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Missed or incomplete miscarriage is rare and occurs when the body fails to recognize the death of an unborn baby. A D&C procedure is performed to minimize the risk of infection, and women may experience pain and bleeding for a few days afterward. Postpartum depression is common and can be managed with treatment or therapy.
A missed or incomplete miscarriage is a rare type of miscarriage in which the body fails to recognize the death of an unborn baby and does not miscarry at the same time. Most miscarriages occur within the first 12 weeks after conception. They are usually identified when the fetal heart rate cannot be heard on Doppler ultrasound testing. The miscarriage is then confirmed by ultrasound.
Many women are unaware that their baby died in the womb, although occasionally women will notice brownish spots. Often if the death has just occurred, the body may simply begin miscarrying within a few days. When it is clear that the body will not abort, an obstetrician has several options for ending the pregnancy.
If the pregnancy is extremely early, before 7-8 weeks, drugs such as misoprostol can cause the body to expel the remaining tissue in the uterus. This is non-invasive and the resulting expelled tissues resemble a heavy period. Pain can be significant with a pregnancy loss even at this early stage. Women are often given pain medication to help with the contractions. Passing any tissue is generally not physically painful, although it can certainly take an emotional toll on any woman experiencing a miscarriage.
When the pregnancy has lasted longer than 8-9 weeks and a miscarriage is confirmed, doctors tend to perform a dilation and curettage (D&C). While this procedure is the same as one done to abort a pregnancy, most women with a miscarriage do not have to go to an abortion clinic to have this procedure done. Almost all hospitals, including those with strong anti-abortion positions, do D&Cs for miscarriages.
The importance of D&C is to minimize the risk of infection. If the pregnancy materials are not removed from the body, they can become infected over time and cause significant health problems. Where a miscarriage goes undiagnosed, such as in a woman who does not realize she is pregnant, the infection can cause significant illness, pain, blood infection, and the ability to not be able to have more children. Women who have long carried the pregnancy materials of a missed miscarriage may need to be hospitalized to treat significant and life-threatening infections.
A D&C for a miscarriage is usually an outpatient procedure. The woman who undergoes it will probably notice some bleeding initially, which will gradually decrease over a few weeks. Fever, significant pain, or exceptionally heavy bleeding (requiring more than one swab per hour), requires immediate medical attention, as very rare but serious complications can occur after a D&C.
Those who have had a D&C for a miscarriage can expect some pain for a few days following the procedure. Most doctors recommend no sexual activity for six weeks after a miscarriage. Additionally, they suggest waiting at least three months before attempting another pregnancy.
Women who have lost a miscarriage are just as likely to be affected by postpartum depression as women who have had a healthy full-term pregnancy. This is due to disruption of pregnancy hormones, which can significantly affect mood. Some depression is quite reasonable after losing a pregnancy. Discuss strong feelings of depression, suicidal thoughts, or unrelenting pain with a doctor. Most doctors can help find means to manage this difficult time and experience, either through temporary treatment with antidepressants or through recommendations for experienced therapists.
