Miscarriage

What to do if you are pregnant and begin bleeding

If you are pregnant and begin bleeding vaginally, go to your local emergency department. A list of Montreal emergency departments is available on the Santé Montreal websiste. If you live outside of Montreal, call 8-1-1 (in Quebec) to find your local emergency department. If you are outside of Quebec, consult our list of telehealth phone numbers across Canada.

What will happen at the emergency department?

You will be triaged by a Registered Nurse and will be seen according to your priority.

You will be seen and examined by a physician to evaluate your condition and discuss the plan of action. This will include an internal exam with speculum.

Blood tests will be performed including pregnancy level and your blood type. If your blood type is "negative" you will need to receive a medication called rho (d) immune globulin.

An ultrasound might be booked, ideally within 24 hours, to determine whether or not:

• You have had a miscarriage
• The baby is still alive
• There is a reason for your pain and/or bleeding (e.g., an ectopic pregnancy)

What will happen next?

If the miscarriage is complete, you will not need any further treatment.

If the miscarriage is not complete, there is a range of options available:

1. You may choose to let nature takes its course (it is normal for the bleeding to continue for up to three weeks).
2. You might want to accelerate the process with a medication.
3. You may choose the surgical treatment. Surgery is usually arranged as a planned operation within a few days. You may be advised to have surgery if you are bleeding heavily and continuously for more than eight hours, if there are signs of infection or if the natural process is unsuccessful.

What is a miscarriage?

A miscarriage is the premature end of a pregnancy before the developing baby is able to survive outside the womb. Between 25% and 30% of all pregnancies may end in miscarriage. 90% of those will occur during the first trimester (the first 13 weeks of pregnancy).

Vaginal bleeding is the most common symptom of miscarriage. If a miscarriage process has started, it will not be possible to stop it through treatment.

No treatment is usually needed but options are available.

What causes a miscarriage?

Research shows that most miscarriages are due to an error in the genetic make-up of the pregnancy. Nature’s response to this problem is by spontaneous miscarriage. Individual causes are not usually found.

Nothing you did (or did not do) could have caused or prevented this.

Miscarriages are unexpected events. They are not caused by exercising, sex, climbing a ladder, lifting heavy objects, going through an emotional experience or being stressed.

Once you get home: Self-care and coping

To reduce the chances of infection, sanitary pads are advised rather then tampons until your next period. You may also be advised to wait until the bleeding has stopped before having sex. Your next period will be in four to six weeks.

Ovulation occurs before your next period, so you are fertile in the first month after a miscarriage. If you do not want to become pregnant, you should use contraception.

How will I feel?

The end of a pregnancy is a deeply personal experience that affects everyone differently. It can have a considerable emotional impact. It is common for both partners to feel a combination of emotions.

Many women grieve but come to terms with their loss. Others feel overwhelmed and find it difficult to cope. Physical symptoms such as fatigue, loss of appetite, difficulty concentrating and trouble sleeping can be signs of emotional distress.

Many women experience a profound sense of loss and disappointment; they describe a feeling of numbness and emptiness. Other women experience feelings of guilt; blaming themselves or others for what they did or did not do.

Grieving

You should take all the time you need to grieve. Talk about your feelings with a close friend, family member, a counsellor or your physician. If you are concerned or feel unable to cope you should talk to your physician and ask for a referral for support or counseling. Concordia students have access to counselors through Counselling and Psychological Services; staff and faculty can access mental health professionals through the Employee Assistance Program.

When can I return to work?

You may discuss this with your physician or nurse.

When can we try for another baby?

You may discuss that with your physician or nurse.

When to contact your physician

Come to Health Services, go see your doctor or go to the emergency department if you experience:

• Chills, flu-like symptoms or fever over 38.5C for more then 24 hours
• Acute abdominal pain or cramping not relieved by acetaminophen or ibuprophen
• Bleeding more then one sanitary pad per hour for over six hours
• Smelly or yellow-green vaginal discharges
• Feeling faint or pain in your shoulders
• Feeling depressed, wanting to die or hurt yourself or others

Additional resources

• Coping with a miscarriage from Babycenter.ca
  
• After a Miscarriage: What Happens and How to Cope from What to Expect
• Emotional Aftermath of Miscarriage from Parents Magazine
• Emotional Healing After a Miscarriage: A Guide for Women, Partners, Family, and Friends from Georgetown University School of Nursing & Health Studies