From the Guidelines
After a spontaneous abortion (miscarriage) that occurred 3 days ago, it is crucial to schedule a follow-up appointment with your healthcare provider within 1-2 weeks to monitor for potential complications, such as infection or retained tissue, and to assess your risk of venous thromboembolism (VTE), which may be increased due to the pregnancy loss 1.
Follow-up Care
The follow-up appointment is essential to confirm that the miscarriage is complete and that no tissue remains in the uterus. Your provider will likely perform a pelvic examination and possibly an ultrasound to check for retained tissue. They may also order blood tests to monitor your hormone levels, particularly human chorionic gonadotropin (hCG), which should gradually decrease to zero.
Monitoring for Complications
It is vital to watch for warning signs that require immediate medical attention, including:
- Heavy bleeding (soaking through more than two pads per hour for two consecutive hours)
- Severe abdominal pain
- Fever over 100.4°F (38°C)
- Foul-smelling vaginal discharge
- Signs of infection
Pain Management and Self-Care
For pain management, you can take over-the-counter medications like acetaminophen (Tylenol) according to package instructions. To prevent infection while your cervix is still dilated, avoid using tampons, having sexual intercourse, or douching for at least two weeks.
Emotional Recovery and Future Pregnancy
Emotional recovery is equally important, so consider seeking support through counseling or support groups. Most women can expect their menstrual cycle to return within 4-6 weeks after a miscarriage, and many healthcare providers recommend waiting for at least one normal menstrual cycle before trying to conceive again to allow your body to heal completely.
VTE Risk Assessment
Given the increased risk of VTE after pregnancy loss, as highlighted in the study published in the Journal of Thrombosis and Haemostasis 1, your healthcare provider should assess your individual risk factors and consider prophylactic measures if necessary. This may include the use of low molecular weight heparin (LMWH) in high-risk cases.
From the Research
Necessary Follow-up Steps after a Miscarriage
After a spontaneous abortion (miscarriage), it is essential to follow up with a healthcare provider to ensure proper healing and to address any potential complications. The following steps are recommended:
- Expectant management is the first-line approach, and is encouraged for 7-14 days after diagnosis of miscarriage, as most women will miscarry spontaneously during this time and will need no further treatment 2.
- If the symptoms worsen, or persist beyond 14 days, a repeat referral should be made to the early pregnancy unit for further assessment 2.
- Assessment of the amount of vaginal bleeding experienced is best made in the context of time taken to saturate a sanitary pad, and changing a pad soaked with blood and clots more than once an hour is an indication of heavy bleeding that requires immediate referral 2.
- Medical management of miscarriage can be offered using misoprostol, and surgical management may be chosen by a woman if she has had a previous adverse or traumatic experience associated with pregnancy 2.
- It is also important to note that after a diagnosis of miscarriage, half the women undergo significant psychological effects, which may last for up to 12 months, and a theory of caring and a model of what it is like to miscarry can be a useful framework for anticipating the variety of responses women have to miscarrying 3, 4.
Additional Considerations
- If a pregnancy is 12 weeks' gestation and the woman is rhesus negative, she will require anti-D prophylaxis if there are symptoms of bleeding 2.
- Women with a history of recurrent miscarriage may benefit from further evaluation and treatment, such as preconceptual administration of doxycycline, to reduce the risk of future miscarriages 5.
- It is also important to screen for pelvic inflammatory disease (PID) and other sexually transmitted infections, especially in sexually active young women or women at risk for sexually transmitted infections, as untreated PID can lead to chronic pelvic pain, infertility, ectopic pregnancy, and intra-abdominal infections 6.