MISCARRIAGE AND OPTIONS FOR MANAGEMENT

Transcription

1 MISCARRIAGE AND OPTIONS FOR MANAGEMENT Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 Why did it happen? Was it my fault? When you conceive and a baby is created, it takes half its genes from the sperm and half from the egg. At the exact time of conception the crossover of these genes takes place; it is thought that two thirds of early miscarriages are due to abnormal chromosomes. Sometimes, no reason will be found; it may be that some information is lost and the pregnancy fails and stops developing. When the needed information is not there, it is then that the pregnancy stops developing and you may begin to miscarry. Another cause can be that the pregnancy did not implant into the lining of the womb correctly. These are the most common reasons that women miscarry, not because of something you did or did not do. Miscarriage does not mean that you will not be able to get pregnant again and it does not mean it will happen again. Miscarriage is very common, it is possible that as many as 50% of pregnancies miscarry before implantation in the womb occurs. The risk of miscarriage decreases dramatically after the 8 th week. Many women will have more than one miscarriage. Considering the frequency of miscarriage, about 1 in 36 women will have 2 miscarriages due to nothing more than chance. There are other things that may contribute to early miscarriage. Multiple pregnancies Maternal age; there is a rise in miscarriage as maternal age increases. For women less than 35, the rate of miscarriage is 6.4%, for it is 14.7% and over 40 it is 23.1% Poorly controlled diabetes Smoking increases the rate of miscarriage by 30-50% Occupational exposure to solvents There are certain things that you can do to improve your chances; taking regular exercise, eating a healthy diet, stopping smoking, reducing alcohol intake and taking folic acid. Symptoms of miscarriage The most common symptom is bleeding. This can vary from light spotting or brownish discharge to heavy bleeding that is bright red with clots. Light bleeding or discharge is common in early pregnancy so having these symptoms does not always mean that you have miscarried. Other symptoms may include cramping and lower abdominal pain. Seek medical help if you have heavy vaginal bleeding (soaking more than one pad per hour) Persistent abdominal pain Pain in your shoulder tip Feeling unwell; faint or dizzy Diagnosing a miscarriage Ultrasound scan can be used but we may also use blood tests to check pregnancy hormone level (HCG)

3 Page 3 of 8 Care Options Every miscarriage is a private loss and each one is different. Unfortunately, miscarriage is quite common with one in five pregnancies ending with this sad loss. This does not deter from personal pain and loss that each individual couple and their families may feel. You may experience some strong emotions. Occasionally, the miscarriage will not be complete. You will be given a choice of care. The three care options available are: 1. Expectant management / Non Invasive (Conservative) Care This gives you the option to return to your own home and family. Expectant management means that we expect the miscarriage to happen naturally, without intervention What are the risks? Risk of infection Approximately 1 in 100 women may develop an infection. It is important that you look out for signs of infection. These are a raised temperature, flu like symptoms, a vaginal discharge that smells offensive and abdominal pain. Risk of haemorrhage / heavy bleeding Approximately 2 in 100 women may experience bleeding that is severe enough to require a blood transfusion and urgent admission and an emergency operation; surgical management. In rare cases, pregnancy tissue maybe become stuck in the cervix and need removing during a vaginal examination. What are the advantages? You do not need to stay in hospital Avoids medication and surgery and the associated risks and side effects It is seen as a more natural process, some women feel that it helps them to say goodbye. What are the disadvantages? It may take several weeks for the miscarriage to complete. You may find waiting difficult. You may be anxious about what to expect and worried about pain and bleeding. What can I expect? Pain Having a miscarriage can be painful, with cramping type pain and lower backache. It is important to be prepared and ensure that you have some painkillers. The following painkillers are useful: Paracetamol Ibuprofen Codeine

4 Page 4 of 8 Please ensure that you read the label / instructions carefully and do not exceed the maximum daily dosage. However, we do not want you to stay at home if the pain cannot be controlled with painkillers. Bleeding Be prepared, bleeding can be heavier than a normal period, you may pass clots, tissue or even a recognizable fetus. This can be frightening; please do not hesitate to contact us if you are unsure. You should not feel unwell, dizzy or faint; if you do you will require admission to hospital. We advise the use of sanitary towels not tampons as this reduces the risk of infection. It is not unusual to bleed for days after a miscarriage, but this should become lighter and more period like. Please avoid intercourse while you are still bleeding; again to reduce the risk of infection. Signs of infection. Increased bleeding or pain, or developing an offensive smelling discharge, flu like symptoms. Please contact us or your own GP if you develop any of these. Work Going back to work is an individual decision. Having a miscarriage can be very distressing, it will also depend on how heavy the bleeding is. We would recommend that you do take some time off to rest. What if the miscarriage does not happen? If you change your mind or the miscarriage does not happen then you can consider managing the miscarriage medically or surgically. What follow up will I need? You will be offered a follow up appointment for review and a pregnancy test in 2-3 weeks to ensure that the miscarriage is complete. If the pregnancy test is negative and the bleeding has stopped you will not need to be rescanned. We will also offer support and on-going advice. When can I expect my next period? Most women have their next period within four to six weeks following a miscarriage; however it can take up to 3 months for periods to return. The first period after a miscarriage can be heavier than normal. We will inform your GP/midwife/health visitor about your miscarriage.

