Medical management of miscarriage

If you have a missed or incomplete miscarriage, doctors will need to make sure the remains of your baby and pregnancy tissue don’t stay in your womb. This is sometimes called management of miscarriage. 

Medical management is one way they can do this. You should be given all the options so you can make a decision that is right for you.

Making this decision may be the last thing you want to do right now. Or you may want to decide quickly and move forwards. Either way, you may be dealing with feelings of shock and grief, or other complicated emotions. We hope this page helps you understand more about medical management. You may also find it helpful to look at our decision aid here.

On this page we talk about your baby’s body as well as pregnancy tissue. Most people we talk to have told us this is the language they prefer. If this isn’t right for you, we’re sorry. We hope this information will still be useful.

On this page:

What happens during medical management of miscarriage?

Preparing for medical management of miscarriage

Will I have to stay in hospital?

Are there any risks to medical management of miscarriage?

How successful is medical management of miscarriage?

What happens after medical management of miscarriage?

Support for you

What happens during medical management of miscarriage?

Medical management means taking medicine to help the remains of your baby and pregnancy tissue come away from your womb. The remains will leave your body through your cervix and vagina - in the same way as any miscarriage that doesn’t involve surgery. 

A doctor or nurse should talk through your options with you and help you decide whether this is the right option for you.

They will usually offer medical management if you don’t want to wait for the miscarriage to happen by itself (expectant management) and you don’t want surgery.

They may also offer it if you’ve been waiting for 14 days for expectant management but the miscarriage still hasn’t happened naturally.

And they may offer it if you’ve had an incomplete miscarriage, where it has started but some of your baby’s remains and pregnancy tissue are still in your womb.

How does medical management work?

If you are having it because you have had an incomplete miscarriage, you will be given medication called misoprostol, usually as vaginal pessaries or oral tablets. This medication helps the neck of the womb (cervix) to open and lets the remains of your baby and pregnancy tissue come away.

If you’ve had a missed miscarriage, NICE guidelines recommend that you are given mifepristone first (usually by mouth) and another medication called misoprostol 48 hours later (as a vaginal pessary). Research has shown that giving people a combination of these medications makes the procedure more likely to work.

You may be able to go home after taking the first tablets and take the second tablets yourself. Or you may have to stay in hospital for some or all of the process. This depends on the size of your baby when they died. Your doctor or nurse will be able to give you more information about what is best for you.

It will take a few hours for the bleeding to start.  You will feel pain and cramping, usually much worse than it would be on your period. Some women and birthing people who have had a full-term baby describe the cramping as more like early labour pain and contractions. Many people say medical management is more painful than expectant management.

You will bleed from your vagina, usually quite a lot. Women and birthing people have told us that they are shocked by the amount of bleeding. You may also pass large blood clots and tissue.

You will probably pass your baby’s body. This can be distressing, especially if you are not expecting it. You may want to think about whether you want to keep your baby’s body to bury. Not everyone wants to do this, it's a very personal decision. For example, some people prefer to flush their baby’s remains away.

You should avoid hot baths while you are bleeding heavily. These can make you feel faint.

Contact your hospital or EPU immediately if:  

• the amount of bleeding makes you feel unwell, dizzy, faint, frightened or if you soak through more than 2 heavy sanitary pads every hour for more than 3 hours  
• you develop a high temperature (fever)  
• you experience severe pain or cramping that you cannot manage with normal painkillers. 

A doctor or midwife will talk through your concerns with you and help you decide whether you need to go back to hospital.

Bleeding will be heaviest for the first few days. Then it should get lighter (although you may have times when it seems heavier again) and stop after 2-3 weeks. You will be offered pain relief and anti-sickness medication. Some women and birthing people may experience diarrhoea and vomiting.

Preparing for medical management of miscarriage

You will need extra thick sanitary pads. It may also help to have old towels available or other material you don’t mind getting stained.

Cramps usually start before or alongside the bleeding so have painkillers, such a paracetamol, to hand. Your doctor may be able to prescribe stronger painkillers too.

It’s a good idea to make sure that someone can be with you or able to come home to you when the bleeding starts to get heavier and the pain more intense. At its height you are unlikely to be able to do much. It would be good to have someone on call if you have caring responsibilities or other chores that need to be done.

You may find it helpful to ask your EPU/doctor:

• When is my next appointment and who is it with?
• Who should I contact if I am worried about my bleeding or in a lot of pain or I am worried about other symptoms?
• What happens if I change my mind and want to have surgical management?
• If I think I have passed the baby or pregnancy tissue, what should I do next? Do I need to contact the EPU?

Will I have to stay in hospital?

You may be able to go home after taking the first tablets and take the second tablets yourself. Or you may have to stay in hospital for some or all of the process. This depends on the size of your baby when they died. Your doctor or nurse will be able to give you more information about what is best for you.

If you are at home, you should contact your Early Pregnancy Assessment Service (EPU) or hospital if:

• bleeding has not started 24 hours after treatment
• you have a high temperature or other signs of infection such as chills and fatigue
• the amount of bleeding makes you feel unwell, dizzy, faint or frightened
• you soak through more than two  heavy sanitary pads more than every hour for more than 3  hours.

A doctor or midwife will help you decide whether you need to go back to hospital.

We have information here on management of late (second trimester) miscarriage .

Are there any risks with medical management of miscarriage?

About 1-3 in 100 women or birthing people who have medical management will develop an infection. This is a similar number to expectant and surgical management.

About 2 in 100 women or birthing people who have medical management will have a haemorrhage (severe bleeding) and may need an emergency operation. This is the same as the number of people who will have a haemorrhage during expectant management.

How successful is medical management of miscarriage?

Medical management is successful in 85% of cases. This means it will be successful in 85 out of 100 women and birthing people who have it.

What happens after medical management of miscarriage?

You may bleed for 2- 3 weeks or more. You’ll be asked to do a pregnancy test after about 4 weeks. If it’s still positive, you should contact your Early Pregnancy Assessment Service. If the treatment has not worked, you will be offered an operation (surgical management).

Find out more about what happens to your baby after miscarriage.  

Read our suggestions for ways to remember your baby after miscarriage.

Support for you

There is no right or wrong way to feel after pregnancy loss. It is a very individual experience. Many people feel a lot of complicated emotions including guilt, shame, sadness, anger and grief, that can sometimes last a long time.  There is support available for you and/ or your partner (if you have one). Have a look at our pages on support after a miscarriage.

You can also talk to a Tommy’s midwife for free. You can call them on 0800 0147 800, 9am-5pm, Monday-Friday. Or you can email them at [email protected].  Our midwives are specialists who can support you with any aspect of pregnancy loss that would be helpful for you.