Expectant Management Following Miscarriage

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Expectant Management Following Miscarriage

Department of Gynaecology
The loss of a pregnancy can be very sad and upsetting for both you and your family. Miscarriages though are common in early pregnancy and no one should ever feel alone whilst going through this difficult time. This leaflet has been written to try to help and support you, ensuring you have the correct information so that you may make informed decisions about your health and care.

Some miscarriages are known as silent, delayed or missed miscarriages; this is when the pregnancy is still intact but is no longer growing. Another type of miscarriage is known as an incomplete miscarriage; this is when some of the pregnancy tissue is left behind.

You will have been given several options and have chosen to have expectant management of your miscarriage. No one option or treatment is better than any other, but the option that you choose will depend on your circumstances and personal preferences.

What does Expectant Management mean?
When you choose to have expectant management you will be left for approximately two weeks to give you a chance to miscarry naturally. In this time we hope that you start to bleed and fully miscarry giving your body time to carry out the task. After two weeks we will rescan and reassess you and we will discuss further treatment with you if required.

What to Expect
When you start to miscarry you will bleed and get crampy lower abdominal pains; this can last up to 10 days. Some women experience severe cramping pains with heavy bleeding and pass clots for 4-5 hours. Take pain killers if you need them, such as codeine, paracetamol and ibuprofen. Please use sanitary towels rather than tampons for the bleeding.

Try to rest at home preferably with a companion. If at any point you feel that you cannot cope (for example if you are faint, dizzy, or have unbearable pain or bleeding) please feel free to contact either the Early Pregnancy Assessment Unit (EPAU) Monday to Friday or the Gynaecology ward. Should the situation become an emergency please go directly to the Accident and Emergency department or dial 999. During this time you should be aware of signs of infection such as temperature, malaise, sickness and offensive smelling discharge. Should you have any of these symptoms please seek further advice from your GP as antibiotics may be required.

Unfortunately we cannot predict when your miscarriage will happen. For some women
the expected bleeding and pain may not happen for 2-3 weeks.

If when you attend for your follow up appointment and you have not miscarried completely or at all you have the option of requesting the surgical or medical treatment.

When the miscarriage is complete you will expect your next period to be between 4-6 weeks. It will be heavier than normal and then you should return to your normal cycle.

Trying again
Just because you have had a miscarriage does not mean that you will have another. Many women who have had miscarriages go on to have successful pregnancies. We advise though that you wait until you have had a period to try to conceive again. You will be fertile between the time that you have miscarried and the time that you have your period so precautions should be taken.

How will I feel emotionally?
It is to be expected that you will feel low after this treatment and that you will feel sad and upset over the whole episode. It is helpful to discuss this with your partner and friends. The nurses will be able to give you information for support groups and information leaflets prior to leaving the hospital.

A nurse will explain to you about the Bereavement Services and options for remembrance available in the hospital. The Hospital Chaplains offer you sympathy in your loss and keep a remembrance book where you may make an entry for the baby you have lost.

A multi-faith prayer room can be found in the main reception area at Worcestershire Royal Hospital and the Alexandra Hospital. The prayer room at Kidderminster Hospital is located in ‘C’ Block. If you would like to see the Hospital Chaplain please ask the ward staff to organise this for you.
If you feel you would like to talk, need support or counselling the Miscarriage Association, National Careline and Cedar Tree offer confidential help, information, counselling and support. Contact details can be found in Other Information on page 4 of this leaflet.

Personal hygiene
You can bathe or shower as normal. You should use sanitary towels but not tampons whilst you are bleeding.

Diet
You do not need to follow a special diet.

Exercise
You should do light exercise, such as walking and light housework, as soon as you feel well enough.

Sex
You can continue your usual sexual activity as soon as you feel comfortable. We advise that you do not try to get pregnant until your periods have returned to normal.

You can fall pregnant again very soon after having this procedure so it is important that you discuss contraception prior to leaving hospital or visit your GP soon after. They can discuss what options are available and how they can be administered.

Work
How long you will need to be away from work varies depending on:

  • How quickly you recover;
  • Whether or not your work is physical; and
  • Whether you need any extra treatment.

Most women prefer to take the following day off work, and sometimes a few days, both for their emotional and physical recovery. Please ask us if you need a medical sick note.

Contact details
If you have any specific concerns that you feel have not been answered and need explaining, please contact the following:

Worcestershire Royal Hospital

  • Early Pregnancy Assessment Unit (phone 01905 733060)
  • Gynaecology Nursing Staff, Lavender Ward 14 (phone 01905 760586)
  • Hospital Switchboard (phone 01905 763333)

Alexandra Hospital

  • Early Pregnancy Assessment Unit (phone 01527 512100)
  • Gynaecology Nursing Staff, Ward 14 (phone 01527 512100)
  • Hospital Switchboard (phone 01527 503030)

Kidderminster Treatment Centre

  • Early Pregnancy Assessment Unit (01562 823424, Bleep 3461)
  • Hospital Switchboard (phone 01562 823424)

Other information
The following internet websites contain information that you may find useful.

Support also offered through:

  • Miscarriage Association 01924 200799
  • Cedar Tree Phone: 01905 616 166
    E-mail: cedartree@connectfree.co.uk
  • National Careline: 0800 028 2228

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Thursday from 8.30am to 4.30pm and Friday: 8.30am to 4.00pm. Please be aware that a voicemail service is in use at busy times, but messages will be returned as quickly as possible.

If you are unable to understand this leaflet, please communicate with a member of staff.

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