Miscarriage Treatment

What Is a Miscarriage? What Are Its Causes and Types?

Miscarriage is the spontaneous end of a pregnancy before the fetus reaches the ability to survive outside the uterus (generally before the 20th week of pregnancy or when the fetal weight is under 500 grams). The vast majority of miscarriages occur in the first trimester (the first 13 weeks).

Causes of Miscarriage: The most common cause of miscarriage (in 50-70% of cases) is chromosomal abnormalities in the embryo. These are usually random errors that occur during the formation of the egg or sperm and are most often unrelated to any health problem in the mother or father. Other possible causes include:

• Maternal Medical Conditions: Uncontrolled diabetes, thyroid disorders, polycystic ovary syndrome (PCOS), certain autoimmune diseases (especially Antiphospholipid Syndrome – APS), severe kidney or heart disease.
• Uterine Structural Problems: Congenital structural abnormalities of the uterus (uterine septum, bicornuate uterus), large myomas (fibroids) or polyps within the uterus, intrauterine adhesions (Asherman’s syndrome).
• Cervical Insufficiency: The cervix being too weak to carry the pregnancy and opening painlessly.
• Infections: Certain serious infections contracted by the mother during pregnancy (Listeria, Toxoplasma, some viral infections).
• Hormonal Imbalances: Insufficient progesterone hormone (luteal phase defect) in particular has been proposed as a controversial cause.
• Advanced Maternal Age: The risk of miscarriage increases after age 35.
• Environmental and Lifestyle Factors: Smoking, excessive alcohol consumption, drug use, high caffeine intake, exposure to certain environmental toxins, severe physical trauma (rarely).
• Immunological Factors: An abnormal response by the mother’s immune system to the pregnancy.

In most cases, especially with early miscarriages, it may not be possible to determine the exact cause. It should be remembered that miscarriage is generally not caused by something the mother did or did not do.

Types of Miscarriage: Miscarriages are classified in different ways based on clinical findings:

• Threatened Miscarriage (Abortus Imminens): Vaginal bleeding occurs during pregnancy, but the cervix is closed and a viable pregnancy (an embryo with a heartbeat) is seen on ultrasound. The pregnancy may continue, but there is a risk of miscarriage. Bed rest and follow-up are generally recommended.
• Inevitable Miscarriage (Abortus Insipiens): There is vaginal bleeding and usually cramp-like pain. The cervix has opened. Continuation of the pregnancy is not possible; the miscarriage will occur.
• Incomplete Miscarriage (Abortus Incompletus): Some of the products of conception (embryo, placenta, etc.) have been expelled from the uterus, but some remain inside. Heavy bleeding usually continues. Treatment (medication or surgery) is required to completely empty the uterine contents.
• Complete Miscarriage (Abortus Completus): All products of conception have been expelled from the uterus. Bleeding and pain generally decrease or stop, and the cervix closes. If ultrasound confirms that the uterus is completely empty, no further treatment is usually needed.
• Empty Gestational Sac (Anembryonic Pregnancy): After fertilization, a gestational sac forms, but no embryo develops within it, or development stops at a very early stage. Pregnancy symptoms may be present, but the sac appears empty on ultrasound.
• Missed Abortion (Undetected or Delayed Miscarriage): Development of the embryo or fetus has stopped (no heartbeat), but the body has not recognized this and miscarriage symptoms (bleeding, pain) have not started. The cervix is closed. It is usually diagnosed during a routine ultrasound check. Treatment options (medication or surgery) or expectant management may be offered.
• Recurrent (Habitual) Miscarriage: Generally defined as three or more consecutive pregnancies ending in miscarriage. Comprehensive testing is required to investigate the underlying causes.

What Are the Symptoms of Miscarriage? When Should You See a Doctor?

The most noticeable signs of miscarriage are as follows:

• Vaginal Bleeding: This can range from light spotting to heavy bleeding, more than a normal menstrual period. The blood may be bright red, pink, or brown, and may contain clots.
• Abdominal or Pelvic Pain/Cramps: Cramp-like pain similar to menstrual cramps or more severe, which may also radiate to the lower back.
• Back Pain: Mild to severe pain, especially in the lower back.
• Passage of Tissue from the Vagina: Passage of grayish or pinkish tissue fragments.
• Loss of Pregnancy Symptoms: A sudden decrease or disappearance of previously experienced symptoms such as nausea, vomiting, or breast tenderness (this sign is not always reliable).

Emergency Warning Signs: Immediate medical attention should be sought in the following situations:

• Very heavy vaginal bleeding (for example, enough to completely soak one or more large pads within an hour).
• Severe abdominal or pelvic pain.
• High fever (above 38°C), chills.
• Foul-smelling vaginal discharge.
• Dizziness, feeling faint.

