A missed miscarriage or incomplete miscarriage is a rare type of miscarriage where the body fails to recognize the death of an unborn child and does not simultaneously abort. Most missed miscarriages occur within the first 12 weeks after conception. They are usually identified when no fetal heart rate can be heard through echo-Doppler testing. The miscarriage is then confirmed by ultrasound.
Many women do not realize that their child in utero has died, though occasionally women will notice brownish spotting. Often if death has just occurred, the body may simply begin to miscarry within a few days. When it is clear the body will not miscarry, an obstetrician has several options for ending the pregnancy.
If the pregnancy is extremely early, prior to 7-8 weeks, medication like misoprostol can cause the body to expel the remaining tissue in the uterus. This is non-invasive, and the resultant tissues expelled 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 contractions. Passing any tissue is not generally physically painful, though it can certainly take an emotional toll on any woman experiencing a miscarriage.
When the pregnancy has lasted for longer than 8-9 weeks, and a miscarriage is confirmed, physicians tend to perform a dilation and curettage (D&C). Even though 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 done. Almost all hospitals, including those with strong anti-abortion stances perform D&Cs for miscarriages.
The importance of the D&C is to minimize risk of infection. If the pregnancy materials are not removed from the body, they can over time become infected and cause significant health problems. Where a miscarriage is not diagnosed, for example in a woman who does not notice she is pregnant, infection can cause significant illness, pain, blood infection, and the ability to not be able to have more children. Women who have carried the pregnancy materials of a missed miscarriage for a long time 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 undergoing one will probably notice bleeding at first, which will gradually lessen within a few weeks. Fever, significant pain or exceptionally heavy bleeding (needing more than one pad an hour), necessitates 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 miscarriage can expect some pain for a few days following the procedure. Most doctors recommend no sexual activity for six weeks after a miscarriage. As well, they suggest waiting at least three months before attempting another pregnancy.
Women suffering a missed miscarriage are as likely to be affected by postpartum depression as women who have had a full-term healthy pregnancy. This is due to the stoppage 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 grief with a physician. Most doctors can help one find the means for handling this difficult time and experience, through either temporary treatment with anti-depressants, or through recommendations for experienced therapists.