If there's no pregnancy tissue left in your womb, no treatment is required.

However, if there's still some pregnancy tissue in your womb, your options are:

• expectant management – wait for the tissue to pass naturally out of your womb
• medical management – take medication that causes the tissue to pass out of your womb
• surgical management – have the tissue surgically removed

The risk of complications is very small for all these options. It's important to discuss these options with the doctor in charge of your care.

Expectant management

It's usually recommended you wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management. 

If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy test after three weeks.

If the test shows you're still pregnant, you may need to have further tests to make sure you don't have a molar pregnancy or an ectopic pregnancy.

If the pain and bleeding haven't started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage hasn't begun or hasn't finished. In this case, you should be offered another scan.

Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever), or you experience severe pain.

After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.

Medication

You may choose to have medication to remove the tissue if you don't want to wait. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out.

In most cases, you'll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve. However, tablets that you swallow may be available if you prefer. A medication called mifepristone is sometimes used first, followed 48 hours later by a medication called misoprostol.

The effects of misoprostol tablets usually begin within a few hours. You'll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to three weeks.

In most units, you'll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.

You should be advised to take a home pregnancy test three weeks after taking this medication. If the pregnancy test shows you're still pregnant, you may need to have further tests to make sure you don't have a molar pregnancy or an ectopic pregnancy.

You may be advised to contact your healthcare professional to discuss your options if bleeding hasn't started within 24 hours of taking the medication.

Surgery

In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:

• you experience continuous heavy bleeding
• there's evidence the pregnancy tissue has become infected
• medication or waiting for the tissue to pass out naturally has been unsuccessful

Surgery involves opening your cervix with a small tube known as a dilator and removing any remaining tissue with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.

This type of surgery is known as evacuation of retained products of conception (ERPC). You may also hear it referred to as surgical management of miscarriage (SMM).

If your blood group is RhD negative, you should be offered injections of a medication called anti-D immunoglobin after ERPC. This is necessary to prevent rhesus disease.

Read more about preventing rhesus disease.

After a miscarriage

A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.

For more information, read what happens after a miscarriage.