Prof Isabel Stabile kindly agreed to answer a couple of important questions about what happens during a miscarriage, as well as how it is currently being handled in our country.
From what I understand there are of course different types of natural miscarriages and all are extremely traumatic to women. Some miscarriages happen quickly and the fetus is naturally expelled by the body and this is usually not a problem for most women: traumatic but quick. What should a woman do if she experiences this type of miscarriage and what is usually the procedure please?
Prof Isabel Stabile: There’s not much to do here other than take pain killers and keep hydrated. The cramps and bleeding don’t usually last more than a few hours, although there may be brownish loss for several days afterwards. I usually recommend that women wait for at least two menstrual cycles before they try to get pregnant again. It is also a good idea to continue taking folic acid during this time.
The other more complicated one I think is called a silent miscarriage or a missed miscarriage where the fetus stops growing and there is no heartbeat – so basically the fetus is no longer alive but the body has not yet expelled it. Can you please explain what treatment and management is usually recommended or followed in these cases and what a woman should expect if she experiences such a sad experience please?
Prof Isabel Stabile: There are actually two situations here: first, the one you describe where the fetus is no longer alive. The second is where the fetus never actually develops. The end result is the same, in other words there is a delay until nature takes its course and the pregnancy ends. It is understandable that women would wish for this process to finish as quickly as possible.
The problem is that a surgical approach, in other words the cleaning out of the uterus (raxkament), has certain risks especially in a pregnant uterus. The biggest risks include perforation of the uterus, haemorrhage, and infection. This is why most doctors would prefer a conservative approach by allowing some time for nature to take its course. Naturally, this causes great distress to women who know their pregnancy has failed but the miscarriage has not yet started. The technical name for this is expectant management or more commonly known as watch and wait.
Evidence-based guidelines from the National Institute for Care and Excellence in the UK, recommend expectant management for 7 to 14 days as the first-line management strategy for women with a confirmed diagnosis of miscarriage. There are of course some exceptions, for example if the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or she is at increased risk from the effects of haemorrhage (for example, if she has blood clotting problems or is unable to have a blood transfusion) or there is evidence of infection.
The guidelines also state that medical management should be offered to women with a confirmed diagnosis of miscarriage if expectant management is not acceptable to the woman. In addition, all women undergoing expectant management of miscarriage should receive oral and written information about what to expect throughout the process, advice on pain relief and where and when to get help in an emergency.
If the resolution of bleeding and pain indicate that the miscarriage has completed during 7 to 14 days of expectant management, the woman should be advised to take a urine pregnancy test after 3 weeks, and to return for care if it is positive.
A medicine called misoprostol can be used for the medical treatment of missed or incomplete miscarriage. This can be taken by mouth or vaginally. Women undergoing medical management of miscarriage should be told about what to expect throughout the process, including the length and extent of bleeding and the potential side effects of treatment including pain, diarrhoea and vomiting. This medication is also called Cytotech and it is available in hospitals in Malta and Gozo.
Finally I should emphasise that women will react to complications or the loss of a pregnancy in different ways, so they should be provided with information and support in a sensitive manner, taking into account their individual circumstances and emotional response.
Thank you Prof Isabel Stabile for your much appreciated guidance about what happens during a miscarriage.
If you have a question you would like to ask one of our experts, you can ask here.
Check out another article featuring more about what happens during a miscarriage here.
For peer-to-peer miscarriage support you may also join the ‘Miscarriages Malta‘ group on Facebook run by Martina Maria Hili.
Francesca Fenech Conti is passionate about social issues and has a BA in Social Policy. She is the Founder and creator of the women only facebook group Women for Women (Malta) and the Women for Women Foundation that works hand in hand with other NGOs and businesses to empower and support women, especially single mothers.
Francesca recently also launched Wham.com.mt to provide a much needed space on the local media scene to promote women’s voices and to provide women with a source of information regarding their general wellbeing.
Click here to check out Francesca’s full bio as well as a list of all her Wham published articles
