The process of a miscarriage is not the same for each and every woman, so it can be difficult and unhelpful to make generalisations. However, the question of what the process might look like is a very common one, so we thought it would be a good idea to explain those more common processes at different stages of miscarriage.

Before we continue, we would just like to state that the information contained within this article may be upsetting and even triggering for some. While many find it helpful to read up on these things, this isn’t true of everyone. So don’t feel that you must keep going if you are struggling.

Now, let’s begin by explaining what the physical process of miscarriage might be like if it occurs in early pregnancy.

What is the usual miscarriage process of a miscarriage in early pregnancy?

The process usually begins with some bleeding from the vagina, which should prompt a visit to the doctor. After an examination, your doctor may suggest an ultrasound scan, especially if it’s unclear what exactly is going on. Please note, this is by no means a bad sign.

Sometimes, if the bleeding is heavy or sudden, it may be possible to see the miscarried pregnancy. A creamy-coloured sac of membranes that may or may not contain an embryo is typically easy to recognise. However, more often than not, the blood will contain clots that make it rather difficult to distinguish pregnancy tissues. Remember too, that it is quite normal to experience some bleeding in early pregnancy, and that it may even contain clots. Bleeding does not equate to a miscarriage but it is important to see your doctor if you notice any blood.

If a miscarriage occurs before 8 weeks and is complete, it may not be necessary to be admitted to hospital. Or there may be a scan that determines that the uterus is empty and you can go home without treatment. But if a scan suggests that there are still tissues present, the advice will be to go to hospital and either undergo a short operation, known as EPRC (evacuation of retained products of conception), or take some medication to help the uterus expel the pregnancy tissues.

What does EPRC involve?

The benefit of EPRC is that it allows for the pregnancy tissues to be examined, which might help doctors determine the cause of the miscarriage. That being said, there isn’t always an obvious cause. After being admitted to hospital, women must give their consent for the operation by signing a form. As with most operations, it’s important that you refrain from eating or drinking anything for at least 4 hours before the operation. Before the operation begins, you’ll be given a general anaesthetic, most likely one injected into your arm.

During the operation, the cervix is gently dilated (opened), allowing for small instruments to be inserted into the uterine cavity where they can clear out any remaining tissues. If the pregnancy is less than 12 weeks, the tissues will usually be sucked out using a tool similar to a small vacuum cleaner. If the pregnancy is older than 12 weeks, doctors may prescribe a drug that will help to gently soften the cervix and minimize any potential damage. This is especially important because the removal may require the use of forceps.

What does the medication option involve?

If a miscarriage has occurred before the 9-week mark it is now possible to administer certain drugs to empty the uterus. The drugs include a combination of anti-progesterone and prostaglandins. The first tablet, called mifepristone, is taken in the hospital. After waiting for 30 minutes, the patient can then head home. It’s normal to feel a little sick, but it should settle fairly quickly. Period pain and some light bleeding may occur the following day, but paracetamol can be taken to relieve any pain. Around 24 hours after taking the first tablet, a dose of misoprostol will be taken, again in the hospital. This can be taken orally or administered as vaginal pessaries. Most women will miscarry within 4 hours but some may continue to bleed up until 12 days later. The bleeding will generally have stopped by the time they visit the clinic for a follow-up appointment 2 weeks later.

If a baby is larger than 16 weeks’ size, doctors will likely have to induce labour and deliver the baby vaginally. This process is a long one and will of course be very difficult for the mother. Pessaries are inserted into the vagina one at a time over a period of hours to soften the cervix and cause it to dilate. It’s also possible to take this medication orally but it may cause nausea and vomiting for some. After a time, the mother will likely experience some pain in the lower abdomen, similar to period pains. Eventually, the uterus will begin to contract and the baby will be delivered. This process usually takes around 24 hours.

To alleviate as much pain as possible, doctors will offer strong painkillers like pethidine or morphine or even an epidural anaesthetic injected into the back, numbing the body from the waist downwards. Many women prefer the use of painkillers as they can make you sleepy and slightly lessen the emotional turmoil of witnessing the delivery. However, in most cases, it’s up to the individual to make a decision. The final hurdle is the delivery of the placenta, which either takes place spontaneously after the baby or with the help of a midwife.

What is the physical process of a miscarriage?