You cannot do anything yourself to prevent the miscarriage from occurring. There are three ways a miscarriage can occur:
- Wait until the miscarriage occurs spontaneously
- Administering medication, misoprostol, after which a miscarriage occurs
- Curettage: a procedure in which the gynecologist removes the pregnancy tissue through the vagina and cervix.
These approaches have advantages and disadvantages. We describe them below and you can also discuss them with your midwife. You decide which method suits you best. An interim solution is always possible, such as waiting for a while and, if it takes too long, still misoprostol or a curettage.
- Wait and see
A miscarriage usually occurs within a few days after the first blood loss; sometimes this takes longer, even a few weeks. Gradually cramping pain develops in the uterus and blood loss increases. The pain disappears almost immediately after a miscarriage that proceeds normally. The blood loss also reduces quickly and is comparable to the last days of a menstruation.
Advantages of waiting: you may prefer to wait because a spontaneous miscarriage has a more natural course. The grief can be experienced at home and any complications of a curettage can be avoided.
Disadvantages of waiting: If you decide to wait for a miscarriage, it is wise to consider how long you want to wait and discuss this with the midwife. Waiting is not medically harmful and has no consequences for a new pregnancy. However, it can be emotionally difficult. Most miscarriages occur within 2 weeks, but can also last 4-6 weeks. Curettage may also be necessary due to extensive blood loss, pain or an incomplete miscarriage. Pregnancy symptoms can persist as long as there is still pregnancy tissue in the uterus.
- Medication: Misoprostol
If a miscarriage does not start on its own, it can be induced with misoprostol. To induce the miscarriage, you can insert a number of misoprostol tablets vaginally. The miscarriage usually occurs within 24-48 hours.
Benefits of Misoprostol: In 80% of cases the miscarriage goes well without further intervention.
Disadvantages of misoprostol: In some people, a number of misoprostol tablets may need to be inserted vaginally again or a curettage may still need to be performed due to remaining remains of the pregnancy (approximately 10%). And in about 10-20% of women, misoprostol has no effect at all.
Misoprostol has not been released on Dutch medicines for use in miscarriage, but to prevent stomach and duodenal ulcers when using painkillers. Although misoprostol has not been officially approved for this indication, it is used responsibly in many hospitals.
- Curettage
During a curettage, the gynecologist removes the pregnancy tissue from the uterus via a thin tube (vacuum curettage) or scraper (curette) through the vagina and the cervix. This can be done under general anesthesia or local anesthesia. This depends on the hospital.
Benefits of a curettage: less uncertainty than with waiting and less disruption of normal life.
Disadvantages of a curettage: a curettage is a medical procedure. A rare complication is Asherman's syndrome. This causes adhesions to form on the inside of the uterus.
Occasionally a perforation occurs: the tube or curette passes through the wall of the uterus. This usually has no consequences and you will be given antibiotics to prevent possible inflammation.
Another complication is incomplete curettage, leaving a remnant of the miscarriage behind. This part can still come out spontaneously, but it may also be necessary to undergo a second curettage.
