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When You've Been Diagnosed with a Miscarriage

Updated on October 11, 2014
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About Your Miscarriage Diagnosis

Because of my work on the Misdiagnosed Miscarriage site, women often ask about the risks and complications associated with surgical, medical and natural miscarriages.

I am not a medical professional but I have talked to thousands of women about their choices. I'd like to share a bit of what I've learned and hopefully help you in making an informed decision. Take what you read here and discuss your options with your physician. This information is only meant to supplement what your physician gives you. If you feel your physician is not doing enough, do not hesitate to seek out a second opinion. With miscarriage comes risk and you need to make the best decision for you.

I am not a medical professional. The information I share is meant to supplement the information given you by your doctor. If you feel your doctor is not doing enough for you or not willing to listen to your concerns, I strongly encourage you to take what you've learned here and get a second opinion.

The Most Important Question:

Are you 100% certain this is truly a miscarriage?

Before you take steps to end your pregnancy, you need to be 100% certain this is an actual miscarriage. I say this because more and more women are sharing their Misdiagnosed Miscarriage stories. Unfortunately some medical professionals are quick, a little too quick to want to end a pregnancy. This is your pregnancy and your body. If you feel rushed to end the pregnancy, seek a second opinion.

So how can I know without a doubt this is an actual miscarriage

If your doctor suspects a molar pregnancy (abnormal tissue) or an ectopic pregnancy (gestational sac growing outside of the uterus), you will most likely need medical intervention.

If your hCG levels are falling quickly, this too can be a sign of miscarriage. Although, please keep in mind, there are reasons why hCG levels slow, plateau and even decline in viable pregnancy. Falling hCGs should not be taken as a sure sign of pregnancy unless they suddenly start dropping quickly or are taken with other signs of miscarriage. Please remember, one hCG level check is not enough to confirm a miscarriage. Please ask for a follow up check about 48 hours out to see what your numbers are doing.

Also, some doctors will tell you that if the gestational sac still looks empty at seven weeks, you should have a D&C. We know this is not necessarily true. I've talked to women who have had hCG levels 50,000 to 100,000 and above before seeing their babies. Often they have a tilted uterus and despite what your doctor may tell you, we've found that women with a retroverted uterus often look one to two weeks behind and see their babies a bit later (most by nine or ten weeks).

Also, if you are showing signs of infection and your doctor believes you are miscarrying, the D&C may be the best course of action.

If you see the baby during the first trimester without a heartbeat during the transvaginal ultrasound, do not automatically assume all is lost. I've been told that in cases like this, you should ask for a follow-up ultrasound at least seven days out. Sometimes the baby is just too small still and you want to give everything a chance to grow if the pregnancy is indeed viable. If you only wait two or three days, the baby could still be too small.

As always, during pregnancy, if you show signs of infection, heavy bleeding, fever, chills, pain in abdomen, chest or shoulder or dizziness, you should be seen immediately.

Once you are certain your pregnancy is no longer viable, you can make one of three choices. You can choose to wait out a natural miscarriage. You can choose surgical intervention (D&C or D&E) or you can have a medically-managed miscarriage by taking medication to induce the miscarriage.

I know this is a painful time and I hope this page can help you make the decision that is best for you.

Miscarriage Options

When you have no doubt you've been diagnosed correctly

When deciding how to end a pregnancy, women need to weigh the risks involved when making their decision. This study looks at the common risks of Surgical Management (i.e. D&C), Medical Management (i.e. Misoprostol) and Expectant Management (aka natural miscarriage)

Complications common to surgical, medical, and expectant management* (this list only takes into account symptoms commonly experienced by all three categories)-- taken from

Managing miscarriage: How the options stack up

Pelvic inflammatory disease:

Surgical - 5.4%

Medical - 2.5%

Expectant - 4.8%

Moderate-to-severe hemorrhage:

Surgical - 3.3%

Medical - 17.6%

Expectant - 0.9%

Blood transfusion:

Surgical - 3.0%

Medical - 1.9%

Expectant - 1.0%

Emergency curettage:

Surgical - 2.6%

Medical - 3.4%

Expectant - 4.3%

Diarrhea:

Surgical - 2.5%

Medical - 28.7%

Expectant - 7.3%

Vomiting:

Surgical - 1.6%

Medical - 7.2%

Expectant - 1.1%

All three choices carry the risk of Sepsis (life threatening) and infection.

