Treatments
Miscarriage
Being told at an ultrasound scan that the pregnancy is not developing often comes unexpectedly and hits hard, especially if you have had no bleeding or pain.
At Femmecare we take the time to explain what is happening. You then choose, together with the doctor, what suits you.
What is it?
What is a missed miscarriage?
In a missed miscarriage, the pregnancy has stopped developing but the miscarriage has not yet started on its own. The doctor sees this on the ultrasound scan: there is no heartbeat, or the pregnancy is not growing.
Often you have no symptoms yet. Sometimes you notice that pregnancy symptoms, such as nausea or tender breasts, are easing. Or you have light bleeding, or a feeling that something is not right.
Are we certain?If the scan is not yet conclusive, the doctor repeats it after 7 to 14 days. Only then do you choose a treatment.
In figures
You are not alone
Miscarriage is more common than many people think. That does not make the loss any smaller.
- 15 to 20%of all confirmed pregnancies end in miscarriage.
- About 20,000women in the Netherlands have a miscarriage each year.
- 35 to 55%of women who wait have a miscarriage naturally within two weeks.
- 85%of women need no operation after treatment with medication.
Sources: Dutch NVOG guideline Miskraam (2020); Femmecare patient leaflet ‘Miskraam’.
Your visit
What happens?
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Consultation and ultrasound
The doctor discusses with you what has been seen and, if needed, performs another scan. There is room for your questions and for how this news affects you.
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Choosing together
The doctor explains the options. You do not have to decide straight away. You are given a leaflet so you can read everything again calmly.
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Follow-up
If you wait, you come back after 7 to 14 days. If you use medication, you come back for a check-up after about 2 weeks.
Treatment
What are the options?
There are three options. You discuss with the doctor which suits you best.
Watchful waiting
You wait for the miscarriage to start on its own. This option carries the fewest risks. The one drawback is that you do not know when the bleeding will start.
Check-up after 7 to 14 days. You can wait for up to 8 weeks in total.
Medication
If you would rather not wait, we start the miscarriage with medication. You take it at home, with clear instructions.
Check-up about 2 weeks after starting the medication.
Surgical removal (curettage)
In a curettage, the womb is emptied in a minor operation through the vagina. Femmecare does not perform curettages; for this we refer you to a hospital.
After about 2 weeks your Femmecare doctor calls you to see how you are.
Whether you wait or use medication, we give you advice about pain relief and bleeding, and you know when to contact us.
Our approach
Time and calm for you
We make time for you at short notice. Where possible, we schedule your appointment at a time when there are no other patients in the clinic or waiting room.
- An appointment at short notice
- Where possible, at a time with no other patients in the clinic or waiting room
- Your partner, or someone you trust, is welcome to come with you
- No rush: time for explanation and for your questions
Good to know
What we do and do not do
Not at Femmecare
- A curettage; for this we refer you to a hospital
- Treatments under sedation or general anaesthetic
Available at Femmecare
- Consultation, explanation and ultrasound
- Support during watchful waiting, with check-ups
- Treatment with medication, with a check-up
- Referral to hospital if a curettage is needed or if that is your choice
For midwives and GPs
Referring patients with a missed miscarriage
Diagnosis and treatment of non-viable pregnancies up to 16 weeks, in line with the Dutch NVOG guideline Miskraam. We make time for your patient at short notice, where possible at a time with no other patients in the clinic or waiting room.
ZorgDomein: ‘Femmecare Clinics’
Reasons to refer
- Non-viable intrauterine pregnancy on ultrasound
- Uncertain viability, for a repeat scan after 7–14 days
What we offer
- Ultrasound using the NVOG criteria for a non-viable pregnancy
- Expectant management with review after 7–14 days (up to 8 weeks)
- Medical management: mifepristone followed by misoprostol; success rate around 85%
- From 10 weeks: blood group and rhesus status, with anti-D if needed
- Surgical management: referral to hospital
Take your time to choose
If your midwife or GP has found that the pregnancy is not developing, they can refer you to Femmecare straight away.