Expert: Doctor Early Options - 11/5/2009

Question
Dear Doctor Joan,
I think I am having a miscarriage.  I have some bleeding, almost as heavy as my period.  I am having bad cramps. I understand that cramping and bleeding are signs of a miscarriage. I had a prenatal visit last week and everything was normal.  I am 9 weeks pregnant.  How do I know for sure if this is a miscarriage? If it is, do I have to get a D&C?

Answer
Dear Daisy,
Thank you for your question about miscarriage. You are correct that cramping and bleeding that is almost as heavy as a period are indicators that you are having a miscarriage.  Sometimes pregnancy symptoms can be another sign of miscarriage. Nausea can start to decline within 24-48 hours and can be another indication that the pregnancy is not continuing.  However, you can also have cramping, bleeding, and changing patterns of nausea in a normal pregnancy.  The only way to know for sure is to get an evaluation at a doctor's office.  I don't know if this was a planned pregnancy for you, so if it was, I'm sorry this is happening.  You can be reassured to know that early miscarriage is completely normal, and does not indicate that you will have a problem with future pregnancies.  

If it you are only 9 weeks pregnant, the doctor should give you several choices to help complete the miscarriage process.  1) you can do nothing, and let it pass naturally on its own; 2) you can take misoprostol to help this process; 3) you can choose the nonsurgical Aspiration Procedure; 4) the doctor may offer a D&C procedure.  There is more information on these options on my website at: http://www.earlyabortionoptions.com  

If the pregnancy is not passing naturally, or if it is emotionally difficult to wait for this process to occur, I personally recommend the Aspiration Procedure.  Unfortunately most women don't know about it, and it can be difficult to find a doctor who offers this option.  The Aspiration Procedure is a simple, nonsurgical procedure that can be completed in a regular doctor's office in just a few minutes.  It does not involve electric suction, uterine scraping, or general sedation.  The reason I recommend the Aspiration Procedure is that it only takes a few minutes, there is significantly less bleeding or cramping than any of the other options, pregnancy symptoms decline quickly, and it only involves one visit to the doctor.  Emotionally, it can be a relief to get the procedure completed, rather than waiting for unpredictable bleeding to occur.

Personally, I do not recommend a D&C procedure for treatment of miscarriage. It has been associated with scarring of the uterus and fertility problems.  If you do need to get a surgical procedure, make sure that they don't scrape the uterus.  There is no need for the use of a "curette" in a first trimester miscarriage or abortion.  

I hope this information is helpful to you, and good luck.
Doctor Joan
New York City