Recommendation: If you experience any amount of vaginal bleeding or severe cramping during pregnancy, especially in the first trimester, you should always consult your doctor to evaluate the situation and rule out other possibilities such as an ectopic pregnancy. You can call 0538 983 18 78 to reach Prof. Dr. Nuray Bozkurt in Ankara.

How Is Miscarriage Diagnosed?

To diagnose a miscarriage, your doctor generally follows these steps:

• Medical History and Symptom Review: Information is gathered about when the bleeding started, its amount and color, the location and severity of pain, and the date of the last menstrual period.
• Gynecological Examination: Performed to assess whether the cervix is open or closed, whether the bleeding is coming from inside the uterus, and its amount.
• Transvaginal Ultrasonography: The most important tool for assessing the status of the pregnancy within the uterus. It evaluates the presence of a gestational sac, the presence of an embryo and its heartbeat, the amount of pregnancy tissue remaining in the uterus, and whether the gestational sac is empty. It distinguishes between complete and incomplete miscarriage, and also rules out the possibility of an ectopic pregnancy.
• Quantitative Beta-hCG Blood Test: Especially when ultrasound findings are unclear or the gestational age is very early, measuring the level of pregnancy hormone in the blood and repeating this a few days later helps with diagnosis. In a healthy pregnancy, hCG levels rise at a certain rate, whereas in miscarriage they usually fall or rise more slowly than expected.

Miscarriage Management and Treatment Options (Case-by-Case Evaluation)

The management and treatment approach after a miscarriage diagnosis is determined based on the type of miscarriage (complete, incomplete, missed, etc.), the gestational age, the severity of bleeding, signs of infection, the patient’s overall health status, and personal preferences. In Ankara, Prof. Dr. Nuray Bozkurt will discuss your situation with you in detail to determine the most appropriate and safest option for you.

1. Wait-and-See Approach (Expectant Management):

• When Is It Considered? This is an option generally for incomplete miscarriages, missed abortions, or inevitable miscarriages in the early weeks of pregnancy (<8-10 weeks), when the patient’s general condition is good, there is no excessive bleeding or signs of infection, and the patient consciously chooses this method. If a complete miscarriage has already been diagnosed, follow-up alone is usually sufficient.
• How Does It Work? The body is allowed to expel the pregnancy tissue from the uterus on its own, naturally. This process can take anywhere from a few days to a few weeks. Bleeding and cramping may occur during this time. Regular follow-up with your doctor (ultrasound, and hCG if needed) is required to confirm success and make sure the uterus has been completely emptied.
• Pros and Cons: It does not require surgical or medical intervention and is a more natural process. However, the timing of completion is uncertain, managing the bleeding and pain can be difficult, the process sometimes does not complete on its own (15-50% failure rate), and there is a risk of infection (albeit low) if tissue remains inside. In cases of failure or complications, medical or surgical treatment is initiated.

2. Medical Treatment (Medication-Induced Miscarriage):

• When Is It Considered? This is a good alternative generally for incomplete miscarriages or missed abortions in the first trimester, for patients who do not want surgery or for whom anesthesia carries risk, and for those who prefer not to choose expectant management.
• How Does It Work? Medications that stimulate uterine contractions and open the cervix to help expel the pregnancy tissue inside (Misoprostol is the most commonly used) are given orally or vaginally. The administration protocol and dosage are determined by the doctor. The process can be followed at home or in a hospital setting.
• Pros and Cons: Surgical and anesthesia risks are avoided. The process is faster and more scheduled compared to expectant management. However, it can cause intense cramp-like pain and bleeding heavier than a menstrual period. Side effects such as nausea, vomiting, diarrhea, and fever may occur. It is not always fully successful (in 10-20% of cases the uterus may not empty completely), in which case an additional dose of medication or surgery (curettage) may be needed. The risk of infection is low. Follow-up (usually ultrasound) is required to confirm success.

3. Surgical Treatment (Emptying the Uterus: Dilation and Curettage – D&C / Vacuum Aspiration):

• When Is It Necessary? Surgical treatment is generally the most appropriate option when there is heavy or uncontrollable bleeding, signs of infection (fever, foul-smelling discharge) develop, a significant amount of tissue remains in the uterus in an incomplete miscarriage, the patient does not prefer expectant or medical management, these methods have failed, or there is suspicion of a molar pregnancy. It is also frequently preferred for patients diagnosed with a missed abortion.
• How Is It Performed? This is usually a same-day procedure performed under light general anesthesia or deep sedation. First, the cervix is gently widened with special instruments (dilation). Then the pregnancy material inside the uterus is removed either by scraping with a special spoon-like instrument (curette) or, more commonly, by suction with a thin cannula and a negative-pressure (vacuum) system (vacuum aspiration). Vacuum aspiration is generally less traumatic and takes less time. The procedure typically takes 10-15 minutes.
• Pros and Cons: It provides fast, controlled, and generally complete emptying of the uterine contents. Bleeding is quickly brought under control. It reduces the risk of infection (especially if tissue would otherwise remain inside). The process is more definitive and predictable. The removed tissue can be sent for pathological examination. However, it is a surgical procedure and carries anesthesia-related risks. Although very rare, there are risks of complications such as uterine perforation, cervical injury, post-procedure infection, or intrauterine adhesions (Asherman’s syndrome).

