What is miscarriage?

Miscarriage is the loss of a pregnancy before 20 weeks. Miscarriage is very common and affects up to 1 in 4 pregnancies before 10 weeks.

When should I see a doctor?

You may see a doctor at any stage of miscarriage. Sometimes the miscarriage has already happened and at other times it’s only just begun.

Your doctor will ask you about your symptoms and will examine you. They may also organise for you to have an ultrasound and blood tests.

This will tell your doctor if your miscarriage is:

• a complete miscarriage — where all pregnancy tissue has passed
• an incomplete miscarriage — where some pregnancy tissue has passed but some is still in your uterus
• a missed miscarriage — where the pregnancy has ended but the tissue has not left your body

What is medical management of miscarriage?

The medical management of miscarriage is when you take medicine to help the pregnancy tissue leave your body.

The medicines used for this are called misoprostol and mifepristone. When combined, these 2 medicines may be called MS-2 Step..

When is a medically managed miscarriage needed?

A medically managed miscarriage may be needed after:

• an incomplete miscarriage
• a missed miscarriage

Medical management of miscarriage is usually not recommended if you:

• have already lost a lot of blood
• have an infection
• have high blood pressure
• are allergic to the medicines used

What does the treatment involve?

Medical management of miscarriage involves taking medicines called misoprostol and mifepristone.

Misoprostol helps your cervix open and your uterus contract. This lets the pregnancy tissue come away from your uterus.

Misoprostol can be taken:

• buccally (put in your mouth between your cheek and your gums)
• sublingually (under your tongue)
• as a vaginal pessary

Mifepristone is taken orally (by mouth).

Your doctor may recommend misoprostol alone or a combination of misoprostol and mifepristone. You may need more doses of misoprostol after the first dose.

Usually, you are given the medicine to take at home. Sometimes, you will take the medicine in hospital. Occasionally, the hospital may want you to stay overnight.

How can I access this treatment?

If you’re having symptoms of miscarriage, you should see your doctor, midwife or obstetrician urgently.

If you are having a miscarriage, your healthcare team will discuss the most appropriate treatment for you.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

What should I expect after the medical management of miscarriage?

After taking the medicine, you should rest for 3 hours.

Pain and vaginal bleeding

You may have some spotting or cramping soon after taking the medicines.

For most women, the pregnancy tissue will start to pass about 4 to 6 hours after taking the medicine. You can expect heavier bleeding and clots with strong cramping, period-like pains.

You may need to take pain-relief medicines to help with cramps or pain. In most cases, paracetamol and ibuprofen will be enough. You may also want to use a heat pack for pain relief.

The pain should start to ease after 24 to 48 hours. Your bleeding will also lessen. The pain and bleeding should stop after 2 weeks.

Side effects

Common side effects of the medicines used in a medically managed miscarriage are:

• fever
• vomiting
• nausea
• diarrhoea

These side effects normally get better after a few hours. You can also take medicines to help stop or treat these side effects.

What will I need at home?

It’s a good idea to have the following at home:

• sanitary pads
• over-the-counter pain-relief medicines, such as paracetamol or ibuprofen
• time to rest
• a support person

How long will it take?

If you have had an incomplete miscarriage, the medicine usually helps the pregnancy tissue leave your body within a few hours. It should take no longer than 1 or 2 days.

If you have had a missed miscarriage (a pregnancy that ends without you having any symptoms of miscarriage), you may pass the pregnancy tissue quickly. But it can take up to 2 weeks and sometimes longer.

When should I see my doctor after medical management of miscarriage?

You will need to have a follow-up appointment and a blood test a week after taking the medicine.

Sometimes, pregnancy tissue may stay in your uterus after the medical management. You may need to have surgery if this happens, because there is a risk of infection.

See your doctor or go to the nearest emergency department if, after medical management, you:

• have pain that’s worse than period pain
• are soaking 1 to 2 sanitary pads per hour
• are passing large blood clots (golf-ball size)
• have unusual or smelly vaginal discharge
• have a fever (a temperature of 38°C or higher) or chills
• feel dizzy, lightheaded or faint
• have heavy bleeding for more than 2 weeks

How long will it take to physically recover?

It can take up to 2 weeks for your bleeding to stop altogether. Until your bleeding stops, you should:

• use sanitary pads instead of tampons
• not have sex
• not swim
• not take a bath

You should have another follow-up appointment with your doctor 4 to 6 weeks after your miscarriage.

You can also expect the return of your period about 4 to 6 weeks after a miscarriage. Your first period may be heavier than usual.

If you have a Rhesus negative blood type, you may be offered an anti-D injection. This helps to stop problems in future pregnancies.

The emotional effects of miscarriage

Having a miscarriage can lead to many different emotions. It’s important you know that there is no right or wrong way to feel at this time.

Services are available to help support you through miscarriage.

Are there alternatives to the medical management of a miscarriage?

Depending on your circumstances, you may be able to:

• wait for the miscarriage to occur naturally
• choose a surgically managed miscarriage

Your preferences are important when deciding how to manage your miscarriage. This is called shared decision making. Talk with your healthcare team about treatment options for miscarriage.

Resources and support

You can talk to your doctor or midwife about where to get support after a miscarriage.

Grief Australia provides support and counselling for people grieving any type of loss.

Miscarriage Australia has resources on what you can expect physically and emotionally after a miscarriage.

Pink Elephants Support Network provides information and support for people who have had a miscarriage.

Red Nose Grief and Loss provides support for miscarriage, stillbirth and newborn death. Call their support line on 1300 308 307.

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