We do not intervene unless we are certain a pregnancy is not viable. Sometimes, this cannot be determined with only one visit or ultrasound and you may need to repeat testing in a week, for example. This can be very emotionally trying when we don’t think a pregnancy will be viable, but we are not certain.
When a pregnancy is not viable, several options are available, depending upon the stage of the miscarriage, the condition of the mother, and other factors. The three main options are: observation, medical treatment, or surgical treatment.
If your body has already passed the pregnancy and bleeding has slowed, nothing may need to be done surgically or medically. Your doctor will instruct you what needs to be done to ensure the miscarriage is complete.
Eventually, your body would start to pass the nonviable pregnancy spontaneously. This can take several weeks for your body to start that process, even though the pregnancy may have stopped developing weeks earlier. Once a woman knows her pregnancy is not viable, she often does not want to wait for the miscarriage to happen spontaneously.
In some cases, medications can be given to stimulate the uterus to contract and pass the pregnancy. This medicine is a pill that can be given by mouth or vaginally, and works over a couple of days. Heavy bleeding and cramping are usually expected with medical treatment.
Surgical Treatment—Suction D&C
The conventional treatment for early miscarriage is a surgical procedure called suction D&C (dilation and curettage). The cervix (the opening to the uterus) is dilated, and an instrument is inserted that uses suction and/or a gentle scraping motion to remove the contents of the uterus.
D&C is generally recommended for women who do not want to wait for spontaneous passage of the pregnancy, and in women with heavy bleeding or infection. This usually avoids the heavy bleeding and cramping that are typically involved with observation or medical treatment.
Women who have an Rh negative blood type (i.e., A, B, AB, or O negative) may need to be given a drug called Rh(D) immune globulin (RhoGam®). This medicine helps protect future pregnancies against problems that can occur if an Rh negative mother is carrying a baby who is Rh positive.