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There are many management options for miscarriages

Dear Doctor,
I have just been diagnosed with a miscarriage in early pregnancy. My doctor says I need an operation to clean my uterus but I don’t want to undergo such a procedure. Is there another way out?

Am sorry to hear about your miscarriage. This is a fairly common occurrence in early pregnancies, and can occur without any warning signs. Luckily for most the chances of another miscarriage are very low, and subsequent pregnancies tend to be normal.

Once a miscarriage has been diagnosed, a discussion needs to take place about how to manage the situation. It’s best to discuss with your regular gynecologist, or a nurse specialized in the management of early pregnancy problems. The first thing to understand is that you are not at any significant risk, and there is usually no urgency in deciding what to do. The only exception to this principle is in cases where there is heavy bleeding, which is uncommon.

The procedure your doctor is suggesting is called uterine evacuation. It involves surgical removal of the miscarriage, and usually requires some form of anesthesia. Admission in a day surgery unit is usually required, and a discharge shortly after the procedure is completed. It’s a fairly simple procedure, with minimal risks. It will however cost more, compared to other alternatives.

Other alternatives are available, and include taking some medications or just waiting for the miscarriage to come out spontaneously. These options are suitable for the vast majority of women, and should always be offered as alternatives to surgery. You can choose to take medications, which can either be given by mouth or vaginally. The medications enhance the process of expulsion of the miscarriage, similar to having a heavy period. The bleeding takes place over several days, and stops spontaneously once everything has been expelled.

Waiting for spontaneous resolution of the miscarriage without doing anything else is perfectly safe. Once a miscarriage has happened, biological processes kick in to initiate expulsion the non-developing fetus. It can take several days, or even weeks, for a spontaneous bleed to occur. Cessation of bleeding is usually a sign that everything has been expelled.

Scientific studies have confirmed that all these options for managing miscarriages are safe. The most important thing is to be aware of all the options, and to select what suits your specific circumstances. For those where cost is not an issue, and are keen on an immediate intervention, surgery may be the way out. Using medications, or just waiting, are good options for those keen on conservative measures. Eventual outcomes for all the options are similar, and none of the choices puts you at increased risks of infections or problems with subsequent conceptions.

Don’t feel compelled to accept the first treatment option that gets recommended after a miscarriage. Ask if other options are suitable for you, and select what suits you best.

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