Let me start again.We have covered quite a bit and there is more to write in this segment.
Q.21. What do you mean by nature taking its own course ?
A.21. We also call this by ‘expectant management’ of an early pregnancy loss. Here your doctor may suggest to you to wait without doing anything for a week or so..Around fifty percent of women who choose this plan of management will be successful in completing the process of emptying the womb.It can take some time before the bleeding starts and can last upto three weeks.There may be heavy bleeding with cramping pain.If you can not tolerate it you may have to be admitted to hospital.
Normally, the doctors call you back( follow up ) two weeks after the diagnosis.If your bleeding and pain has settled by then,it is safe to assume that all the pregnancy has come away. You can do a pregnancy test after one week after this. Usually it will be negative but if it still remain positive you need to contact your doctor or hospital.
On the other hand,if the bleeding fails to stop within seven to fourteen days or is persisting or is getting heavier,you may need another scan. Depending on the scan findings further discussion on management will be discussed,for example,continuing expectant management, medical treatment or an operation.
Q.22. What do you mean by medical treatment of early pregnancy loss?
A.22. It is where you will be offered a medication called misoprostol, usually as vaginal pessaries, however, if you like to take it by mouth you can ask for it. This medicine will help to open up the neck of the womb ( cervix ) and let the remaining pregnancy come away. It may take a few hours and you may experience some bleeding and pain. You will also get painkillers and other medicines to stop vomiting. Some women experience diarrhoea and vomiting.
You need to contact your doctor or hospital,if bleeding has not started 24 hours after treatment.
It is expected that you may bleed for upto three weeks after the treatment is over but if you think it is very heavy then certainly contact your hospital.
Your doctor will advise you to do a pregnancy test three weeks later. If the test is positive,you should contact your hospital for a follow up appointment. It may be possible that the treatment has not worked and then you will be given the option of having an operation.
Usually,the treatment is successful in 85 out of 100 patients. You may choose this medical treatment if you want to avoid an anaesthetic.
Q.23. What is involved in operation?
A.23. We call it as evacuation of retained products of conception ( ERPOC ).It may be carried out under general or local anaesthetic.In the former you will sleep for a few minutes and in the later an anaesthetic injection will be put in your neck of the womb.It is successful in 95 out of 100 women.
You may be given tablets to swallow or vaginal pessaries before the operation to soften your neck of the womb.The pregnancy will be removed through the cervix.You will have no cuts in your body.
We normally advocate surgery a few days of your pregnancy loss but occasionally we advise it immediately.Immediate surgery is needed if there are signs of infection,if you are bleeding heavily and continuously or medical treatment to remove pregnancy has been unsuccessful.
Q.24. What happens to the pregnancy remains? Does the fetal tissue go to waste?
A.24. No.When you go operation theater your doctor take your consent on a form.He should explain to you that the tissue goes for some test.It is examined under microscope ( a machine which can show magnified details of tissue to make a diagnosis).We need to know whether there are fetal tissues in the sample that has been sent to the laboratory.If is it there then we know that the pregnancy was in the womb. If fetal tissue is not present in the sample then the pregnancy could be elsewhere,for example,in the tube ( ectopic pregnancy ).It may be also possible to check whether there is an abnormal change in the placenta,for example,molar pregnancy.
You will be able to discuss options for disposal of fetal remains with the doctor.
Q.25. How long will I suffer from vaginal bleeding and discomfort in my tummy?
A.25. It is possibile to have vaginal bleeding for one or two weeks after your miscarriage.Initilly,it will be heavy and later it will become light.Red coloured blood may be replaced by a brown discharge later on.It is best to avoid using tampons for the fear of infection and instead of that I will suggest sanitary towels use.
You can expect your period to return in 4-6 weeks but remember the egg will be released before the period. So if you have not taken a suitable contraceptive precaution you can fall pregnant before your next period.
Your discomfort should pass away in a few days.But if it remains for a long time and on top of that there is heavy vaginal bleeding,cramps,foul smelling vaginal discharge,fever or vomiting please go to your doctor.Either there is some infection in your womb or there is an injury to the pelvic organs.
Q.26. How long does it take for emotional recovery?
A.26. It varies from patient to patient. Most recover within a few weeks but in others it may take a long time.Some of you remain depressed and tearful for months. You should then take professional advice. Remember your partner may go through similar mental trauma.Also your family and friends can chip in at this time.
Q.27. How early I can try for a baby?
A.27. It depends how quickly you and your partner recover physically and mentaly.There is no fixed time. You may wait till your discharge subsides,discomfort disappears and you feel the urge. There is a small risk of infection if you engage in sexual activity within couple of weeks of miscarriage.
Q.28. I am a working woman. When can I return to work ?
A.28. It depends on you and how you feel. It is advisable to rest for a few days before your routine activity. You must be physically and mentaly strong enough to go out.
Q.29. When can I resume sexual activity ?
A.29. There is no hard and fast rule.You and your partner both must feel ready.When your bleeding and pain is significantly reduced and you are feeling well you may resume sexual activity.
Q.30. When can we try for a baby ?
A.30. When you and your partner feel it is the right time physically and mentally you can try for a baby..
Q.31.Is my risk of having an early pregnancy loss more next time?
A.31. Not all.You are not at a higher risk. Most early pregnancy losses happen as a one off event and you have a good chance of a successful pregnancy next time round.Very few women have a condition which makes them more prone to have further miscarriages.
We will talk again later and point out some measures to implement before the next pregnancy.