Loss

Bleeding: Usually the first sign is bleeding from the vagina. It may be light or heavy, constant or on and off.

It is important to note not all pain or bleeding ends with a pregnancy loss.

Conversely, some people don’t have any symptoms at all when they experience a loss.

Pain/cramping: Usually in the lower belly or lower back.

Passing tissue: dark red blood clots or thick stringy material may pass from the vagina.

If you are experiencing vaginal bleeding or pain, you should seek medical attention. You should contact your family physician, midwife, or obstetrician/gynecologist.

If none of these options are available to you within one to three days, you should go to
your local emergency department.

However, you should go to the emergency department immediately if you:

• Suddenly have severe pain in your abdomen that is not going away or is not lessened with acetaminophen (Tylenol)
• Suddenly feel faint or like you are passing out
• Have very heavy bleeding (soaking more than three pads in three hours)
• Have chills or a fever higher than 38°C (100.4°F)
• Pass any material that looks like tissue. Put the tissue in a clean container and bring it with you to the Emergency Department

Complete Miscarriage

A complete miscarriage means that all pregnancy tissue has passed from the uterus. After diagnosis, bleeding may continue for several weeks and can sometimes be heavy, with cramping and blood clots that may look dark and jelly-like — this can be normal, even if it feels concerning. However, seek immediate medical care if you are soaking more than three pads in three hours, have severe pain not relieved by Tylenol, or feel faint or like you might pass out.

Incomplete Miscarriage

An incomplete miscarriage occurs when some pregnancy tissue has passed, but some remains in the uterus. Vaginal bleeding and cramping may have already begun in this situation.

Missed Miscarriage 

A missed miscarriage occurs when a pregnancy stops developing without symptoms such as bleeding to indicate a loss. Despite the term “missed,” it’s important to know that you did nothing wrong and did not overlook anything.

If you are diagnosed with an incomplete or missed miscarriage, this confirms an early pregnancy loss. Your doctor will discuss the available management options with you.

Expectant Management 

Watchful waiting (expectant management) is an approach to early pregnancy loss where no medical treatment is used. Instead, the goal is for the pregnancy to pass naturally without medication or surgery. Some people choose this option if bleeding has already started, while others choose it after a confirmed loss but before bleeding begins. The process can take days to weeks, and in some cases, medication or surgery may still be needed if it is not successful.

Medical Management 

Medical management of miscarriage uses medications to help the pregnancy pass more quickly and predictably. Options include misoprostol alone or mifepristone followed by misoprostol (Mifegymiso). Misoprostol helps dilate the cervix and expel pregnancy tissue, while pre-treatment with mifepristone can increase the chance of complete expulsion.

Medications may be taken orally or vaginally, and cause cramping and bleeding, which can start within hours or take up to 48 hours, sometimes continuing for up to 2 weeks. Side effects can include nausea, diarrhea, chills, and severe cramping. Pain can be managed with acetaminophen, NSAIDs, or sometimes prescribed narcotics.

Patients receive guidance on expected bleeding, pain management, and when to seek help. In some cases, medical management may not fully work, requiring additional medication or surgery.

Surgical Management 

The CuddleCot is a unique temperature-controlled cooling system that slows natural changes, and allows parents to hold, cuddle, and spend meaningful time with their baby after death.

It is available to all of our patients experiencing a stillbirth loss. This option will be presented to you by your care team and the choice to use this is optional. 

There are several things you can do to ease breast discomfort you may experience and stop milk production when you are diagnosed with the loss of a pregnancy.

The main thing that impacts milk production is how fully and how often the breast tissue is emptied. When milk is removed from the chest/breast, it sends signals to your brain to produce more.

The goal is to have most of the milk stay in the breast tissue so your body knows to stop making more, without causing engorgement and/or mastitis. Removing small amounts (drops or a teaspoon worth) is okay. Do not drink less fluids – this will not slow down milk production, and can make you dehydrated.

Some tips to help with any discomfort are to:

• Gently express tiny amounts of milk
• Apply cold compresses for 15 minutes at a time – you can repeat this every hour
• Avoid the use of heat on your breast tissue
• Take over the counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil) as recommended on the label
• Wear comfortable bras and tops that are not too tight. Tight clothing can cause problems such as blocked ducts which can lead to mastitis.

Stopping milk production can take a few days to a few weeks. If you have any concerns or are worried you may have an infection, please contact your healthcare provider (OB, midwife or family doctor).

You may also reach out to Algoma Public Health for guidance and support from a lactation nurse.