Pregnancy loss aftercare and advice

We are sorry for your pregnancy loss.

This leaflet will be given to you by hospital staff, to help you understand what can happen following your pregnancy loss. It explains the importance of looking after yourself both emotionally and physically, plus it gives advice on what will happen next depending on what type of miscarriage you have had. If after reading this leaflet you have any questions or concerns, please speak to a member of staff in the Early Pregnancy Assessment Unit (EPAU).

How can counselling help me?

Following a pregnancy loss there is no right way for you to feel emotionally. You may find your emotions are heightened following your loss. This is to be expected due to grieving the loss itself and needing time to process what has happened. The emotions you will be feeling will also be heavily affected by the sudden dropping of your hormone levels. This may cause sudden tearfulness, and spells of headaches and fatigue (extreme tiredness).

Should you feel you need some counselling after your pregnancy loss, please contact your nearest EPAU Clinic to be referred for this service. For more information on counselling, please ask a member of staff for a copy of the Women’s Health Counselling Service leaflet.

Looking after yourself following a pregnancy loss is as important as any medical care you receive. You should make sure you are eating and drinking well. You should also make sure that you are resting but remaining active, to prevent developing complications such as a blood clot.

General advice for women following a miscarriage

The following advice should be read and followed by all women who have had a miscarriage.

• Bleeding from your vagina can be expected to last for up to two weeks following a miscarriage. This should ease over time with less clotting. If bleeding continues for longer than two weeks, please contact the EPAU.

• There should be no abnormal smell. If your discharge does smell abnormal, please contact the EPAU as you may have an infection.

• Sanitary towels should be used while you are bleeding, to lessen the chance of you developing an infection. You can use tampons when you have another period.

• You may feel pain for a few days after your miscarriage. This is normally a period type cramping, which should get better over time. Paracetamol and ibuprofen can be taken to help with pain relief. If you still have pain and / or bleeding two weeks after your miscarriage, contact the EPAU for advice (see contact details at the end of this leaflet).

• If you are feeling unwell, like you have an infection, please contact the EPAU.

• You will be asked to carry out a urine pregnancy test following your miscarriage at an appropriate time; this is usually three weeks after your miscarriage. If this test is positive you should contact the EPAU for advice. This is to make sure all the pregnancy tissue has gone.

Advice for women following a molar pregnancy

A molar pregnancy is when there is a problem with a fertilised egg. This means a baby and a placenta do not develop the way they should after conception.

If you have been told you have a suspected molar pregnancy, this will be confirmed by histology testing. Histology testing is the study of microscopic pieces of tissue. Results should be available approximately 14 days after the sample is sent to the laboratory. You will be contacted if it is confirmed as a molar pregnancy.

Until your results are available, you should follow the General advice for women following a miscarriage above. If you have very heavy vaginal bleeding during this time, please contact the EPAU or go to your nearest Emergency Department immediately.

Advice for women following a miscarriage where genetic testing is involved

If you have had recurrent miscarriages (three or more in a row) you will have been offered genetic testing, so we can try and find out why this keeps happening to you. It is a woman’s choice whether to have this testing, and your consent is needed. The EPAU nurse will discuss with you why this is important.

The sample that is taken from you is sent to Guy’s and St Thomas’ Hospital in London for testing. Please note that this sample is not returned to us. We recommend you wait for your test results to arrive (usually a few months) before trying to get pregnant again.

Your GP should refer you to the East Kent Hospitals’ Recurrent Miscarriage Clinic for further investigations, if these have never been carried out.

Should you fall pregnant again at any time in the future, you should have an early scan with the EPAU to assess your pregnancy at around six to seven weeks. You can book this scan yourself, using the contact details at the end of this leaflet.

Advice for women following conservative or medical management of an ectopic pregnancy

Following Methotrexate (medication) management for an ectopic pregnancy, or conservative management, it is not unusual to have some pain intermittently, and vaginal bleeding as the pregnancy resolves. If you have a sudden increase in pain or more constant pain you should contact the EPAU for advice. Only go to the Emergency Department if your pain is not controlled with normal painkillers (such as paracetamol or ibuprofen) or it is causing you to lose consciousness.

You should continue going to your follow-up appointments with the EPAU clinic until you are fully discharged.

Your first period following an ectopic may be delayed, but you will hopefully return to a regular cycle by your second period.

You should use contraception following an ectopic pregnancy, and not try to get pregnant again for another three months. If you do become pregnant again, you should book an early scan at around six weeks with your closest EPAU clinic.

For more information, please ask a member of staff for a copy of the Medical management of ectopic pregnancy and pregnancy of unknown location (PUL) which is not resolving spontaneously leaflet.

Advice for women following surgical management of an ectopic pregnancy

• In the first few weeks following your surgery for an ectopic pregnancy, even though you must rest you must also make sure you move around to prevent problems, such as developing a blood clot.

• You should not do any heavy lifting, exercise, have sex, or drive for at least two weeks after your surgery, or until you feel well enough to.

• It is normal to have vaginal bleeding following surgery. But if you have large blood clots or the blood smells bad, you should contact the EPAU for advice.

• Wound care is important. You can get your wounds wet, but you should not soak in the bath. You should keep your wounds uncovered at all times and report any concerns regarding possible infection (such as redness around the wound, the wound leaking, or if you feel as though you have a temperature) to your closest EPAU.

• The sutures (stitches) should dissolve (go away on their own) 10 to 14 days after your surgery.

• Your first period following an ectopic maybe delayed, but will hopefully return to a regular cycle.

• You should use contraception following an ectopic pregnancy, and not try to get pregnant again for another three months. If you do become pregnant again, you should book an early scan at around six weeks with your closest EPAU clinic.

What should I do if I feel unwell at home?

If you feel unwell following any treatment for pregnancy loss, please contact the EPAU or Gynaecological Assessment Unit (GAU) for advice about what to do.

Further information

• Miscarriage Association

Contact details

If you have any further questions or concerns, please contact one of the following:

• EPAU, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate

  Telephone: 01843 234469

• GAU, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate

  Telephone: 01843 235009

• Women’s Health Suite, William Harvey Hospital, Ashford

  Telephone: 01233 651987