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DECISION BOARD Early Pregnancy Loss Clinic Women’s Health Centre SPONTANEOUS MISCARRIAGE PROS Miscarriages are common and occur in 15-30% of all pregnancies. Having a miscarriage does not mean you will not carry a normal pregnancy in the future. Miscarriages are not your fault. Able to be at home during the process. Expulsion of the products of conception (POC) without the assistance of either medical or surgical means (D&C) This is a natural process with an unknown timeline. CONS Length of time for the process to complete and the potential prolonged draining of the emotions of you and your significant other Fear of the unknown – especially with the first pregnancy If the miscarriage is not complete (some of the products of conception do not expel) there is a chance that a D&C may be needed. If bleeding severely, i.e., soaking one pad per hour for two hours or soaking a full pad in one half hour for one hour you must seek medical attention at the nearest Emergency Department for potential D&C. ADMINISTRATION OF VAGINAL MEDICATION PROS This method is commonly used worldwide and is 89 – 98% effective. If a follow up D&C is required the medication has begun the process of dilating the cervix which will assist the surgeon and yourself. This pre-dilatation should therefore reduce your operative risk. D:\493700134.doc CONS Minimally invasive medical procedure. Fear of the unknown – emotional upset High rate of effectiveness on the first insertion. Two insertions may be necessary Cramping and Bleeding May end up with a D&C Must be willing to return to clinic for several visits, as necessary 60+% of patients will begin to miscarry on first dose – usually 8 hours after insertion. This will be evident by increased cramping and some bleeding. Process timeline usually 48 hours to 3 days. MISOPROSTOL ONLY REGIME Effects of fetal demise process: COMMON SIDE EFFECTS Cramping - Often described as similar to menstrual cramps. Nausea Bleeding Vomiting Average bleeding time usually 2 weeks. Diarrhea Often described as similar to a heavy period in a spontaneous miscarriage. Headache OF THE DRUG Dizziness Fever and Chills Rashes Pelvic Pain DILATATION AND CURETTAGE. (D&C) PROS This is the surgical stretching (dilatation) of the cervix (opening into the uterus) and the gentle scraping away of the uterine contents. This lining is normally shed during the menstrual cycle each month. D:\493700134.doc CONS Procedure booked and performed usually within a week. Use of anesthetic and surgical procedure is invasive, and therefore has risks. Able to return to usual daily activity after 24 hours, or when you feel able to do so. 98-100% effective. Possible complication of infection as noted by – fever, foul smelling discharge, persistent abdominal pain not relieved by analgesic, continuing to pass clots or bleed. If you get an infection following, this may cause damage to uterine lining (Asherman’s Syndrome) and may make future pregnancy implantation difficult. Possible uterine or cervical damage.