My doctor has informed me that there is no heartbeat. He told me that there are 3 options going forward. Can you please elaborate on what the pros and cons would be for each of them?
Option 1: Letting it Pass Naturally (this is called “Expectant Management”)
Pros - Works completely for 80% of women. Good for those who prefer not to have a D&C or medical intervention. Lower infection rate.
Con - Not as effective if no symptoms of a miscarriage.There is moderate-heavy bleeding and cramping. Not recommended for second trimester loss. Can take longer than the other options. Possible follow up surgery.
Option 2: Medication
Pro - if you want to get it over in a shorter time frame, but prefer not to have a surgical procedure. If this doesnt work can still choose option 1.
Con -Not an option if there is infection, hemorrhage, anemia, or bleeding disorder. May need several doses. can cause excessive bleeding and cramping. And there may be retained tissue.
Option 3: D&C
NOTE: This may be your only option if you have an infection, hemorrhage or medical issue.
Pro - Faster and more predictable. You go to sleep and when you wake up, it’s over.
Con - This is a medical procedure with all the associated risks. You want to make sure it's being done correctly by someone skilled. Most expensive option.
Overall serious complications from management of miscarriage is the same across the board. None of these are significantly superior to the other and your choice and preference is what should guide the decision making process.
In all options:
Keep an eye on blood loss. Soaking 2 maxi pads in 2 hours is a potentially emergent issue, and you should contact your provider (doctor/midwife).
You will be given antibiotics to avoid possible infection.
Ultrasound confirmation may be used to check that there is no retained tissue.
Pain medication will be recommended or prescribed.