Outpatient Medical Management Of Miscarriage

Transcription

1 Outpatient Medical Management Of Miscarriage Information for women Early Pregnancy Assessment Unit (08:15-11:00 Monday Friday) Ward 2 (24 hours) Ref: Review: 07/2015 Page 1

2 Introduction We are sorry that you have had a miscarriage. A miscarriage can have a significant emotional effect and you and your partner may need counselling or support. Treatment depends on whether there is any foetal tissue left in your womb. If there is no foetal tissue left in your womb (a complete miscarriage), no further medical treatment is required. You have had an incomplete miscarriage which means that baby remains (tissue) are still in your uterus (womb). Medical management of miscarriage means taking tablets and vaginal pessaries to expel any baby remains from your uterus. Your ultrasound scan shows that you have had a miscarriage at less than nine weeks, or have tissue remaining from the pregnancy inside your uterus. The Treatment This treatment involves taking tablets and vaginal pessaries to open the cervix, allowing the tissue to pass out. This is a safe treatment whilst being in your own environment at home. It is important that your womb is completely empty otherwise complications such as infection can occur. You will usually be required to come to hospital at least three times to ensure the medication has worked and to check your uterus is completely empty. First visit This will normally be to our Early Pregnancy Assessment Unit (EPAU). You will be seen by a midwife and doctor following your ultrasound scan. They will explain the procedure to you and give you written information. A blood test will be performed to check your full blood count and blood group. If you are a rhesus negative blood group it is recommended that you have an anti d injection. Page 2

3 You may be able to start the treatment on this day or be given a date to come back. You will be asked to sign a consent form in order for the treatment to begin. The procedure You will be given two types of tablets at two separate visits 48 hours apart (oral tablets and vaginal pessaries). The first tablet is called Mifepristone which blocks the pregnancy hormones. It also primes your uterus for the next part of the treatment. The tablet is taken with water and will then be asked to wait for 30 minutes after which you can go home. Some women may have nausea and vomiting, if so you may need a second tablet if you vomit within two hours of taking it. You may experience period type cramps a few hours after this tablet. You can take simple pain killers such as paracetamol or cocodamol. A few women may pass all the pregnancy tissue after this tablet but this is very rare. If you think this is the case, please contact Ward 2 on at any time and we will advise you accordingly. The second visit The second visit will be two days after you have taken the tablets. You will be seen on Ward 2 at Macclesfield Hospital. A nurse will administer four misoprostol pessaries into your vagina. The pessaries will make your uterus expel the pregnancy tissue, usually within four to six hours. Occasionally some women may have nausea, vomiting and diarrhoea. Some women may also experience dizziness and headaches which usually settle. You will be observed for one hour and then you can go home with pain killers if you wish. We will also recommend Anti D if your blood group is rhesus negative. You MUST be accompanied by an adult and MUST remain at home with an adult during that day. You must also have transport available in case you need to come back to the hospital that day, as well as access to a telephone. Page 3

4 At home Bleeding and cramps usually start within three to four hours of having the misoprostol pessaries. However, in a few women it may start earlier or later. You may wish to take the pain killers you have been given to take home. The amount you will bleed is usually heavier than a normal period, and may contain large clots. If you find yourself soaking sanitary pads continuously for more than one hour please contact ward 2 on If you would prefer to bring any fetal tissue to ward 2 or EPAU to dispose of sensitively, please speak to one of the nurses on the ward. Usually the procedure is complete if your bleeding becomes lighter and crampy pains settle. If you are concerned about the amount of bleeding or pain, please contact ward 2 on After the procedure You will need to stay off work on the day you are having the misoprostol pessaries but should be able to go back to your usual routine the next day if you feel able to. You may continue to have light bleeding, spotting or pass small bits of tissue for two to three weeks after the misoprostol treatment. This is not of any concern and will settle. A few women have period type cramps for a few days after misoprostol as well. Simple painkillers such as paracetamol usually help. Do not use tampons, use sanitary pads instead until the bleeding stops to help prevent infection. If your vaginal loss becomes smelly or offensive, this may be a sign of infection. You will need to contact ward 2 or your GP immediately. You must also avoid sexual intercourse until the bleeding stops. We usually recommend you wait for a normal period before starting to try for a pregnancy again. Page 4

5 Your period should return after four to six weeks. If you do not have a period in six weeks it is advised that you perform a pregnancy test if you have had sexual intercourse since your miscarriage. If you experience Heavy vaginal bleeding with large clots Severe abdominal pain Fever or raised temperature Offensive vaginal loss, or any other symptoms you are concerned about You must contact Ward 2 ( ) or your GP The third visit This is a very important visit as this is where we check that you have passed all pregnancy tissue and your uterus is empty. This appointment will be seven to ten days later and will be in the Early Pregnancy Assessment Unit. An ultrasound scan is usually performed to confirm this. If there are concerns that there is still tissue left, we will discuss any further treatment with you. This may mean more tablets or a surgical procedure (5% of women may still have pregnancy tissue in their uterus despite this treatment). Further Information Having a miscarriage can be a very emotional experience for you and your partner. The Miscarriage Association can offer advice and support. See their website at References Title: Medical management of incomplete miscarriage Author(s) Saude EJ, Lang ES, Ekwalanga P Citation: Annals of Emergency Medicine, 01 April 2012, vol./is. 59/4; ( ) Source: CINAHL Title: Miscarriage and ectopic pregnancy, part 2: management Author(s) Murphy, F, Jones, E, Horsley, S Citation: Nursing Times, Jun 2008, vol. 104, no. 23, p Source: BNI Page 5

6 Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: Phone: Textphone: Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation contact Communications and Engagement on Admission information The trust accepts no responsibility for the loss of, or damage to, personal property of any kind, in whatever way the loss or damage may occur, unless deposited for safe custody. Please leave valuables at home. If you need to bring personal items that are expensive, for example micro hearing aids, please be aware that you do so at your own risk East Cheshire NHS Trust is committed to ensuring ethat patients and staff will always be treated with dignity and respect. There will be no age, disability, gender, race, sexual orientation or religious discrimination NHS Direct (part of NHS Choices) is a 24 hr phone advice service providing confidential health advice and information. Phone: (Textphone ) Page 6