Missed miscarriage — what now?

When an ultrasound shows that there is no heartbeat, it’s often a huge shock for parents. Because your body hasn’t yet started a miscarriage, your pregnancy hormones are still high — and you may still feel pregnant. Only when your body recognises that the pregnancy is no longer viable will the miscarriage begin naturally.

Making choices after the shock

After the initial disbelief, you suddenly find yourself having to make decisions you’ve probably never thought about before. There are three ways your body — or your doctor — can help release the pregnancy tissue:

• Expectant management: waiting for the miscarriage to start naturally. You can decide yourself how long you want to wait — from a few days to several weeks.
• Medication: a vaginal tablet that triggers the miscarriage. This works in about 80% of cases.
• Curettage: a small surgical procedure in which, under local or general anaesthesia, the pregnancy tissue is removed through the vagina and cervix.

Together with us or with the gynaecologist, you’ll discuss which option feels best for you.

Dutch Decision aid: miscarriage option

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Expectant management

This means allowing your body to do the work itself. By waiting, you give your body time to release the pregnancy naturally. Around 70% of people experience a miscarriage within two weeks of the first bleeding; for the rest, it takes longer or doesn’t happen on its own.

Advantages:

• No need to go to hospital or take medication.
• No risk of uterine damage or adhesions.
• No increased risk of preterm birth in a future pregnancy.
• Pain is often milder than with medication.

Disadvantages:

• You don’t know exactly when it will happen, which can be emotionally challenging.
• The miscarriage itself can be painful, and bleeding can sometimes be heavy enough to require emergency treatment.
• Occasionally, tissue remains in the uterus, increasing the risk of infection.

Medication

Helping your body along. Another option is medication that helps your uterus release the pregnancy tissue more quickly. These tablets are prescribed by a gynaecologist; you insert them at home and wait for the miscarriage to occur.

In about 58 out of 100 cases, one dose works. In 85 out of 100 cases, two doses are successful.

Advantages:

• You decide when to begin.
• The miscarriage usually starts within one to two days.
• Most people don’t need a surgical procedure afterwards.
• No risk of uterine damage, adhesions, or increased risk of preterm birth.

Disadvantages:

• The treatment doesn’t always work — 15–42% still need a curettage.
• Pain may be stronger than with a natural miscarriage.
• Possible side effects: nausea, diarrhoea, or fever.
• Small risk of retained tissue or infection.

Curettage

A miscarriage through a surgical procedure. During a curettage, a gynaecologist removes the pregnancy tissue through the vagina and cervix, usually under anaesthesia or local sedation. This takes place in hospital.

Advantages:

• You know exactly when the procedure will happen.
• The procedure is short and recovery is usually quick.

Disadvantages:

• A curettage is a medical procedure under anaesthesia, so there are some risks.
• Possible complications include heavy bleeding, infection, or — rarely — uterine damage.
• There’s a small risk of intrauterine adhesions (Asherman’s syndrome), which may require later treatment.
• A slightly higher risk of preterm birth in a future pregnancy — the more curettages, the higher the risk.

Take your time to decide

You don’t need to decide immediately. We often recommend taking a few days to think things through. Many people first choose to wait for a natural course, but the choice is entirely yours — it’s a matter of personal preference. Discuss your wishes with us, weigh the pros and cons, and take your time. You can also combine options, for instance waiting first and later choosing medication or curettage.

If you prefer not to wait or if the miscarriage doesn’t start naturally, we’ll arrange an appointment for you with a gynaecologist (usually within a week). The doctor will check how you’re doing, go over the options again, and help you make a choice. And you can always change your mind later.

When to contact us

Contact us, your GP, or the hospital right away if you:

• Lose a large amount of blood (more than 2 large sanitary towels/hour for 2 hours)
• You feel dizzy, sweaty and faint
• Have severe pain that doesn’t subside
• Have a fever higher than 38°C
• Are worried or need emotional support

Remember that you can always reach us on our emergency number 06 5478 8178 — even at night.