Medication Management

Medication management involves taking medication to help start the miscarriage process. This option may be chosen for several reasons, including personal preference or when expectant management has not progressed (e.g., incomplete miscarriage) or when waiting for the natural process is not advised.

The medication works by softening and opening the cervix, allowing the baby and pregnancy tissue to pass. The medications offered often include Mifepristone followed by Misoprostol, which will be provided by your healthcare provider along with detailed instructions on how and when to take them.

There may be circumstances where medication management cannot be offered, such as if your doctor suspects a molar pregnancy, if you have experienced severe bleeding and lost too much blood, if you have an increased risk of hemorrhage or are unable to have a blood transfusion, if you have any signs of infection, if you have an intrauterine device (removal would be required), if you have hypertension, or if you are later in gestation when medication may not be appropriate.

What to Expect with Medication Management

Taking the Medication

You may be sent home with the medication or it will be given to you in a day hospital setting. The medication can be administered either orally (under the tongue) or inserted into the vagina according to your healthcare provider's instructions. You will likely have a Beta HCG blood test done prior to starting the medication and again on day eight after having the medication. You may be required to take two doses of medicine, one on the first day (day 0) and the second 24 hours later.

It's possible that you may experience side effects from the medication, including nausea (more likely when taken orally), vomiting, diarrhea, and fever and chills. Your healthcare provider will likely check in on you on Day 2 and Day 8 after starting the medication. If an incomplete miscarriage occurs (where tissue remains in your uterus), you may require further intervention. Depending on your circumstances, this may involve taking more medication or surgical intervention, a procedure called Dilation and Curettage.

Bleeding

When the pregnancy begins to pass with medication management, bleeding will likely be heavier than your period. The baby and pregnancy tissue will typically start to pass approximately four to six hours after taking a dose of the medication. You should contact your healthcare provider if this does not occur within 24 hours of starting treatment.

As with natural management, you may see blood clots and tissue, and the colour of blood may vary. The visibility of the embryo depends on gestational age. If your pregnancy was early in gestation (5-8 weeks), it is unlikely that you will see a distinct embryo, as it may be reabsorbed by your body or appear as part of the blood clot. In later stages (8-10 weeks), the fetus may be more recognisable. After 10 weeks, the fetus will typically be fully formed and more easily identifiable.

You will need to use sanitary pads rather than tampons or menstruation cups. You may wish to flush the tissue, or you may choose to collect your baby and pregnancy tissue using the Soul Collection Kit. If you choose collection, store the jar in a refrigerator until you have decided on the next steps. If you have had multiple pregnancy losses, your healthcare provider may suggest testing the tissue.

You may experience period-like bleeding for a week (after the first 72 hours of tissue passing). If bleeding continues into a third week, you should consult your healthcare provider, as you may need another Beta HCG blood test or scan.

Pain

You may experience pain in the abdomen, pelvic region, lower back, or tip of shoulder. This pain can vary from mild period-like cramps to strong labor-like contractions and may come and go in waves. You will likely be advised to take analgesics such as Paracetamol or Ibuprofen according to package directions. Heat packs may also help provide some relief.

Hormones Decreasing

As your hormone levels decrease (at a rate that varies from woman to woman), you may experience headaches, emotional changes including feelings of sadness, mood swings, and tiredness. Morning sickness will subside, and breast tenderness will diminish.

Some women may experience milk production, which can be managed by minimizing breast stimulation, avoiding expressing milk, wearing a firm-fitting bra, and using cold packs for relief.

Like natural management, medication management can be emotionally challenging due to the sometimes prolonged and unpredictable nature of the process. Feelings of sadness, anxiety, or grief are common, and seeking emotional support is advisable.

Managing Your Baby's Remains

If you have experienced an early pregnancy loss under 20 weeks, and the baby was born with no signs of life. The following options can be considered:

• Returning the remains to hospital for communal cremation, staff may be able to tell you where remains will be laid to rest
• Private burial or cremation arrangements through a funeral director (fees may apply)
• Burial in a garden or pot plant, consider the ability to transfer when moving house and also Local Council guidelines

When Should I Seek Further Medical Assistance?

You should seek medical advice if bleeding does not start 24 hours after taking medication, if you are bleeding heavily and soaking a pad in 30 to 60 minutes, if you are passing large blood clots (golf ball sized), if you feel faint or dizzy, if your pain is increasing and not relieved by analgesics, or if you notice a strange smell or color in your vaginal discharge.

If you need to go to the hospital because you are concerned about excessive bleeding, you may require an internal examination. The doctor will place a speculum in your vagina (similar to a pap smear) to check for active bleeding or if any tissue remains in your cervix. Sometimes the baby and pregnancy tissue can get caught in the cervix and cause bleeding. In some cases, women may need urgent surgery to control bleeding.

If you are concerned about your health, please seek advice from your healthcare professional.