Microsoft word - managing_a_miscarriage_2nd_edition

Maternity
Managing A Miscarriage
This leaflet is available in other languages and formats, please contact the
Patient Quality team on 0151 702 4160
This is a brief outline of the problem and is not intended to replace discussion withmedical or nursing staff.
Managing a miscarriage
Experiencing a miscarriage is very distressing and may have a great impact on you,your partner and your family. We understand the grief you are experiencing and wewould like to support you and your family in the best way we can. The majority ofmiscarriages cannot be explained and there are usually no reasons why theyhappen, so it is important that you don’t blame yourself and think that yourmiscarriage is a result of “that glass of wine” or the “heavy shopping you carried”.
We want to make sure that the care you receive is the best for you and that youunderstand the choices available to manage your miscarriage. We will supportthroughout your treatment. Sadly, there are times when you do not pass all of thepregnancy and in this situation it is important that you consider the three treatmentoptions available to you. It may take some time for you to come to terms with whathas happened so please do not feel you need to make a decision immediately.
You can contact the nurses in emergency room on 0151 702 4140 at any time if youhave any questions or concerns.
The treatment options are
Expectant management
This is a matter of waiting and allowing nature to take its course. You may prefer thisas it should avoid admission to hospital or having an anaesthetic for surgery.
Unfortunately, with this management we cannot be certain how long it may take;therefore an appointment will be arranged for you in two weeks time for anultrasound scan (USS) This enables us to monitor you, answer any questions and arrange any further follow up or treatment that you may need.
You may experience pain and bleeding. You will be provided with a prescription forpain relief (analgesia). When you start bleeding use a sanitary towel not tampons. Ifat any time your sanitary towel is soaked through and having to be changed halfhourly to hourly, or you are in a lot of pain you should attend the Emergency Room.
The Emergency Room is open 24hrs a day, 7 days a week, please phone at any timefor advice.
We advise you take Paracetamol if you are able to if you begin to experience pain. Ifhowever you feel you want to change your mind and want the medical or surgicaloption please contact the ER.
Bleeding can continue for about 7-10 days and then should become lighter.
The benefits of this management is that it may avoid the need for medical or surgicaltreatment There is therefore a risk that either medical or surgical treatment may be requiredeventually if bleeding continues. There is a small risk of infection developing Medical management
Medical management is given in two stages over 48 hours.
Firstly you are given tablets called Mifepristone. These tablets stop the pregnancyhormone. There is a slight chance that you will pass the pregnancy after thesetablets.
The tablets are given in the Emergency Room, and then you are able to go home.
We will give you a letter explaining what ward and what time you should attend in 48hours later.
You will be admitted to hospital 48 hours later.
The second tablets are Misoprostol. These are given orally or vaginally and theDoctor will decide which way to give the tablets to you. These tablets encourage theuterus to contract and pass the pregnancy.
You may be given a further dose of Misoprostol four hours after the initial dose. Yourpain and bleeding will be monitored. If your bleeding is not heavy and your paincontrolled you may be discharged home a further two hours later.
An overnight stay should not be required. However if the nursing staff feel that youshould stay overnight, they will discuss their reasons with you. This may be due tothe level of pain and vaginal bleeding you may be experiencing at this time Following discharge home, you can expect to experience vaginal bleeding forapproximately 7 to10 days as the miscarriage process will continue at home.
You will be given a three week follow up appointment to do a pregnancy test andanswer any questions you may have, this is done via a telephone follow up. We askyou to do a pregnancy test to ensure your hormone levels have returned to a normallevel.
The benefits of this type of management is that surgery may be avoided.
There is a risk that the process may become prolonged. There is a small risk of aninfection developing during the process. Occasionally, surgical treatment may berequired if problems occur during this process.
Surgical management
This involves you being admitted to hospital for the day, as this procedure isperformed under a general anaesthetic. In some cases it may be necessary toadminister a pessary into the vagina an hour prior to surgery. This helps the neck ofthe womb to gently open and decreases the risk of damage to the neck of the wombor the womb itself. During the operation the pregnancy will be removed.
After the procedure you may experience some abdominal pains or cramps which canbe controlled by pain relief and the ward will provide a prescription for you when youare discharged. You may also experience bleeding which is quite normal and canlast for approximately 7-10 days after the procedure.
Benefits
Surgery reduces the risk of treatment becoming prolonged Very rarely the instrument used during the procedure may perforate the womb(uterus) and cause damage to other organs in the pelvis such as the bowel. If thisoccurs you may require further surgery and a longer stay in hospital.
There are always risks associated with all of the options. Some of the pregnancy
tissue may not be removed, therefore you need to be aware that if your bleeding
persists for longer then two weeks or becomes heavy, passing clots/tissue, is
offensive or your pain is uncontrollable, you need to attend the Emergency Room
(702 4140).
The hospital ensures all pregnancies that are miscarried are sensitively disposed of.
We also have to make you aware that there are no ashes available following yourmiscarriage as the pregnancy was too early in the developmental stage.
Take this information with you to read and contact the hospital when you have madeyour decision. You will not damage your health by taking time to make your decision,but you should ensure you are comfortable and confident with the treatment optionyou choose.
The Miscarriage Association
C/O Clayton Hospital
Northgate
Wakefield
West Yorkshire
WF1 3JS
Helpline:
The Ectopic Pregnancy Trust
Helpline:
If you would like to make any suggestions or comments about the content of thisleaflet, or would like a copy in a different format please contact the Patient QualityTeam on 0151 702 4160 or e-mail Please note that Liverpool Women’s NHS Foundation Trust is a smoke free site.
Smoking is not allowed inside the hospital building or within the hospital grounds, carparks and gardens.
Staff are available to give advice about stopping smoking, please ask your nurseabout this.
Copyright Liverpool Women’s NHS Foundation Trust 2008.

Source: http://www.liverpoolwomens.nhs.uk/Library/our_services/maternity/FMU/Managing_A_Miscarriage_2nd_Edition.pdf