After miscarriage, bleeding will frequently remain heavier than a period for the first twelve to twenty-four hours after the uterus has been emptied, but it is OK if bleeding is light. It is not normal to have large clots (greater than a few “grapes”), or very heavy flow (more than a pad in two hours) after the first hour or two. (If either of these things happens, call us). After the first day, the bleeding will begin to be more like a menstrual period and gradually taper off, usually ending by ten to twelve days or sooner.

Cramps should diminish after the first day and be gone within a few days. They should be milder and more tolerable than what you may have had before your miscarriage. Motrin or aspirin or a heating pad may help. Alcohol decreases uterine contractions, so a glass of wine may be beneficial the first day. If you have recurrence of severe cramps after the first few days, call us.

A fever or a foul odor to the vaginal discharge could indicate an infection. Frequently there will be excessive bleeding and cramping also. Please call us if you notice these signs.

Tampons should not be used until the bleeding has stopped, because there is a chance of pushing vaginal bacteria into the healing uterus. For the same reason, swimming should also be avoided until you reach the point that you would be comfortable without a tampon. Bathing in a tub is fine, just climb out once the water is dirty and do not make the water excessively hot. A hot bath can cause dizziness or increase the bleeding in the first few days.

Intercourse is fine once the bleeding has stopped. Please use a contraceptive method for at least the first cycle. Refer to the section that covers starting another pregnancy.

Activity can be resumed as tolerated. Many women feel better returning to their normal activities (including work) after a day or two. You should find your energy level improving rapidly. Exercise is fine. If you experience cramping or bleeding after you exercise, slow down for a while. Your body will let you know if you overdo; in general, you can follow your instincts and do what you feel like doing. There is no reason to stay in bed for two weeks.

You should schedule a follow-up exam in the office for three weeks after the miscarriage occurred.

It is a standard of care to prescribe 5 days of an antibiotic to be taken after the procedure to decrease the risk of developing an infection. We generally give doxycycline for this prophylaxis. If you experience nausea, dizziness or diarrhea while taking this drug, please discontinue its use. We will not plan on using a different antibiotic in this situation, so you don’t need to call us unless the symptoms persist. At your follow up exam, let us know if this happens so we can note it in your chart.

If you are Rh negative you will receive an injection of RhoGam after the miscarriage procedure, to prevent any future Rh antibody development. The injection must be given within 72 hours of the miscarriage to be effective.

Every woman who experiences a miscarriage will feel grief and depression. These reactions are normal and appropriate. Even though you may intellectually understand and accept the loss, do not expect that you can rationalize your feelings. You may feel angry, sad, empty and generally unsettled for several months. The important thing to realize about this grief reaction is that it is normal.

Do not get upset with yourself for feeling sad weeks after the miscarriage, particularly if you encounter a pregnant woman or visit our office (full of reminders of pregnancy), or if a friend conceives or delivers a baby. Time will allow you to work through your grief and prepare yourself emotionally to try again. Sharing your feelings, crying when you feel the need, and continuing with your daily pre-pregnancy activities will help you to gradually return to normal. Exercising and shedding a few extra pounds can help with your self-image and general feeling of well-being also.

A woman who has had one miscarriage does not have an increased risk of a miscarriage with the next pregnancy, although her fear will certainly increase. A woman who has had two or more miscarriages in a row may have an increased risk and some testing may be indicated.

We would like to see you wait at least one full, normal cycle before attempting another pregnancy. This will allow your menstrual cycle to re-establish itself and make sure the uterus has healed. More importantly, it will allow you time to emotionally recover from this loss and be ready for the next pregnancy.

Understandably, you will be anxious with the next pregnancy. Call us as soon as you think you are pregnant. We will try to see you early in the pregnancy. Often an ultrasound will confirm a fetal heart beat and help to reassure you that all is well! (We will discuss this further at your follow-up visit).