What happens after a miscarriage? Treatment and support

Miscarriage management options as explained by fertility specialists: Dr. Wais and Dr. Garcia

First of all, if you are reading this and have experienced a miscarriage, we want to say: we are so sorry for your loss. A miscarriage is not just a medical event; it is a deeply personal loss, and however you are feeling right now is completely valid. Whether you are experiencing sadness, anger, confusion, or even numbness, all of these emotions deserve space.

Miscarriage can be a difficult subject to discuss, and in many cases, it is not socially recognized as a loss in the same way other types of bereavement are. But it is a loss, and grieving is natural.

Beyond the emotional toll, miscarriage also comes with physical concerns. What happens next? What steps do you need to take for your health? How do you ensure your body recovers safely? We hope this post provides you with the information and reassurance you need during this challenging time.

We will cover: 

1. What are retained products of conception (RPOC)?
2. 3 options for miscarriage management
3. What happens after a miscarriage?
4. The emotional toll of a miscarriage
5. How to move forward after a miscarriage?

You may also be interested in learning about the types of miscarriages, causes and symptoms.

Understanding Retained Products of Conception (RPOC)

After a miscarriage, one of the most important steps is confirming that all pregnancy tissue has passed. If any tissue remains in the uterus, it is referred to as retained products of conception (RPOC). This can include placental fragments or fetal tissue, and ensuring it has all passed is crucial for preventing complications.

Why does this matter? Retained tissue can:

• Increase the risk of infection, which in rare cases can lead to serious conditions like sepsis.
• Cause prolonged bleeding, which can lead to anemia and significant distress.
• Prevent the uterus from healing, delaying your physical recovery and ability to conceive again.
• Lead to scarring of the uterus, also known as Asherman’s Syndrome, which can impact future pregnancies.

To confirm whether all tissue has passed, doctors usually perform an ultrasound two to three weeks after the heaviest bleeding has subsided. Sometimes, bloodwork (beta hCG levels) may also be used to confirm if pregnancy hormones are decreasing as expected.

If the miscarriage is complete (meaning all tissue has passed naturally), no further medical treatment is needed. However, if there is still tissue remaining, further treatment options will be considered.

Miscarriage Management Treatment Options

If a miscarriage is missed (where the pregnancy has stopped developing but the body has not yet expelled the tissue) or incomplete (some tissue has passed, but some remains), there are three primary management options:

1. Expectant Management (Natural Passing)

This approach involves waiting for the body to complete the miscarriage naturally, without medical or surgical intervention.

Considerations:

• It can take weeks for the body to expel all the tissue, making it unpredictable.
• Heavy bleeding or severe cramps may occur unexpectedly, which can be distressing.
• There is a small risk of infection, especially if the pregnancy tissue remains for an extended period.
• Psychologically, some individuals find it difficult to wait for something painful and emotional to happen unpredictably.

For these reasons, most fertility specialists do not recommend expectant management unless miscarriage bleeding has already started. If your body has already begun the process, expectant management may be reasonable for a short period. However, it’s important to have a clear timeframe and follow up with your doctor to ensure the miscarriage completes.

2. Medical Management (Medication-Induced Miscarriage)

For those who do not want to wait, medication can be used to help the uterus expel the pregnancy tissue.

This is typically done with a combination of two medications:

• Mifepristone: Blocks progesterone, the hormone that helps support pregnancy.
• Misoprostol: Causes the uterus to contract and expel the tissue.

This combination is free in Ontario with a valid OHIP card and requires a prescription.

What to expect:

• After taking Mifepristone, you may experience mild cramping or light bleeding.
• 24 hours later, you take Misoprostol, which will cause the uterus to contract and push out the pregnancy tissue.
• Bleeding and cramping will usually start within a few hours, often heavier than a regular period, and may include large clots.
• Cramping can be intense, similar to labor pains.
• Bleeding typically continues for 7-10 days but should slow over time.

Preparing for Medical Management:

• Stay at home, ideally with a trusted support person.
• Have pain medication (Tylenol, Advil, or prescription pain relief if necessary).
• Use sanitary pads (not tampons) to manage bleeding.
• Have a heating pad for cramping relief.
• Be aware that nausea, diarrhea, and feverish feelings are common but should pass within a few hours.

3. Surgical Management (D&C Procedure)

A Dilation and Curettage (D&C) is a surgical procedure to remove pregnancy tissue from the uterus.

When is surgery recommended?

• If heavy bleeding continues and poses a risk to your health.
• If medication fails to fully expel the tissue.
• If there is a concern for infection.
• If a person prefers to have the miscarriage managed quickly and definitively.

Risks of D&C:

• Bleeding and infection risks are low but possible.
• There is a risk of uterine scarring (Asherman’s Syndrome), which can impact future fertility.
• It requires hospital admission and anesthesia, meaning it may involve a wait for scheduling.

While D&C is effective, fertility specialists often prioritize medical management to minimize the risk of Asherman’s Syndrome, which can lead to infertility.

What Happens After a Miscarriage?

Once the miscarriage has been managed, recovery looks different for everyone. Some key points:

• Your first period will typically return 4-6 weeks after a miscarriage, though it may be different from your normal menstrual cycle.
• If you plan to conceive again, it’s generally safe to try after one full menstrual cycle (but only after confirming all tissue has passed).
• The risk of miscarriage in a future pregnancy depends largely on age and egg quality rather than the fact that you’ve had a previous loss.

The Emotional Toll of Miscarriage

It’s important to acknowledge that miscarriage is not just a physical event—it is a deeply emotional experience. Many people blame themselves, but please know: this is not your fault.

The most common cause of miscarriage is chromosomal abnormalities, meaning the embryo was not genetically viable. Nothing you did—your diet, exercise, stress levels, or anything else—caused this to happen.

If you are struggling emotionally, you are not alone. Reach out to a trusted friend, partner, therapist, or support group. Your feelings are valid, and healing takes time.

Moving Forward with Hope

If you take away one message from this, let it be this: your miscarriage does not define you, and it does not determine your future. While every miscarriage carries heartbreak, the likelihood of a future successful pregnancy is far greater than the risk of another loss.

You are not alone in this journey. There is support available, and in time, hope and healing will come. Be gentle with yourself, and know that your emotions—and your dreams for the future—matter.