Recovery After Miscarriage: Support for Both the Physical and Emotional Dimensions

The period after a miscarriage is a process that requires both physical and emotional healing.

Physical Recovery:

• Bleeding: Vaginal bleeding or spotting after a miscarriage or curettage can last from a few days to 1-2 weeks and is expected to gradually decrease. It may be similar to a normal menstrual period or lighter.
• Pain: Mild cramp-like pain may occur, usually controlled with simple pain relievers.
• Risk of Infection: You should watch for signs of infection such as fever, chills, foul-smelling discharge, or severe abdominal pain, and see a doctor immediately if any of these occur.
• Activity: A few days of rest is usually sufficient, after which you can gradually return to normal activities. Unless your doctor advises otherwise, it is recommended to avoid heavy lifting and strenuous exercise for a while.
• Sexual Intercourse and Tampons: To reduce the risk of infection, you should avoid sexual intercourse for the period recommended by your doctor (usually until bleeding has completely stopped, or 2-4 weeks) and use pads instead of tampons.
• Return of the Menstrual Cycle: The first menstrual period usually begins 4 to 8 weeks after a miscarriage or curettage.
• Rh Incompatibility: If the expectant mother’s blood type is Rh negative, an Anti-D immunoglobulin injection may need to be given after the miscarriage or curettage to prevent Rh sensitization.

Emotional Recovery: Having a miscarriage is a significant loss experience, whether the pregnancy was planned or unplanned. It is completely normal to experience a wide range of complex emotions such as sadness, grief, mourning, guilt, anger, disappointment, fear, and loneliness.

• Give Yourself Time: Accept that healing takes time and be kind to yourself. Allow yourself to feel your emotions rather than suppressing them.
• Seek Support: Sharing what you have gone through with someone you trust (your partner, family, or friend) can be comforting. It is important to remember that partners may also experience this loss in different ways.
• Professional Help: If you are struggling to cope, or are experiencing intense sadness or symptoms of depression, getting support from a therapist or counselor can be very helpful. Support groups also offer the opportunity to connect with others who have had similar experiences.
• Remember: A miscarriage is not your fault and is generally not something you could have prevented. Avoid blaming yourself.

Future Pregnancies: Having a single miscarriage generally does not significantly affect your chances of having a healthy pregnancy in the future. However, it is important to feel physically and emotionally ready before considering another pregnancy. By talking with your doctor, you can plan the most appropriate timing for your next pregnancy and any precautions that may be needed. For couples who have experienced recurrent miscarriage (more than two), more comprehensive testing is required to investigate the underlying causes.

Miscarriage Management in Ankara: Prof. Dr. Nuray Bozkurt’s Compassionate and Expert Approach

At her clinic in Ankara, Prof. Dr. Nuray Bozkurt offers patients facing a difficult experience such as miscarriage not only her medical expertise, but also her compassionate, human support:

• Fast and Accurate Diagnosis: Using modern ultrasound and laboratory facilities, she accurately diagnoses the type of miscarriage and rules out other possibilities such as ectopic pregnancy.
• Thorough Information and Shared Decision-Making: She discusses all of the expectant management, medical treatment, and surgical treatment options with you in detail, along with their advantages, disadvantages, and risks. She takes your concerns, preferences, and values into account so that you can decide on the most appropriate management plan together.
• Safe and Skilled Treatment: Whichever treatment method is chosen (expectant follow-up, medical treatment, or surgical curettage/vacuum aspiration), she performs the procedure in line with current medical guidelines, with the highest safety standards and expertise.
• Empathy and Emotional Support: She is aware of the emotional challenges of the loss you have experienced and the process. She approaches you without judgment, listens, patiently answers your questions, and tries to provide the emotional support you need. If she deems it necessary, she refers you for professional psychological support.
• Expertise in Recurrent Miscarriage: If you are experiencing recurrent pregnancy loss, she is experienced in planning and managing the advanced testing needed to investigate possible causes.
• Guidance for the Future: She guides you through your physical and emotional recovery process, offers hope for your future pregnancies, and provides the necessary counseling.
• Accessibility and Trust: She offers you a reliable communication channel for any questions or issues that may arise during or after the treatment process (0538 983 18 78)(0312 284 00 12).

If you are experiencing symptoms of miscarriage or have received a miscarriage diagnosis, you need an experienced specialist who can guide you through this sensitive process, provide the right treatment, and offer support. To meet with Prof. Dr. Nuray Bozkurt at our clinic in Ankara and determine the most appropriate management plan for your situation, please book an appointment by calling 0538 983 18 78 . We are here to support you both medically and emotionally.