Miscarriage Diagnosis: What Tests Do Hospitals Use?

Miscarriage, or spontaneous abortion, is the unexpected ending of a pregnancy before 20 weeks of gestation. The main symptom of a miscarriage is vaginal bleeding, which is usually followed by cramping and pain in the lower abdomen. If you experience vaginal bleeding, you should contact a healthcare provider, who may refer you to an early pregnancy unit at a hospital for tests. In most cases, an ultrasound scan can determine if a miscarriage is occurring. If a miscarriage is confirmed, the pregnancy tissue will usually pass out naturally within one to two weeks. However, medication or minor surgery may be recommended to speed up the process if necessary.

Ultrasound scans

If there is vaginal bleeding or spotting, or if there have been problems in a previous pregnancy, a woman may be referred for an early scan. The best time to have a scan is from about seven weeks' gestation, when it is usually possible to see the baby's heartbeat. However, it can be challenging to detect a heartbeat in early pregnancy, and a clear determination of miscarriage may not always be possible. In such cases, a follow-up scan after one to two weeks may be recommended to look for changes in the size of the pregnancy sac and the development of the baby and its heartbeat.

Vaginal bleeding

The bleeding can vary from light spotting or brownish discharge to heavy bleeding with bright red blood or clots. The bleeding may come and go over several days and can continue for several weeks after a miscarriage, but it tends to become lighter as the uterus empties. If you experience heavy vaginal bleeding or are feeling very sick, you should go to the hospital's emergency department.

If you are experiencing vaginal bleeding, it is important to contact your healthcare provider as soon as possible. They may recommend a check-up to ensure the miscarriage is complete and to prevent infection. An incomplete miscarriage occurs when some pregnancy tissue has passed, but some remain in the uterus, which can lead to infection. Your doctor may recommend medicine or surgery to complete the miscarriage.

In some cases, you may be offered medicine called misoprostol, which encourages the cervix to open and the uterus to contract, facilitating the passing of pregnancy tissue. This process can cause heavy bleeding, pain, and nausea. Your doctor may advise you to stay in the hospital until the tissue has passed. Alternatively, you may be able to return home and take medication to manage the symptoms.

If you experience heavy bleeding, significant pain, or signs of infection, your doctor may recommend a minor surgical procedure called 'dilatation and curettage' (D&C). This procedure is often recommended if expectant or medical management has failed or if you prefer not to see the pregnancy tissue.

Cramping and pain

The pain caused by a miscarriage can vary from woman to woman. Some women have reported experiencing mild cramps, while others have described the pain as the most intense they have ever felt. The duration of cramping can also vary, with some women experiencing cramps for a few days, while others have reported cramping lasting several weeks.

It is important to note that cramping and pain can also be present during early pregnancy and may not always indicate a miscarriage. Hormones, constipation, and trapped wind can also cause discomfort. However, if you are experiencing severe pain or any other concerning symptoms, it is always best to seek medical advice.

If you are experiencing a miscarriage, there are some treatment options available. Expectant management involves waiting to see if the pregnancy tissue will pass naturally, which can take a few days to a few weeks. Medicine can also be taken to speed up this process, although it may not be suitable for pregnancies older than nine weeks or in cases of heavy bleeding or infection. In some cases, surgery may be necessary to remove any remaining pregnancy-related tissue from the uterus.

To manage the pain associated with a miscarriage, over-the-counter pain relievers and heating pads can be used. It is also important to stay hydrated and get enough rest. If the pain is severe or persistent, it is recommended to consult a healthcare provider for further advice and treatment options.

Treatment options

If a miscarriage has been confirmed, you will be advised on treatment options by your doctor or midwife. If there is no pregnancy tissue left in the womb, no treatment is required. However, if there is remaining tissue, you may choose to:

• Wait for the tissue to pass naturally (expectant management): This approach can feel more natural and may help with the grieving process. It usually takes 1-2 weeks, but in some cases, it can take up to 4 weeks. During this time, you may experience bleeding and cramping.
• Take medication to help pass the tissue (medical management): If you do not wish to wait or if the tissue does not pass naturally within 2 weeks, medication can be prescribed to assist. This typically involves taking tablets called pessaries, which are inserted into the vagina and cause the cervix to open, allowing the tissue to pass. You may experience symptoms similar to a heavy period, such as cramping and bleeding.
• Undergo surgery to remove the tissue (surgical management): If waiting is not safe or you prefer to remove the tissue as soon as possible, surgery may be recommended. This is usually performed if the pregnancy is beyond 10 weeks of gestation. During surgery, your cervix is dilated, and any remaining tissue is gently scraped or suctioned out of the uterus. This procedure is done under anesthesia, and you will be hospitalized.

It is important to note that these options should be discussed with your healthcare provider to determine the best and safest approach for your individual situation. Additionally, if you experience heavy bleeding, strong pain, abnormal discharge, or a fever, seek medical attention immediately.

Emotional support

Experiencing a miscarriage can be emotionally and physically draining. You may feel a range of emotions, including guilt, shock, and anger. It is important to remember that most miscarriages are beyond your control and are not caused by anything you have done. It is common to have a strong emotional response to having a miscarriage, and it is normal to want to look at the remains of the pregnancy tissue. However, you may decide that you do not want to see it. There is no right or wrong way to handle this.

• Seek professional support: Hospital counselling services are available to provide you with the necessary support during this difficult time. These services can offer guidance and help you navigate your emotions.
• Connect with support groups: Charity groups and support communities can provide a sense of connection and understanding. Sharing your experience with others who have gone through similar situations can be comforting and validating.
• Consider a memorial: Creating a memorial for the baby you lost can be a meaningful way to honour your experience and facilitate healing. It can provide a sense of closure and help you process your emotions.
• Take time for self-care: Prioritise self-care and engage in activities that nurture your emotional well-being. This may include spending time in nature, practising relaxation techniques, or connecting with loved ones. Allow yourself to feel and process your emotions without judgment.
• Seek medical advice: Consult your doctor or midwife for ongoing support and to ensure your physical health is monitored. They can provide guidance on your road to recovery and offer advice on trying for another baby when you feel emotionally and physically ready.
• Practice self-compassion: Be kind and compassionate towards yourself. Recognise that this is a challenging experience, and treat yourself with understanding and empathy. Remind yourself that healing takes time, and be patient with your journey.

Remember, everyone's experience is unique, and there is no one-size-fits-all approach to emotional support. Find what works best for you and seek the help you need to navigate this difficult time.

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