Early Pregnancy Loss- What You Should Know…

The loss of a pregnancy before 20 weeks is called early pregnancy loss. Often, the loss is a miscarriage (sometimes called spontaneous abortion by doctors). Miscarriages occur in about 15–20% of all pregnancies. Most occur in the first 13 weeks of pregnancy. Don't blame yourself for the pregnancy loss. It is not likely that it could have been prevented. Often, this is nature's way of ending a pregnancy in which the fetus was not growing as it should and would not have been able to survive.

Treatment Options- Often when a miscarriage occurs early in pregnancy, tissue is left in the uterus. The tissue can be part of the fetus, part of the placenta (tissue that provides nourishment to the fetus), or both.

1. Medicine Your doctor prescribes misoprostol, a small tablet which causes the cervix to open after it is placed in the vagina. What to expect: Within 24-48 hours after the medicine is inserted, expect bleeding like a heavy period, passage of tissue and clots, and cramping. You may also have fever, nausea, and diarrhea as normal side effects from the medicine. Advantages: No surgery necessary. You are able to plan and predict when bleeding/cramping will occur. Disadvantages: Side effects from the medicine include cramping, nausea, diarrhea and fever.

Directions: ____ Misoprostol ______mg Insert in vagina. If no bleeding occurs within 12 hours, repeat. ____ Lortab 5/500 mg Take 1-2 tabs every 4-6 hours as needed for pain ____ Darvocet Take 1 tab every 4-6 hours as needed for pain ____ Phenergan ____ mg Take 1 tab every 6 hours as needed for nausea

*You may take the pain and nausea medications 30 minutes before using the Misoprostol

2. Observation (or expectant management) No intervention is also an option. This means allowing the miscarriage to complete on its own. Advantages: No medicine or surgery Disadvantages: Unpredictable bleeding/cramping, the possibility for need for surgery in the future (D&C), possibility of prolonged time period.

3. Surgery- The tissue that remains may be removed by dilation and curettage (D&C), a procedure done at the hospital in the operating room. With this method, the cervix may be widened with instruments if needed. The tissue is then removed gently from the lining of the uterus. Advantages: All tissue is removed completely at one time. Surgery is scheduled. Usually outpatient procedure (go home same day). Disadvantages: Risks of surgery which include pain, bleeding, infection, surgical injury to adjacent organs, small risk of uterine perforation, anesthesia complications, etc.

Follow-Up 1. VERY IMPORTANT! Whichever treatment option you choose, you must call Russell Gynecology Clinic at ______to schedule a follow-up appointment. 2. In case of an emergency contact the Gyn doctor on-call by calling the UAB paging operator at 934-3411.