Expectant management

Expectant management is one of 3 treatment options you can have if you have a missed or incomplete miscarriage.

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 might 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 expectant management?

Expectant management means waiting for the miscarriage to happen by itself naturally, without treatment. You don’t need to be at the hospital for expectant management.

You may not be offered expectant management if:

  • doctors think you have an increased risk of haemorrhage (severe bleeding)
  • you’ve had a stillbirth, miscarriage or haemorrhage in a previous pregnancy
  • you are at increased risk from the effects of haemorrhage (for example, if you’re unable to have a blood transfusion
  • you may have an infection.

How long does expectant management take?

It can take some time for the bleeding to start and this may continue for up to 3 weeks. This may be heavy and you may have cramps.

Contact your hospital immediately if:

  • the bleeding becomes particularly heavy
  • you develop a high temperature (fever)
  • you experience severe pain or cramping.

This may mean that the pregnancy tissue isn’t coming away by itself and you are at risk of infection.

You’ll be given a follow-up appointment about 2 weeks later. If the bleeding and pain has settled by then, the pregnancy has probably come away. You’ll be asked to do a pregnancy test a week after this appointment. If it is still positive, you should contact your local Early Pregnancy Assessment Service.

If bleeding doesn’t start within 7–14 days, isn’t stopping or is getting heavier, you will be offered another ultrasound scan. If the pregnancy hasn’t completely come away, your doctor will talk to you about your options. These may include:

How successful is expectant management?

Expectant management is successful in about 50% of cases.

What happens to my body during a miscarriage?

Your body will go through some changes when you miscarry. 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. However, different clinics will have different criteria, so speak to your GP to find out what your local policy is. 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.

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.

Read more about miscarriage management

Sources

Clinical Knowledge Summaries. Miscarriage https://cks.nice.org.uk/miscarriage#!topicSummary (Page last reviewed May 2018 Next update due: December 2023)

Royal College of Obstetricians & Gynaecologists (2016) Early miscarriage https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-early-miscarriage.pdf

NHS Choices. Miscarriage. https://www.nhs.uk/conditions/miscarriage/ (Page last reviewed: 01/06/2018 Next review due: 01/06/2021)

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    Last reviewed on January 15th, 2020. Next review date January 15th, 2023.

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    Comments

    Please note that these comments are monitored but not answered by Tommy’s. Please call your GP or maternity unit if you have concerns about your health or your baby’s health.
    • By D. Ramirez (not verified) on 9 Dec 2019 - 11:43

      So in August I found out I was pregnant. Right after I found out I had a miscarriage or wat I thought was a miscarriage. Before I was able to go to Dr I went to jail for a month. When I got out I was still testing positive on pregnancy test but was told it could be a false positive. But then kept on growing. Could I had possibly had a miscarriage of one baby and still be pregnant with the other???

    • By Shree (not verified) on 14 Oct 2019 - 08:36

      How long is it safe to wait for fetus to pass after a missed miscarriage? I was told I miscarriage at 8 week. Not blood, no spotting, no pain no nothing. If has be 4 weeks since the doctor couldn’t find a heartbeat. I really want my fetus to pass natural but I don’t want to jeopardize my health so how long should I wait before I proceed with another option?

    • By Anon (not verified) on 25 Jun 2019 - 15:55

      I’ve just gone through a missed miscarriage. I’ve had my follow up scan which should have been my 12 week pregnancy scan and the doctor has said the miscarriage is incomplete and to wait 2 weeks more for the miscarriage to complete naturally. On my scan last week (I would have been 11weeks) she said the baby hadn’t grown since 8-9 weeks so I’m scared waiting for 2 weeks more leaves me vulnerable to infection? All in all the aftercare hasn’t been good at all and leaving me very worried and unsure.

    • By Amanda (not verified) on 2 Jul 2019 - 11:02

      I would contact your local hosptials early pregnancy assessment unit (EPAU) and ask them, you should be given 3 options : expectant management (waiting), medical management or surgical. These should be your choices .

    • By eva (not verified) on 27 Mar 2019 - 22:01

      hi i had miscarriage i was 10weeks but the doctor said after the ultrasound she did not hear any hearbeat and no sac. after few days, i bleed and had cramps which lasts for 5days. After that it stops and only small spots. When i went back to doctor she claims i had miscarriage however, she ask me for D&C since there is still 2cm remnants. but im not bleeding anymore. Should i go with D&C or should i go home and wait till my body remove it naturally. Im actually frightened on the thought of going through D&C

    • By Erika Alvarado (not verified) on 12 May 2019 - 22:55

      Hi, I know it’s been over a month. I’m very sorry for your loss. I’m going through the same. I was told the sac it’s still inside. I was wondering, what did you end up doing? I’m suppose to take medication if I don’t see more tissue or heavy bleeding again by May 14th.

    • By Kiran (not verified) on 14 Jun 2019 - 21:17

      Hello!
      I had a missed miscarriage at 17 weeks of pregnancy but baby heart beat was stopped at week 13+4 days. I went to hospital they have given me medicine so that I can start bleeding and start contractions but after that medication I didn’t started bleeding at all. After two days I admitted to hospital they put medication on my vagina and opened up cervix to deliver the baby naturally. I delivered baby naturally same like labour.
      After 2-3 days I started contractions again and passing up some tissues. Went to hospital again they did my scan after a week and they said some of the tissues still their. And my midwife told me they can’t give any medication and can’t perform any surgery I will pass up tissues naturally may b on my next period or later. Is anyone their who experienced same thing or they are aware that those tissues which r left will not harm me. What should I do to pass the tissues soon. Please help

    • By Anonymous (not verified) on 17 Sep 2019 - 15:43

      Same here what was the outcome, please share

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