Editing Miscarriage (section)

==Management==
Women who miscarry early in their pregnancy usually do not require any subsequent medical treatment, but they can benefit from support and counseling.<ref name="auto"/><ref name="jeve">{{cite journal | vauthors = Jeve YB, Davies W | title = Evidence-based management of recurrent miscarriages | journal = Journal of Human Reproductive Sciences | volume = 7 | issue = 3 | pages = 159–69 | date = July 2014 | pmid = 25395740 | pmc = 4229790 | doi = 10.4103/0974-1208.142475 | doi-access = free }}</ref> Most early miscarriages will be completed on their own; in other cases, medication treatment or aspiration of the products of conception can be used to remove the remaining tissue.<ref>{{cite web |url=http://www.babycentre.co.uk/a1039515/understanding-early-miscarriage#ixzz2x52G1IYu |title=Understanding early miscarriage |date=January 2017 |access-date=June 4, 2017 |publisher=BabyCenter, L.L.C. |url-status=live |archive-url=https://web.archive.org/web/20170905095051/https://www.babycentre.co.uk/a1039515/understanding-early-miscarriage#ixzz2x52G1IYu |archive-date=September 5, 2017 |df=mdy-all }}</ref> While [[bed rest]] has been advocated to prevent miscarriage, this is not of benefit.<ref>{{cite journal | vauthors = McCall CA, Grimes DA, Lyerly AD | title = "Therapeutic" bed rest in pregnancy: unethical and unsupported by data | journal = Obstetrics and Gynecology | volume = 121 | issue = 6 | pages = 1305–8 | date = June 2013 | pmid = 23812466 | doi = 10.1097/AOG.0b013e318293f12f }}</ref>{{sfn|Hoffman|page = 176}} Those who are experiencing or who have experienced a miscarriage benefit from the use of careful medical language. Significant distress can often be managed by the ability of the clinician to clearly explain terms without suggesting that the woman or couple is somehow to blame.<ref name="Chris2014">{{cite book|title=Recurrent pregnancy loss|last=Christiansen|first=Ole|publisher=John Wiley & Sons|year=2014|isbn=978-0470672945|location=Chichester, West Sussex, UK|pages=98–99|quote=It is important to bear in mind that some clinical terms can cause great distress and even anger.  It is not acceptable to use the term "abortion" for miscarriage, despite its historical clinical prevalence.  To the layperson, "abortion" means the elective termination of pregnancy, and while they may have no theoretical objections to that procedure, they are likely to be distressed and even angered at its use in their situation.  "Miscarriage" (qualified by adjectives such as recurrent, delayed, early, late, etc.) is easily understood and well accepted.}}</ref>

Evidence to support [[Rho(D) immune globulin]] after a spontaneous miscarriage is unclear.<ref>{{cite journal | vauthors = Karanth L, Jaafar SH, Kanagasabai S, Nair NS, Barua A | title = Anti-D administration after spontaneous miscarriage for preventing Rhesus alloimmunisation | journal = The Cochrane Database of Systematic Reviews | volume = 3 | issue = 3 | pages = CD009617 | date = March 2013 | pmid = 23543581 | doi = 10.1002/14651858.CD009617.pub2 | pmc = 11365588 }}</ref> In the UK, Rho(D) immune globulin is recommended in Rh-negative women after 12 weeks [[Gestational age (obstetrics)|gestational age]] and before 12 weeks gestational age in those who need surgery or medication to complete the miscarriage.<ref>{{cite web|author1=Royal College of Obstetric and Gynecologists|title=The Use of Anti-D Immunoglobulin for Rhesus D Prophylaxis|url=https://www.rcog.org.uk/globalassets/documents/guidelines/gtg22antidjuly2013.pdf|access-date=25 September 2014|page=5|date=March 2011|url-status=dead|archive-url=https://web.archive.org/web/20141128192127/https://www.rcog.org.uk/globalassets/documents/guidelines/gtg22antidjuly2013.pdf|archive-date=November 28, 2014|df=mdy-all}}</ref>

