Diagnosis and treatment of miscarriage
If a miscarriage is suspected the first thing your doctor will probably do is arrange an ultrasound to determine whether or not the pregnancy is viable. Sometimes, particularly early on in the pregnancy, it is difficult to determine viability, in which case you may be asked to wait a few days and then have a repeat ultrasound to see if the baby has grown.
Your doctor may also order blood tests to check your hCG levels. If they are falling, miscarriage is inevitable, if they are slow to rise you may decide to wait a few more days and have a repeat blood test to be sure. Your doctor may also perform an internal examination to determine whether your cervix is open or closed. If the cervix is open miscarriage is inevitable.
Once miscarriage is confirmed you will usually be given two options. The first is to wait for the body to miscarry naturally, the second is to have the pregnancy removed by D and C.
If you decide to wait for the pregnancy to be lost naturally you can expect bleeding and cramping to start within a few days. Some women liken the bleeding to a particularly heavy period. If bleeding does not start spontaneously within a few days you may be advised to consider a D and C to prevent the risk of infection and preserve future fertility.
If you opt for a D and C (dilatation and curette) you will be admitted to hospital, usually as a day-stay patient. You will be given a general anesthetic, and whilst you are under anesthetic the doctors will dilate your cervix and gently remove any remaining pregnancy tissue. Some hospitals routinely test the removed tissue for abnormalities to help determine the cause of the miscarriage, others only do so if you have already suffered more than two previous miscarriages. It is your right to have your baby and/or placental tissue returned to you after surgery but you must request this before going into surgery. After a D and C you can expect to have some bleeding which will taper off by the end of the first week.
