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Testing & investigations for miscarriage

 

If pregnant women do not have any symptoms of miscarriage, they may only find out when they attend a standard perinatal appointment.

 

Here is how doctors assess a woman for miscarriage:

 

• Detailed medical history review

• Physical exam: in cases of vaginal bleeding, doctors will check for the source of the bleeding, see if the cervix is dilated, and check for evidence of pregnancy tissue

• Ultrasound: doctors will check for the presence of pregnancy in the uterus, as well as the status of the fetus heart rate

• Blood test: women can have their human chorionic gonadotropin (hCG) blood levels tested 

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All of these factors are included together to diagnose the status of the pregnancy or miscarriage.

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Treatment & management of miscarriage

 

Most miscarriages occur before 12 weeks of pregnancy, and don’t require any treatment.

 

Miscarriages that do not pass on their own, have heavy bleeding or infection, or occur later in pregnancy will likely require medical or surgical intervention. If pregnancy tissues remain inside a woman who has had a miscarriage, this can be cause very serious, life-threatening illness. 

 

A medication called misoprostol is prescribed for some women who do not have a complete miscarriage. This medication will cause the cervix to soften and open, and cause the uterus to contract; these contractions will push out any pregnancy tissue remaining in the uterus. Misoprostol typically causes cramping and bleeding within 6-8 hours. Common side effects of this misoprostol include nausea, vomiting, diarrhea and fever. However, this first dose of misoprostol may not completely remove pregnancy tissues from all women.

 

If pregnancy tissues remains in the uterus, a second dose of misoprostol or surgery may be needed to clear it.

 

The surgical procedure for manually removing pregnancy tissue from the uterus is called dilatation and curettage (D&C). Doctors will dilate the cervix and use a special instrument to gently scrape the lining of the uterus to remove all the remaining pregnancy tissue.

 

Doctors will also check a woman’s blood type and Rhesus (Rh) status, referring to a protein located on the red blood cells. If a woman is Rh-negative (meaning her blood cells don’t have the Rh protein on their blood cells), she will need a shot called ‘RhoGam or WinRho’. This shot is protective for future pregnancies by preventing the maternal immune response from reacting to the developing baby, if the baby is Rh-positive.

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Prevention of miscarriage

 

There are currently no treatments to prevent miscarriage. Scientists have identified some lifestyle factors that are associated with a lower risk of miscarriage, including taking vitamins, eating fresh fruits & vegetables, dairy, chocolate and white meat and maintaining low stress levels.

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Current evidence does not support bed rest to prevent miscarriage. Further work is needed to determine if progesterone therapy could be a useful for miscarriage prevention.

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Summary​

 

Miscarriage is the loss of a baby before a woman is 20 weeks pregnant. This is the most common pregnancy complication and is associated with vaginal bleeding and cramping. The majority of miscarriages are spontaneous or caused by a chromosomal abnormality. Miscarriage can have a significant impact on a woman’s physical and mental health. Talk your doctor if you are concerned about any of these symptoms or have concerns in early pregnancy.   

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Disclaimer

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Every woman and every pregnancy is unique. Pregnant women should speak to their healthcare provider to ensure maternal and fetal safety. This article is meant to provide readers with current information and opinions. All medical and treatment decisions should be discussed with your healthcare provider.

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This article was written by Dr. Kelsey McLaughlin and edited by Dr. Melanie Audette​.

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