Complications
Retained early pregnancy tissue within the uterine cavity results in persistent vaginal bleeding and suprapubic pain.
Brisk bleeding may follow complete evacuation of the uterus. The first maneuver is to bimanually compress the uterus. It is sometimes necessary to administer oxytocin or prostaglandin analogs to reduce the chances of postmiscarriage bleeding.
May occur before or after the miscarriage. Characterized by fever, chills, and abdominal pain.
May occur during surgical evacuation of the uterus. Can result in severe blood loss and shock requiring blood transfusions.
Cervical ripening drugs (e.g., isosorbide mononitrate or dinitrate, misoprostol) or mechanical dilators are often used to soften and dilate the cervix prior to surgical evacuation to decrease the risk of injury to the cervix and uterus, and improve ease of the procedure. However, a Cochrane review found that there is no evidence that these therapies reduce the risk of injury, although caution should be exercised when interpreting the results of this review due to these outcomes being very rare anyway. Mechanical dilators were found to be as effective as chemical dilators.[143]
Recurrent miscarriage of pregnancies with the same partner; affects 1% to 2% of otherwise healthy women.
Follows a curettage procedure with trauma to the endometrial lining. Results in uterine cavity adhesions that may obliterate the cavity. May result in infertility, recurrent miscarriages, and high-risk pregnancies.
A rare consequence of presumed "overzealous" use of the curette as a uterine evacuation tool for induced abortion, incomplete miscarriage, or retained early pregnancy tissue after childbirth. It is not clear if it is less likely after use of a plastic, suction-dominant tool for the same procedure. Patients typically complain of a relative reduction in menstrual blood loss volume or subfertility. Hysteroscopy and/or hysterography usually show "synechiae."
The severity varies between patients. Psychological support must be offered to all patients. Loss of an early pregnancy can affect couples as significantly as a neonatal death. The patient may experience guilt in addition to grief.
Vaginal bleeding due to placental abruption, leading to disseminated intravascular coagulation, has been reported following a late miscarriage.[144] A pre-evacuation risk prediction and planned response strategy may be advisable in such selected patients. It would seem wise to treat the patient for a placental abruption if the pain is of recent abrupt onset, and the uterine fundal height is much greater than expected with an unexpectedly low hematocrit.
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