Choosing the Appropriate Management Option

When a woman has been diagnosed with a miscarriage, there are three main methods by which the miscarriage may be managed.

The first is what we call “Expectant management”. In this method, the woman is left to bleed and miscarry naturally. This is usually recommended when a scan shows that a significant amount of tissue and blood has passed out of her womb already. The second is the “Surgical management”. Here, the woman is taken to a theatre and her womb is cleaned out and the contents sucked out with a suction device. In the third method, called the “Medical management”, the woman is given a drug (misoprostol) and this is usually given vaginally to enable the woman to miscarry completely without having to go to theatre.

I will start by saying the good points about each method. Expectant management enables you to be at home, in familiar surroundings and with people you know who love you. The advantage of the surgical intervention is that is gives a sense of finality: when you go home, you know it’s over and you are not dealing with a prolongation of the loss. Medical treatment has been shown in studies to be preferred to surgical in cases where the woman needs the miscarriage to be over quickly.

Unfortunately, no method is perfect. With Expectant management, the bleeding is very heavy with a lot of clots and cramping, much worse than a normal period. Surgical methods may cause a lot of fear in women already disposed to fear of anaesthesia and medical interventions. Also, women report feeling like they were killing their baby or the baby was being ripped out of them; this can be emotionally disturbing. Medical management is fraught with uncertainties and the women have to be monitored for up to 48hours and still may have surgical intervention. An extensive study carried out found that, based on specific criteria, Expectant and Surgical management both had similar success rates of approximately 97% with Medical management having a success rate of about 51%.

At the end of the day, whatever treatment method is chosen, it is important that the woman understands the implications of each choice and is comfortable with the decision that has been taken.