Miscarrage Management

Once you have been diagnosed with a miscarriage you need to make a decision you’re your gyno regarding the medical therapy.   It’s important to determine if you are anemic, if you are Rh negative need a Rhogam shot, if you have any special considerations that would affect your next pregnancy, but then ultimately; you and your gyno will then have to determine how to manage the treatment of the evolving situation that is a miscarriageMiscarriage management has changed over time. Ten or fifteen years ago all women had a surgical dilatation and curettage ( D and C) as well as being told to wait three months to get pregnant. Both of those older recommendations have evolved. Many women will select surgery as they do not want to wait for the process to complete. Most recent studies show that conceiving earlier than 3-6 months after a miscarriage does not affect future pregnancies in the since of causing any fetal anomalies, malformations, preterm labor or premature rupture of membranes, etc. However, these older studies showed that there can be a slightly higher rate of recurrent miscarriages if conception occurs before 3 months mostly talked about birth spacing not separating out early miscarriages from what is called birth spacing of full term pregnancy. Most OB's will recommend this 3 months for hormone regulation, to be sure ovulation has returned, to allow you to improve nutrition, and to also allow for emotional grievance if needed before attempting to conceive again.

For women with persistent positive pregnancy tests, retained tissue seen on ultrasound, or persistent bleeding, the D and C may in fact be recommended. This is a relatively simple procedure, with a very low complication rate. Most are done in an outpatient or ambulatory surgical setting; some offices are set up to do the procedure under local anesthesia or simple iv sedation in their office.  D and C will not prolong the time you have to wait to conceive, you cannot begin to try for pregnancy until the preceding pregnancy (the miscarriage itself) has resolved.

Bleeding after the miscarriage is most often related to passage of the last products of the pregnancy. It  is  not abnormal to have irregular bleeding and bleeding patterns for even up to 1 month after your miscarriage. Certainly waiting on the procedure and continuing to monitor bleeding habits is a viable option for those without medical risk factors. However recommending and/or having a D and C is not an uncommon step after a miscarriage especially if say the bleeding does not seem to be tapering, or dependent on how quickly you are wanting to again try for pregnancy, or if products of conception are still present.  D and C can of course help facilitate this.

Without you being a patient of ours and having full disclosure to your medical history, blood work, or ultrasounds, we unfortunately cannot guide you in your decisions one way or the other. We would certainly encourage you to further discuss with your OB/GYN before you proceed with any procedures to ensure that you are adequately informed as well as comfortable with your care. We welcome patients to come to http://www.womenshealthpractice.com to have an appointment and further discuss.


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