Some additional considerations when making your decision:

Surgery - additional risks:

--Uterine perforation or cervical trauma

--Uterine adhesions

--Repeat D&C when products of conception are missed the first time

--Higher risk of infection

--Sepsis (life threatening)

Medical - additional risks:

-- Should not be done if you are anemic, have asthma or a clotting disorder. Should also not be done if infection or an ectopic pregnancy is suspected.

-- cramping and bleeding can be much more intense

-- --More likely to need a D&C if used for a blighted ovum diagnosis

--Allergic reactions (i.e. facial swelling, rash, edema, shock)

--Not recommended if pregnancy is more than 49 days. See the FDA's Warning

Expectant - additional risks:

-- The larger the gestational sac, the greater the chance an emergency D&C will be needed.

-- Higher risk of incomplete miscarriage

-- Infection

-- Most miscarriages occur quickly but in some cases they can take days or even weeks to begin.

Reasons to have an Expectant, Medical or Surgical Miscarriage

Now that you know the risks and possible complications, let's decide which method is right for you.

Why an Expectant Miscarriage may be right for you

-- You want your body to take care of this naturally.

-- If successful, does not require the risk of surgery or anesthesia.

-- You have ready access to medical care if complications arise.

Why Surgical Management may be right for you

-- Best if you have unstable vital signs, uncontrolled bleeding, or evidence of infection.

-- You are not comfortable waiting for a natural miscarriage.

-- Fastest way to end a miscarriage.

Why Medical Management may be right for you

-- You are not comfortable waiting for a natural miscarriage.

-- if successful, does not require surgery or anesthesia.

-- You have ready access to medical care if complications arise.

Ectopic and Molar Pregnancies

Your choices are a bit different

Ectopic Pregnancy

If your hCG levels have reached 1500 and a gestational sac is still not seen, your doctor may diagnose you with an ectopic pregnancy. Although we have has some misdiagnosed ectopic stories, due to the very serious risks associated with ectopic pregnancy, this is not one to wait out.

According to the American Family Physician

"Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements."

Many doctors may suggest using Methotrexate. When taken as a multiple dose, the success rate is 93%. Women with lower hCG levels respond more favorably to this treatment.

Also according to the American Family Physician

Methotrexate Therapy Success Rate at Different Baseline Beta-hCG Levels

Initial beta-hCG level (mIU per mL) -- Success rate (%)

Less than 1,000 (1,000 IU per L)-- 98%

1,000 to 1,999 (1,000 to 1,999 IU per L)-- 93%

2,000 to 4,999 (2,000 to 4,999 IU per L)-- 92%

5,000 to 9,999 (5,000 to 9,999 IU per L)-- 87%

10,000 to 14,999 (10,000 to 14,999 IU per L) -- 82%

15,000 or greater (15,000 or greater IU per L)-- 68%

Women experienced more pain, had less energy, and had worse health perception during the first few weeks after treatment with methotrexate, but they had the same quality of life after 16 weeks.

Laparoscopy is the preferred surgical method for treating an ectopic pregnancy. Although, some doctors will first do a D&C and monitor hCG levels to rule out an ectopic pregnancy first. If hCG levels begin to rise during the expectant management phase or after taking the Methotrexate, surgical intervention is often necessary.

Molar Pregnancy

Diagnosis of a molar pregnancy almost always ends in surgery. When the tissue that was supposed to be the placenta begins to grow abnormally it can form into a spreading tumor. The good news is that in roughly 80% of cases, these tumors are non-cancerous. You are more at risk for this cancer if you have a complete as opposed to a partial mole. Fortunately most can be cured.

The most common way to treat a mole is the D&C procedure. If there are complications, chemotherapy or even radiation therapy may be needed.

