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A complete miscarriage will be characterized by
subsiding vaginal bleeding, resolving abdominal pain and internal (vaginal) examination
will reveal a closed cervix. If still unsure, an ultrasound scan can be performed
to confirm that the womb is empty. No further action is required. Of-
Incomplete miscarriage management
If there are still products of conception in the womb cavity, the diagnosis is that of incomplete miscarriage.
Presentation of incomplete miscarriage varies:
There could be continuing vaginal bleeding and lower abdominal pain. This is not always the case as bleeding could be minimal even when miscarriage is incomplete. Plus, there may not be any significant pain.
Management will largely depend on presentation and the patient’s wishes. If there are minimal symptoms, she has a choice of all three forms of treatment:
Watchful waiting: This is a hands-off approach which allows for spontaneous conclusion
of the miscarriage
Surgical evacuation: A minor procedure, usually under general anesthetic in theater to empty the uterine contents.
Medical management: Prostaglandin tablets administered to accelerate the conclusion of the miscarriage.
If there are significant symptoms, the only practical option is surgical evacuation. It is a minor procedure which would take only a few minutes allowing the patient to leave hospital only a few hours later.
Attempting to conceive again after a miscarriage
Following a miscarriage, especially if it was a planned pregnancy, one of the questions that soon come to the fore is, when should one start trying for a baby again.
Ovulation will usually resume within three to six weeks following a miscarriage. That means; the body is then ready for another pregnancy. It follow therefore that, once the woman has psychologically come to terms with the pregnancy loss, she can start trying again. The miscarriage or its management will have no influence whatsoever on the prospect of the subsequent pregnancy, however soon that is conceived. The unique condition of recurrent miscarriage is discussed in the following section.
Other causes of spontaneous (isolated) miscarriage
- Women with polycystic ovarian syndrome (PCOS) are a known to have a somewhat higher risk of early pregnancy loss (miscarriage).
- The older woman (over 35 years) is at a significantly higher risk of miscarriage,
presumably because the risk of a chromosomally abnormal fetus increases with the
age of the mo
ther. - There is some evidence that fibroids, especially if they have grown inside the uterine cavity, may make conception difficult and if this has successfully occurred there may be a risk of miscarriage. It is important to stress that most women with fibroids will encounter no such problems. Fibroids which grow outside the uterine cavity (and which are commoner) do not seem to pose this risk.