarriage is complete.

D & C for Pregnancy Loss

Most of the time, a surgical management of miscarriage will be done through a D&C. If you are having a D&C, you will need to check into the hospital and have a pre-surgical workup. Some doctors perform D&Cs in their office, so this is not always necessary. You will get either local or general anesthesia, depending on you and your doctor's preference. Your doctor will then dilate your cervix and scrape away or vacuum your uterine lining. You will usually be discharged on the same day as the procedure. Your doctor will most likely give you a prescription for pain medication and a recommendation to follow-up either a few days or a week or two later.

A D&C may be necessary if the miscarriage poses an immediate threat to your health. This may be the case if you are hemorrhaging or if tissue remains in your uterus after a natural miscarriage. Surgical management may be the recommended for some ectopic pregnancies and late pregnancy losses.

A D&C provides the fastest closure, particularly in losses where the bleeding has not yet started. Some women may wish to avoid having a visual image of the remains of the pregnancy. A D&C can make it easier to collect tissue for chromosome analysis to rule out chromosomal abnormalities for those with recurrent losses.

Some doctors also use D&C as the default medical treatment for all miscarriages. If you prefer nonsurgical management and your doctor is recommending a D&C without any clear medical need, ask your doctor if they can accommodate your wishes.

Regardless of the management option, be sure to seek support resources and lean on your family and friends in the time of your grief. If you are having recurrent miscarriages, read up on possible causes and tests you may want to pursue before trying again.

Sources:

Butler, Charles, Gary Kelsberg, and Leilani St. Anna. "How long is expectant management safe in first-trimester miscarriage?" Journal of Family Practice Oct 2005. [Online]. 24 Sept 2007.

U.S. Food and Drug Administration, "Mifeprex (mifepristone) Information." Drug Information. 29 Aug 2007. U.S. Food and Drug Administration. 24 Sep 2007.

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