Medical management

If you have a missed or incomplete miscarriage, you may be offered medicine to help the miscarriage move along.

If you miscarry early, it’s possible that the pregnancy will come away from the womb naturally and you won’t need any treatment. This is called a complete miscarriage.

But if you have a missed miscarriage or incomplete miscarriage, there are 3 ways this may be managed:

Your doctor should talk with you about what may be the best option for you. You should be given some time to think about the diagnosis and what you want to do.

If you lose your baby after the first 12 weeks of pregnancy, but before 24 weeks, this is known as a late miscarriage. Find out more about treatment after a late miscarriage.

What is medical management?

Medical management means taking medicine to help the pregnancy come away from the womb. You’ll usually be offered medical management if waiting for the miscarriage to happen by itself naturally (expectant management) isn’t medically appropriate or if you’ve been waiting for 14 days but are still having symptoms.

How does medical management work?

If you have been diagnosed with an incomplete miscarriage, you will be given medication called misoprostol, usually as vaginal pessaries or oral tablets. This medication helps the neck of the womb (cervix) to open and lets the pregnancy come away.

If you are diagnosed with a missed miscarriage, the NICE guidelines recommend that you are given mifepristone first and another medication called misoprostol 48 hours later. Research has shown that giving people a combination of these medications makes the procedure more likely to work.

It will take a few hours for the bleeding to start. You’ll feel some pain and have bleeding or clotting (like a heavy period). You will be offered pain relief and anti-sickness medication. Some women may experience diarrhoea and vomiting.

Will I have to stay in hospital?

This depends on your local hospital or Early Pregnancy Assessment Service but in most cases, you’ll be able to go home while you wait for the miscarriage to complete. This is safe, but you should contact your Early Pregnancy Assessment Service or hospital if:

  • bleeding has not started 24 hours after treatment
  • your bleeding becomes very heavy (if you soak through 1 or more sanitary pad in an hour).

After medical management

You may bleed for up to 3 weeks and you’ll be asked to do a pregnancy test after 3 weeks. If it’s positive, you should contact your hospital or Early Pregnancy Assessment Service to arrange a follow-up appointment. If the treatment has not worked, you will be offered an operation.

How successful is medical management?

Medical management is successful in 85% of cases.

Are there any risks with medical management?

The risk of infection is the same if you choose medical or surgical treatment. Your doctor should talk to you about any possible risks before you have surgery.

What happens to my body during a miscarriage?

When you miscarry, your body will go through some changes. Find out more about what happens.

Will they do any tests to find out why I miscarried?

Unless this is your third miscarriage in a row, it’s unlikely you’ll receive more tests. This is because most women will go on to have a successful pregnancy in the future. Find out more about tests after miscarriage.

Your emotional health after a miscarriage

Losing a baby can be heart breaking. Your feelings and emotions are your own and no-one can tell you how you should or shouldn’t be feeling. There is no right or wrong way to feel about pregnancy loss. 

Everyone is different. Some women come to terms with what happened within a few weeks, for others it takes longer.

Taking the time you need to grieve may help you move on and think about the possibility of trying again, if that’s what you want to do. There is support available if you need help. 

You can also talk to a Tommy’s midwife free of charge from 9am–5pm, Monday to Friday on 0800 0147 800 or you can email them at [email protected]. Our midwives are also trained in bereavement support and are able to talk to you about what you're going through.

Can I have a memorial for my baby?

If you lose a baby before 24 weeks, you won’t be given a legal certificate for the loss. This can be very upsetting for some parents because there is no legal recognition that their baby existed.

There is no legal requirement to have a burial or cremation, but some women find that having a memorial for their baby helps them to cope with their grief. You can ask your nurse, midwife the hospital chaplain, PALS (Patient Advice and Liaison) officer or hospital service about the arrangements at your hospital. For example, some hospitals have a book of remembrance.

There are lots of other ways to commemorate your loss. Find out more about remembering your baby after miscarriage.

Clinical Knowledge Summaries. Miscarriage!topicSummary (Page last reviewed May 2018 Next update due: December 2023)

Royal College of Obstetricians & Gynaecologists (2016) Early miscarriage

NHS Choices. Miscarriage (Page last reviewed: 1 June 2018 Next review due: 1 June 2021)

NICE (2023). Ectopic pregnancy and miscarriage: diagnosis and initital management . National Institute for health and care excellence Overview | Ectopic pregnancy and miscarriage: diagnosis and initial management | Guidance | NICE

Chu JJ  et al. (2020) Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial. Lancet. 2020 Sep 12;396(10253):770-778. doi: 10.1016/S0140-6736(20)31788-8. Epub 2020 Aug 24. PMID: 32853559; PMCID: PMC7493715.

Review dates
Reviewed: 15 January 2020
Next review: 15 January 2023

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