What are the post-procedure instructions and precautions after a dilation and curettage (D&C) for a missed miscarriage?

Post-Procedure Care After D&C for Missed Miscarriage

You should monitor closely for warning signs of complications, particularly excessive bleeding (soaking more than one pad per hour for 2 consecutive hours), fever above 100.4°F (38°C), severe abdominal pain, or foul-smelling discharge, all of which require immediate medical attention. 1

Immediate Warning Signs Requiring Emergency Evaluation

Contact your healthcare provider immediately if you experience:

• Excessive bleeding: Soaking through more than one pad per hour for 2 consecutive hours indicates potential uterine atony or incomplete evacuation 1
• Large blood clots: Clots larger than a quarter may signal incomplete evacuation 1
• Fever: Temperature greater than 100.4°F (38°C) suggests infection 1
• Severe abdominal pain: Pain not relieved by prescribed medications may indicate uterine perforation or infection 1
• Foul-smelling vaginal discharge: This indicates potential endometritis or other infection 1
• Syncope or dizziness: May indicate significant blood loss 1

The classic triad of post-procedural infection includes increasing pelvic tenderness, fever, and abnormal discharge 1. This combination requires urgent evaluation and treatment.

Expected Normal Recovery

Bleeding patterns:

• Normal post-procedure bleeding typically decreases gradually over 1-2 weeks 1
• Persistent bleeding beyond this timeframe warrants evaluation 1
• Some spotting or light bleeding is expected and normal during the recovery period 2

Pain management:

• Mild to moderate cramping is normal and can be managed with prescribed pain medications 1
• Pain should progressively improve, not worsen 1

Activity and Physical Restrictions

Pelvic rest is essential:

• Avoid sexual intercourse for at least 2 weeks or until cleared by your provider 2
• Do not use tampons; use pads only to monitor bleeding 2
• Avoid douching, which increases infection risk 2

Infection Prevention

Key measures to reduce infection risk:

• The risk of infection increases with retained products of conception and prolonged procedure time 1
• Watch for the infection triad: fever, pelvic pain, and purulent discharge 1
• Incomplete evacuation presents as continued bleeding or persistent symptoms 1

Rh Status Considerations

If you are Rh-negative:

• You should have received anti-D immunoglobulin (50 μg dose) to prevent alloimmunization 2
• Approximately 32% of spontaneous abortions involve fetomaternal hemorrhage, making this prophylaxis critical 2

Follow-Up Care

Clinical monitoring:

• Follow-up appointment should be scheduled to confirm complete resolution and rule out complications 2
• Persistent or recurrent abnormal bleeding, even with normal initial findings, requires further evaluation 1

Contraception counseling:

• Contraceptive counseling should be provided to prevent unintended pregnancy 2, 3
• You can become pregnant again before your next menstrual period 2

Future Pregnancy Considerations

Timing of next pregnancy:

• Research suggests the endometrium may require up to 6 months to fully recover normal reproductive function after D&C 4
• While you can attempt pregnancy sooner, waiting 6 months may optimize chances of successful pregnancy outcome 4
• There is a significantly higher risk of postpartum hemorrhage in pregnancies following D&C 5

Common Pitfalls to Avoid

Do not ignore subtle warning signs:

• Gradual worsening of symptoms, even if initially mild, requires evaluation 1
• Incomplete evacuation can be missed; ultrasound guidance during the procedure significantly reduces this risk (0.87% vs 2.6-4.9% without guidance) 6
• Misdiagnosis can occur; ensure ectopic pregnancy was definitively ruled out 2