5 Page 5 of 8 2. Medical Care. Medical management of miscarriage Am I suitable for this option? Most women are, but a midwife / nurse will discuss this option with you. You will be asked questions about your general health in order to obtain a full picture of your wellbeing. Blood samples will be taken. If you are suitable for medical management you will be given a date and time to return to the Jasmine Ward. You may experience pain and bleeding at home and occasionally the miscarriage happens at home. If you need to take pain killers, take co-codamol or ibuprofen What happens next? Upon your return to the hospital you will be admitted to the gynaecology ward. Your stay will be for approximately 1 hour. You will be given a pessary, this time vaginally. You are likely to experience some further pain and bleeding as the womb contracts, you may also feel sickly. The ward staff will take care of you and ensure pain relief is provided. Anti-sickness tablets are also available if required. Normally you will be able to go home later the same day. If the miscarriage does not happen whilst you are in hospital you may still go home. The miscarriage may occur whilst you are at home and it will be like a very heavy period (see expectant management). You may require a follow-up appointment in 2-3 weeks; you will be reviewed and offered a pregnancy test. If this is negative and the bleeding has stopped, you will not need to be rescanned. If your miscarriage is not complete you will be offered further conservative or surgical treatment. 3. Surgical Care. Surgical management of miscarriage Advantages You will be asleep during the procedure. Usually no follow is required. Disadvantages Requires hospital admission Risk of general anaesthetic Risk of perforation to uterus, bladder, bowel Risk of infection Risk of retained products of conception Can affect subsequent fertility You will be admitted to a ward, this will be organised by the Jasmine Assessment Unit staff and Bed Manager. You will be advised not to eat or drink for up to six hours before admission.

6 Page 6 of 8 On the ward the doctor and anaesthetist will explain the operation to you. You will then be taken to the operating theatre and given a general anaesthetic. Following the operation, you will return to the ward to recover. You will be allowed home later in the day. For hours after the anaesthetic you must not drive, drink, make important decisions, use hazardous machinery, and engage in sport or strenuous exercise. It is advisable to have a family member or friend to look after you. When can I start trying again for another baby? We recommend that you wait for one period before you start trying again. It is perfectly safe to try for another pregnancy once you and your partner feel ready and well Please speak to your GP / midwife about preconception care. Remember to take folic acid as discussed with your midwife / nurse. If you require support or counselling please contact us. How will I feel when I go home? Reaction to miscarriage is very variable and there is no right or wrong way to feel, a range of reactions are normal. In addition to the grief you may feel, your body will be undergoing some profound hormonal adjustments that may make you feel very emotional. Grief is a very normal reaction to the loss you have experienced and it may be as intense as that after any other loss. Many couples describe the feeling of numbness and emptiness, feeling alone and isolated. Helping to prevent a miscarriage Do not smoke Do not drink alcohol Do not use illegal drugs Eat a healthy diet Drink plenty of fluids such as water Take folic acid If you are reading this on behalf of somebody Do let your concern and caring show Do be available to listen Do say you are sorry Do allow them to express their feelings and talk about their loss Don t avoid them Don t say you know how they feel Don t point out that they already have a child or can always have another Don t avoid mentioning their loss Listen

7 Page 7 of 8 Contact us Please contact the Jasmine Assessment Unit if you have any queries or questions. Telephone number: Fax number: Jasmine Ward: Your G.P. can also provide advice and support. Do not be afraid to contact them. Further contact numbers for information: Miscarriage Association Tel: British Pregnancy Advisory Service Tel: Weekdays 8.00am to 8.30pm Saturdays 8.00am to 4.30pm Sundays 8.00am to 3.00pm (answer machine outside these hours) NHS Choices website

8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT179 Publication date June 2013 Review date June 2016 Department Jasmine Assessment Unit / Jasmine Ward Location Women s Unit