Miscarriage Management

A miscarriage is characterized by repeated, sudden type of vaginal bleeding and cramping during the pregnancy of a woman. 
It is important to consult a gynecologist immediately if such symptoms are noticed, as the gynecologist will first try and save the pregnancy if possible. However, in cases of miscarriages that are inevitable, the gynecologist can help in rapid expulsion, management of pain, prevent the risks of incomplete natural expulsion, and reduce the chances of infection.

Types:
The different types of miscarriages include:

1. Threatened miscarriage: If the woman is bleeding, but her cervix has not begun to dilate, it indicates a threat of miscarriage. Most such pregnancies proceed without any further problems.
2. Inevitable miscarriage: If a pregnant woman is bleeding, cramping, and her cervix is dilated, a miscarriage is considered to be inevitable.
3. Incomplete miscarriage: If a woman passes the fetal or placental material, but some of it remains in the uterus, the condition is considered to be an incomplete miscarriage.
4. Missed miscarriage: When the placental and embryonic tissue is still remaining in the uterus, but the embryo was never formed or had died, the condition is known as a missed miscarriage.
5. Complete miscarriage: If a woman has passed all the pregnancy tissues, it is considered to be a complete miscarriage. This is commonly seen in miscarriages that occur before 12 weeks.
6. Septic miscarriage: When a woman develops an infection in her uterus, it is known as a septic miscarriage. This could be a severe type of infection and requires immediate care.

Causes:
The following could be the possible causes of a miscarriage:

• Abnormal embryo formation due to an extra or a missing chromosome
• Abnormal fetal and placenta growth due to the abnormal division of the embryo
• Abnormal embryo planting in the ovaries, fallopian tubes, abdomen, or cervix, instead of the uterus (womb)
• Infection of the uterus or cervix
• Fluctuations in the health of the mother, such as diabetes, high B.P, thyroid or hormonal imbalance

Risk factors:
The following factors increase the risk of a miscarriage:

• Teenage
• Old age
• Excessive weight
• Less weight
• Imbalance in the hormone levels
• Accidents
• Fluctuations in blood pressure 

Prevention:
Although a miscarriage cannot be prevented as such, the following tips may help in taking good care of the mother and the baby and reducing the risk of a miscarriage:

• Get regular prenatal care
• Take a multivitamin daily
• Avoid smoking, drinking, and illicit use of drugs
• Limit your intake of caffeinated drinks  to not more than two drinks a day
• If you have a chronic (long-term) medical condition, work with your doctor to keep it under control 

Symptoms

The following symptoms may be seen in case of a miscarriage:

• Bleeding from the vagina
• Cramping
• Abdominal pain
• Back pain
• Passing of the fetal tissues
• Passing of the vaginal fluid

Diagnosis

1. Pelvic exam: The doctor will check if the cervix has started dilating.
2. Ultrasound: The doctor will check the heartbeat of the fetus and also check if the embryo is developing the way that it should.
3. Blood tests: The doctor will check the levels of the human chorionic gonadotropin (HCG) hormone (pregnancy hormone) in the blood and compare it to the previous levels. An abnormal pattern in the HCG level could indicate a problem. The doctor will also check if the woman is anemic in cases of heavy bleeding. The woman’s blood type is also checked.
4. Tissue tests: If the woman has passed tissue, this tissue will be sent to the laboratory to confirm that a miscarriage has taken place and that the symptoms are not related to any other cause.
5. Chromosomal tests: If a woman has had two or more previous miscarriages, the doctor may recommend blood tests for the woman and her partner to check if chromosomal defects are leading to the miscarriages.

Treatment

The management for miscarriage varies depending on the type of miscarriage the woman has and may include the following treatment options:

Treatment for threatened miscarriage:

• Bed rest until pain and bleeding subsides
• Avoid sex and exercise
• Postpone traveling

Treatment for an expectant miscarriage:

1. Non-surgical treatment methods:

a)Natural expulsion:
An ultrasound is a good indicator of a dead embryo or an embryo that was never formed.
If the doctor detects no signs of infection, the doctor may choose to let the miscarriage progress naturally. This normally happens within a couple of weeks of determining that the embryo has died.
This procedure may take up to three to four weeks, and this time could be emotionally draining for the mother.
If the expulsion does not happen on its own, a medical or surgical type of treatment may be needed.

b) Medical treatment:
Medicines help the body to expel the pregnancy tissue and placenta more rapidly.
The doctor advises medications that can either be taken orally or inserted into the vagina.
The medication inserted vaginally has increased effectiveness and minimizes the risk of side effects such as nausea and diarrhea.
For approximately 70 to 90 percent of women, this type of treatment works within 24 hours.

2. Surgical treatment:

• A minor surgical procedure known as dilation and curettage (D & C) may be performed by the doctor.
• The procedure involves dilating the cervix and removing the tissue from inside the uterus by the doctor.
• This procedure is generally recommended in cases of heavy bleeding or when there are signs of an infection.

Risks

A miscarriage that is not managed properly or treated well may lead to a septic miscarriage (infection in the uterus). The symptoms of this type of infection are:

• Chills
• Fever
• Nausea
• Foul-smelling discharge from the vagina
• Tenderness in the lower abdomen 
• Increased risk of miscarriage in the next pregnancy
• Infertility

The side effects associated with the medications used to manage a miscarriage include:

• Pain in the abdomen
• Nausea
• Vomiting
• Diarrhea
• Dizziness
• Vaginal bleeding 

The complications associated with the D & C procedure include the following:

• Infection
• Excessive bleeding
• Allergic reaction to the anesthesia used
• Blood clot formation
• Damage to the surrounding organs, like the ovaries, ureter, bladder, or rectum

After Procedure

• Following a D & C procedure, the woman may feel immediate relief in the abdominal area. However, she may feel a slight pull, discomfort, and emotional disturbances after the procedure.
• The prescribed medications should be taken regularly and the woman should seek emotional support from her family and loved ones.
• A blood transfusion may be needed after the surgery if the woman’s hemoglobin levels are lower than normal.
• Complete recovery following medical or surgical treatment for miscarriage may take a couple of weeks.
• It is normal to feel mild, constant abdominal pain and discomfort during the recovery period. The woman may also experience emotional disturbances.
• The doctor needs to be contacted immediately if the woman experiences fever, heavy bleeding, or extreme abdominal pain during the recovery period.
• The woman could ovulate as soon as two weeks following a miscarriage.
• The woman can expect her periods to resume within four to six weeks.
• Avoid having sex or inserting anything into the vagina, such as a tampon, for two weeks following a miscarriage.
• Avoid planning a pregnancy for at least one to six months after a miscarriage, depending on the cause of the miscarriage. Contraceptives should be used during this period to avoid pregnancy.

Cost of Miscarriage management and treatment :

The cost of miscarriage management and treatment using medications in India is between INR 2,000 to INR 12,000.

The cost of miscarriage management and treatment using surgical methods in Mumbai is between INR 20,000 to INR 50,000.
The cost of miscarriage management and treatment using surgical methods in Delhi is between INR 18,000 to INR 45,000.
The cost of miscarriage management and treatment using surgical methods in Bangalore is between INR 18,000 to INR 45,000.
The cost of miscarriage management and treatment using surgical methods in Chennai is between INR 15,000 to INR 40,000.