A miscarriage or non-vital pregnancy
Unfortunately, it doesn't always go well. 20% of all pregnancies end in miscarriage. A miscarriage cannot be prevented. Maybe you have already had blood loss and abdominal cramps, but it is also possible that you have not noticed anything. Sometimes women even feel very pregnant, but it turns out, during the first ultrasound, that the pregnancy has not developed and there is no beating heart. We call this a non-vital pregnancy. Women often feel empty and sad, sometimes feelings such as loneliness and anger overwhelm you and you feel like you have to do it alone. We are also there when a pregnancy is not going well! Discuss your feelings and don't bottle it up.
Give yourself time to let this news sink in and don't do it alone
A miscarriage... What now?
There are several ways to treat a miscarriage. Below is an overview of the different treatment methods and the pros and cons. Also view the AMC selection table: Miscarriage decision aid : AMC miscarriage
Option 1: Expectative
You can safely wait until the miscarriage starts spontaneously. If the blood loss has already started, it can last for a few days to two weeks. It is getting a little less every day. After a miscarriage, you may have some blood loss for another 6 weeks. Most women have a normal menstrual period again within 6 weeks after the miscarriage
The benefits of waiting
- You don't have to go to a doctor/hospital
- You will not receive any medication or infusion.
- Often you have less pain than with medication.
- No damage to the uterus.
- No extra chance of adhesions.
- No extra risk of premature birth in a subsequent pregnancy.
The disadvantages of waiting
- Uncertainty about when to expect blood loss. It can be emotionally taxing that you don't know when it will start.
- A miscarriage is accompanied by cramps. It is often more painful than menstruation. You can take paracetamol or ibuprofen (not aspirin) for this
- Sometimes the blood loss is too extensive. This does not happen often (1 in 200), but can be scary. Sometimes you have to go to the hospital urgently. In these cases, a curettage is often necessary.
- There is also a small risk (3 in 100) of infection/inflammation in the uterus.
Information leaflets
Option 2: Medication
The gynaecologist can prescribe medication that can induce the miscarriage. You use the medication at home. You will be given 1 tablet of mifepristone to swallow. 24 to 48 Then you use 4 tablets of misoprostol (vaginal insertion is preferred).
Benefits of medication
- You have control over when you use the medication.
- Most women have blood loss and abdominal cramps
- within a day of inserting the vaginal tablets. It causes uterine contractions (contractions), which induce the miscarriage. Often effective. In 85%, these drugs induce a complete miscarriage (often within two days).
- No damage to the uterus or adhesions.
- No extra risk of premature birth in a subsequent pregnancy.
Disadvantages of medication
- 15% still need surgery (curettage).
- A miscarriage can be painful. The use of medication is generally experienced as more painful.
- Sometimes the medicines cause some side effects such as diarrhea, fever, nausea.
- Sometimes the blood loss is too extensive. (1 in 100) In that case, you will usually have surgery (curettage).
- Sometimes the miscarriage is not complete and an inflammation/infection occurs in the uterus (3 in 100).
Is there no pain and blood loss within 48 hours after inserting the vaginal tablets? Then contact the hospital. In most cases, the blood loss and pain after the miscarriage will quickly subside. The miscarriage lasts for several hours.
Option 3: Curettage
The surgical removal of a non-vital pregnancy is called a curettage. This is done in a hospital or clinic after referral from us or the general practitioner. Under light anesthesia, the gynecologist inserts a tube through the cervix into the uterus. This allows the tissue to be sucked away. This procedure does not take long (about 15 minutes). Usually the blood loss after curettage lasts about two weeks.
Benefits of curettage
- You know when the procedure is and therefore do not have to wait.
- The procedure takes a short time, so you will suffer from pain for less time than with waiting or medication.
Disadvantages of curettage
- It is an operation with anesthesia.
- You can have side effects such as drowsiness and nausea.
- Chance of a lot of blood loss. 2 out of 100 women need extra blood after surgery (blood transfusion).
- Risk of perforation (cavity) in the uterus. This is caused by the curette. (1 in 100). In this case, you will have to stay longer in the hospital for observation.
- You will be given antibiotics.
- More likely to have problems in a subsequent pregnancy. 2 out of 100 women have difficulty getting pregnant due to adhesions after the procedure. (Asherman syndrome).
- More chance of a premature birth in a subsequent pregnancy (8-9 out of 100).
