The physical process of miscarrying varies greatly in the intensity of bleeding and pain. Often, there is a correlation between the number of weeks pregnant and the severity of these symptoms (the further along in pregnancy, the worse the symptoms are). With a very early miscarriage (4-5weeks gestation which is just after missing a period), often women experience a heavier than normal period with moderately increased cramping. This pain can usually be controlled with ibuprofen.
With a mid-first trimester miscarriage (6-9 weeks gestation by ultrasound dating), the bleeding and cramping can be much more intense. At its worst, some patients describe the pain as equivalent to labor contractions. In essence, the uterus is actively contracting to open the cervix and expel the non-viable pregnancy. This more intense pain can last for a few hours or more. While many patients can use ibuprofen and Tylenol to adequately manage their pain symptoms, some women find that they need stronger medication. If this happens, you should call your doctor or midwife office to request stronger prescription pain medication which can be sent to your local pharmacy. If it is overnight or weekend hours, please find your closest 24-hour pharmacy (take care to look at pharmacy hours not just store hours) and advise the doctor/midwife. Given the national narcotic abuse problems that face our country, these medications are not prescribed automatically at the diagnosis of a miscarriage. This miscarriage experience is similar whether it starts naturally or is initated with the use of misprostol (cytotec). About 15% of women who attempt to miscarry vaginally, ultimately are unsuccessful and need a d&c because of hemorrhage or incomplete emptying of the pregnancy tissue.
The alternative to passing the tissue vaginally is a D&C (dilation and curettage). In this procedure, you have IV sedation which allows you to sleep through the outpatient surgery. This can be done in the office, surgery center, or hospital. The surgery involves opening the cervix to 8-10mm, inserted a cannula “straw-like device” into the uterus, and removing the pregnancy tissue with vacuum. This procedure is very safe, and has only a small risk of bleeding, uterine infection, uterine perforation (temporary hole in the uterus which usually occurs when opening the cervix), and Asherman’s syndrome (scarring inside the uterus). After D&C, patients experience mild bleeding and cramping that can last up to a week. Usually, tylenol and ibuprofen are adequate to control this pain.
For miscarriages that occur at 10+ weeks gestation by ultrasound dating, it is NOT recommend passing the tissue vaginally due to the higher risk of hemorrhage and need for emergency d&c. In these cases, a scheduled d&c should be planned to ensure your safety.