A missed miscarriage or incomplete spontaneous abortion is a rare type of spontaneous abortion in which the body does not recognize the death of a fetus and does not miscarry simultaneously. Most miscarriages occur within the first 12 weeks after conception. They are usually identified when the fetal heart rate cannot be heard through echo-Doppler testing. Missed miscarriage is confirmed by ultrasound.
Many women do not realize that their child in the womb has died, although women will occasionally notice brown spots. Often, if death has just occurred, the body can simply begin to miscarry within a few days. When it is clear that the body will not miscarry, an obstetrician has several options to terminate the pregnancy.
If the pregnancy is extremely early, before 7-8 weeks, medications 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 relievers to help with contractions. Passing any tissue is usually not physically painful, although it can certainly take an emotional toll on any woman who has to experience a missed miscarriage.
When the pregnancy has lasted more than 8-9 weeks, and a miscarriage is confirmed, doctors tend to perform a dilation and curettage (D&C). Although this procedure is the same as that performed to abort a pregnancy, most women with a miscarriage do not have to go to an abortion clinic to have this procedure. Almost all hospitals, including those with strong anti-abortion stances, do D&Cs for miscarriages.
The importance of the D&C is to minimize the risk of infection. If the pregnancy materials are not eliminated from the body, they can become infected over time and cause significant health problems. When a miscarriage goes undiagnosed, for example, in a woman who is unaware that she is pregnant, the infection can cause significant illness, pain, infection of the blood, and the ability to be unable to have any more children. Women who have carried the pregnancy materials from a missed miscarriage for a long time may require hospitalization to treat significant and life-threatening infections.
A D&C for a missed miscarriage is usually an outpatient procedure. The woman who undergoes one will probably notice bleeding at first, which will gradually subside over a few weeks. Fever, significant pain, or unusually heavy bleeding (needing more than one pad per hour), requires contacting a doctor immediately, as very rare but serious complications can occur after a D&C.
Those who have had a D&C for a missed miscarriage can expect some soreness for a few days after the procedure. Most doctors recommend no sexual activity for six weeks after a miscarriage. Also, they suggest waiting at least three months before trying another pregnancy.
Women who experience a missed 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 the disruption of pregnancy hormones, which can significantly affect mood. Some depression is quite reasonable after losing a pregnancy. Discuss strong feelings of depression, thoughts of suicide, or unrelenting pain with a doctor. Most doctors can help you find ways to manage this difficult time and experience, either through temporary treatment with antidepressants or through referrals to experienced therapists.