After a miscarriage, the womb (uterus) is typically managed through one of three approaches to ensure all pregnancy tissue is expelled: expectant management (waiting for the body to pass the tissue naturally), medical management (using medication to induce the process), or surgical management (a procedure like dilation and curettage or vacuum aspiration).
Most women pass the tissue within 2 weeks of a miscarriage diagnosis, but it can take longer. If it takes too long, your ob-gyn may recommend medication to start the process. (Once the process starts and cramping and bleeding begin, most of the tissue passes within a few hours. More on that below.)
The full name is dilatation and curettage. It is done in an operating theatre, usually under general anaesthetic. There is no cutting involved because the surgery happens through the vagina. The cervix (neck of the uterus) is gently opened and the remaining pregnancy tissue is removed so that the uterus is empty.
Often, some of the pregnancy tissue remains in the uterus after a miscarriage. If it is not removed by scraping the uterus with a curette (a spoon-shaped instrument), you may bleed for a long time or develop an infection.
A fertilized egg develops into an embryo at the start of the 6th week of pregnancy. Before 8 weeks, the embryo is small and will look white or tan. If you have a miscarriage at this stage, you might not notice the embryo with the bleeding and clots. If the pregnancy is 8 weeks or more, you may see the embryo.
A dilation and curettage procedure, also called a D&C, is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated (expanded) so that the uterine lining (endometrium) can be scraped with a curette (spoon-shaped instrument) to remove abnormal tissues.
A woman with a miscarriage can take a medication called misoprostol to miscarry at home. Misoprostol, also known by the trade name “Cytotec”, stimulates the uterus to expel the pregnancy.
Whether they occur early (between the 14th and 22nd week of pregnancy) or late (from the 22nd week of amenorrhea), they raise a lot of concerns. Among them: the fear of infertility. However, did you know that it is precisely after a miscarriage that your chances of conceiving are the best? Yes, it's surprising!
Risks
Generally, if it is a fairly early loss, waiting for the pregnancy to miscarry naturally will be the most common course of action. For later first trimester losses or if a missed miscarriage has occurred, a D&C is usually recommended.
How long does a dilation and curettage (D&C) take? The procedure itself takes about five to 10 minutes. But the entire process takes longer due to receiving anesthesia and other preparations. You'll also need to wait in the recovery room for a few hours after the procedure before you go home.
After the pathology exam, the hospital will care for your fetal remains. remains sent to a mortuary of your choice for cremation or burial at your expense. We can provide a list of mortuaries for your information, but you will need to contact the mortuary and make arrangements directly with them.
Sometimes, pregnancy tissue that stays in the uterus after a miscarriage can lead to a uterine infection about 1 to 2 days later. The infection is called a septic miscarriage. Symptoms include: Fever higher than 100.4 degrees Fahrenheit more than two times.
All facilities should perform, and insurance should cover, a confirmation ultrasound before completing a D&C or a dilation and evacuation (D&E) procedure.
After a miscarriage, avoid excessive physical activity as it can affect health, especially since the abdominal muscles haven't fully contracted. After a miscarriage, women should avoid sexual intercourse for a certain period of time.
Is recurrent pregnancy loss considered infertility? Recurrent pregnancy loss is not the same as infertility. Infertility is not being able to get pregnant after trying to conceive for a year or longer.
Most couples are told not to have sex for two weeks after a miscarriage. This is to prevent an infection. But you can become pregnant as soon as two weeks after a miscarriage. Once you feel ready for another pregnancy, ask your healthcare professional to guide you.
Your hCG level is elevated when you are pregnant, and elevated hCG levels suppress ovulation. After a miscarriage, hCG levels need to drop below 5 mIU/mL for your menstrual cycle to resume (and your pregnancy tests to return to normal).
Even though you lost your child during pregnancy or soon after, you are still a parent. Take care of yourself.
If you miscarry naturally, even in the early weeks of pregnancy, you are likely to have period-like cramps that can be extremely painful. This is because the uterus is tightly squeezing to push its contents out, like it does in labour – and some women do experience contractions not unlike labour.
It's important to supplement enough iron, folic acid, and vitamin B6 after a miscarriage. You can find those vitamins and nutrients in food as well like pork liver, spinach, black beans, red beans, and red dates.
Things we would typically worry about if the uterus isn't properly cleaned after miscarriage are bleeding, infection, and retained placenta and/or blood clots. It is the woman's personal choice whether she wants to have her uterus cleaned through surgery or simply let nature work its course and clean it out naturally.
Recovering from a dilatation and curettage
You can get back to most normal activities in a couple of days. You might feel some cramping and discomfort after a D&C.