Generally, women are asked to wait a half year to a year before trying to conceive again. During this time, your physician will want to monitor your hCG levels to make sure they remain at non-pregnancy levels.

Want to Know More

Here are some helpful sites and studies

Should I have medical, surgical, or no treatment to complete a miscarriage? by Quest Diagnostics

Managing First Trimester Spontaneous Abortion article in the American Family Physician

D&C procedure after a Miscarriage information taken from the American Pregnancy Association

D&C procedure after a Miscarriage information taken from the American Pregnancy Association

Court will decide future of abortion pill although this article is discussing abortion rather than miscarriage, this recent article does discuss some risks to take into account before taking this medication

Management of spontaneous abortion in family practices and hospitalsThis study looked at the differences in care between hospitals and family practices as well as the rate of complications.

Diagnosis and Management of Ectopic Pregnancy article in the American Family Physician

Molar Pregnancy information from Everyday Health.

The UK is the first to acknowledge that misdiagnosed miscarriages are indeed a problem. The Royal College of Obstetricians and Gynaecologists has revised its guidelines. If your gestational sac is more than 25mm and/or the CRL is 7mm or more, you should wait a week to verify (if there are no complications). If the measurements are less, you are too early to diagnose. For more information (and something to take to your doctor), please, see my new page:

New Blighted Ovum Guidelines! You ARE Being Diagnosed Too Soon!

I want this information to be helpful for you. If you know of any useful resources or links, please share them. If you can think of any information that would be helpful, please, let us know.

If I don't reply to you here, please feel free to e-mail me directly at misdiagnosedmiscarriage@gmail.com

Comments? Concerns?

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    • Cari Kay 11 profile image
      Author

      Kay 4 years ago

      @SassyH7777: I apologize that this took so long to post. I was out of town for the holiday. Do you have any update. It is early. The discharge could mean miscarriage but it is just so hard to say. Huge (((hugs))) for you.

    • profile image

      SassyH7777 4 years ago

      HiI have literally just found out I was pregnant. my first pregnancy with my 5 year old daughter showed low hcg levels throughout. My 3 subsequent pregnancies ended in miscarriage. I had only just found out I was pregnant when I had my first Ultrasound Scan. Which showed a small black circular sac. I had another ultrasound only 10 days later which showed the same sac but only ever so slightly bigger. I am guessing that I am now 4 weeks pregnant. The doctors have done 3 blood tests all show that hcg levels are climbing but by nowhere near enough what they should be. They want me to go back in 7 days for a scan but I think it is too early. My period cycle is 35 days long and they doctors guessed by the first ultrasound scan how far along I am. They say it's a failed pregnancy, or a miscarriage but as I am not experiencing a lot of pain or problems I want to wait and see.I have had ever so slight bit of brownish discharge but no other bleeding or any pain. What would you do if you were me? I am so emotional and heartbroken because of everything the doctors have said but if my pregnancy is that early, they would see anything on the Ultrasound would they?I am also still getting pregnancy symptoms but it's hard to continue but I know I wouldn't forgive myself if I did what the doctors want me to do.Please contact me or reply back I appreciate any advice you can give me.Xxxx

    • OUTFOXprevention1 profile image

      OUTFOXprevention1 5 years ago

      Wow. Tough subject that needs to be shared. Thanks for the lens.

    • profile image

      anonymous 6 years ago

      I know the pain when miscarriage is happen. The information about the misdiagnosed miscarriage is necessary for every women. You given the excellent clear and detailed information about misdiagnosed and miscarriage. Thanks for sharing this lens. how to induce a miscarriage

    • profile image

      anonymous 8 years ago

      I went to the emergency room on may 29, I was supposedly 12 week pregnant. The ER doctor asked me if I was positive of my dates... I was. My HCG level was 7500, I was sent to ultra-sound were I was informed that I had a blighted ovum. I was heart-broke. I am thirty one years old and this was to be my first child. I opted for a natural miscarriage, because I wanted the time to grieve. Currently my HCG level is 6. I feel better physically, but it will take a while emotionally. I thank you for these comments, it is comforting to know that I am not in this alone. God Bless You