A Referral is required for this type of Appointment! Please consult with your Physician or Midwife.
There are options about how to manage a miscarriage. All are safe, but none are easy on you.
Our nurse educator and physician team will help you decide what is best option is for you.
1) Wait and Watch, or Expectant Management
This option can be used for as long as you want. There is no clear research that indicates “how long is too long”. It
is likely fine physiologically to wait up to 8 weeks, though emotionally this can be hard. You may want to wait for a few weeks.
The best published statistics show that if you wait 2 weeks from your diagnosis, 3 out of 4 people will not need any extra treatment. The others will need medication or surgical management (D&C).
2) Medical Management
In 2018, some great research showed that Mifepristone and Misoprostol are the best medications to use. In
Canada the medication combination is called Mifegymiso© and was originally intended for abortions. Using this
properly will trigger a miscarriage if it is not starting naturally. Within 4 days, it works about 84% of the time, and
within 2 weeks works 93% of the time. The advantage is that you will usually know when the bleeding and
cramping will start. We can give you a prescription for this.
The research shows even after medication, that 8-10% of women will need an aspiration (sometimes called D&C), 1% bleed much more
heavily than expected (go to ER) and 1-2% have infection needing antibiotics.
3) Surgical Management (Uterine aspiration or D&C)
Some people prefer to have a short surgical procedure to remove the pregnancy tissue. This is done safely in the
OR at Victoria General Hospital by one of our experienced physicians. Usually, you will be given IV sedation to
manage the pain and cause a lack of awareness. Because of this, you cannot eat or drink for 8 hours prior to the
procedure, and must have someone accompany you, and stay with you overnight afterwards. While the procedure
is only 5-10 minutes, you will be at the hospital for 3-4 hours.
Our local experience shows that less than 1% of people choosing this option will need another aspiration or
treatment for infection and even less will have intra-operative complications.
MANAGING MISCARRIAGE AT HOME
Even if you decide to have a uterine aspiration, the miscarriage could start on its own. If this happens, you will have access
to the physician on call, after your appointment with us we will do the booking for the procedure. In most situations, we will see
you again at the clinic for an ultrasound to re-assess.
Whether it happens naturally, or provoked with medication (Mifegymiso), use pads rather than tampons for the
bleeding. Avoid sex during this time. Taking ibuprofen 600-800mg every 4-6 hours or naproxen 275-550 mg every
8-12 hours is best for the few hours of pain you will experience. If strong, you can add 2 extra strength Tylenol
(acetaminophen) every 4-6 hours. Come for an ultrasound check up about a week after the heaviest bleeding to be
sure it is completed.
No matter what your choice the nurse educator and physician will go through your options in detail.