=== Methods ===
No treatment is necessary for a diagnosis of complete miscarriage (so long as ectopic pregnancy is ruled out). In cases of an incomplete miscarriage, empty sac, or missed abortion, there are three treatment options: watchful waiting, medical management, and surgical treatment. With no treatment ([[watchful waiting]]), most miscarriages (65–80%) will pass naturally within two to six weeks.<ref name="afp2">{{cite journal | vauthors = Kripke C | title = Expectant management vs. surgical treatment for miscarriage | journal = American Family Physician | volume = 74 | issue = 7 | pages = 1125–6 | date = October 2006 | pmid = 17039747 | url = http://www.aafp.org/afp/2006/1001/p1125.html | url-status = live | archive-url = https://web.archive.org/web/20140525195924/http://www.aafp.org/afp/2006/1001/p1125.html | df = mdy-all | archive-date = May 25, 2014 }}</ref> This treatment avoids the possible side effects and complications of medications and surgery,<ref>{{cite journal | vauthors = Tang OS, Ho PC | title = The use of misoprostol for early pregnancy failure | journal = Current Opinion in Obstetrics & Gynecology | volume = 18 | issue = 6 | pages = 581–6 | date = December 2006 | pmid = 17099326 | doi = 10.1097/GCO.0b013e32800feedb | s2cid = 23354454 }}</ref> but increases the risk of mild bleeding, the need for unplanned surgical treatment, and incomplete miscarriage. Medical treatment usually consists of using [[misoprostol]] (a [[prostaglandin]]) alone or in combination with [[mifepristone]] pre-treatment.<ref>{{cite journal | vauthors = Schreiber CA, Creinin MD, Atrio J, Sonalkar S, Ratcliffe SJ, Barnhart KT | title = Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss | journal = The New England Journal of Medicine | volume = 378 | issue = 23 | pages = 2161–2170 | date = June 2018 | pmid = 29874535 | pmc = 6437668 | doi = 10.1056/NEJMoa1715726 }}</ref> These medications help the uterus to contract and expel the remaining tissue out of the body. This works within a few days in 95% of cases.<ref name="afp2" /> Vacuum aspiration or sharp curettage can be used, with vacuum aspiration being lower-risk and more common.<ref name="afp2" />

===Delayed and incomplete miscarriage===
In delayed or incomplete miscarriage, treatment depends on the amount of tissue remaining in the uterus. Treatment can include surgical removal of the tissue with [[vacuum aspiration]] or [[misoprostol]].<ref>{{cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK333519/|title=Surgery for Family Planning, Abortion, and Postabortion Care|last1=Babigumira|first1=Joseph B.|last2=Vlassoff|first2=Michael|last3=Ahimbisibwe|first3=Asa|last4=Stergachis|first4=Andy |date=2015|publisher=The International Bank for Reconstruction and Development / The World Bank|isbn=978-1464803468|editor-last=Debas|editor-first=Haile T. |location=Washington (DC)|doi=10.1596/978-1-4648-0346-8_ch7|pmid=26741012|editor-last2=Donkor|editor-first2=Peter|editor-last3=Gawande|editor-first3=Atul|editor-last4=Jamison|editor-first4=Dean T.|editor-last5=Kruk|editor-first5=Margaret E.|editor-last6=Mock|editor-first6=Charles N. |archive-url=https://web.archive.org/web/20170910181311/https://www.ncbi.nlm.nih.gov/books/NBK333519/ |archive-date=September 10, 2017|df=mdy-all|url-status=live}}</ref> Studies looking at the methods of anaesthesia for surgical management of incomplete miscarriage have not shown that any adaptation from normal practice is beneficial.<ref>{{cite journal | vauthors = Calvache JA, Delgado-Noguera MF, Lesaffre E, Stolker RJ | title = Anaesthesia for evacuation of incomplete miscarriage | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD008681 | date = April 2012 | pmid = 22513963 | doi = 10.1002/14651858.CD008681.pub2 | pmc = 11305452 }}</ref>

===Induced miscarriage===
{{Further|Self-induced abortion}}
An induced abortion may be performed by a qualified healthcare provider for women who cannot continue the pregnancy.<ref name="GLOWM_Late2">{{cite journal|last1=Borgatta|first1=L|date=December 2014|title=Labor Induction Termination of Pregnancy|url=http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443|journal=Global Library of Women's Medicine|volume=GLOWM.10444|doi=10.3843/GLOWM.10444|archive-url=https://web.archive.org/web/20150924082507/http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443|archive-date=September 24, 2015|access-date=25 September 2015|url-status=live|df=mdy-all}}</ref> [[Self-induced abortion]] performed by a woman or non-medical personnel can be dangerous and is still a cause of maternal mortality in some countries. In some locales, it is illegal or carries heavy [[social stigma]].<ref name="auto82">{{cite journal | vauthors = Haddad LB, Nour NM | title = Unsafe abortion: unnecessary maternal mortality | journal = Reviews in Obstetrics & Gynecology | volume = 2 | issue = 2 | pages = 122–6 | date = 2009 | pmid = 19609407 | pmc = 2709326 }}</ref>

===Sex===
Some organisations recommend delaying sex after a miscarriage until the bleeding has stopped to decrease the risk of [[infection]].<ref name="misorg" /> However, there is not sufficient evidence for the routine use of antibiotics to try to avoid infection in incomplete abortion.<ref name = "May_2007">{{cite journal | vauthors = May W, Gülmezoglu AM, Ba-Thike K | title = Antibiotics for incomplete abortion | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD001779 | date = October 2007 | pmid = 17943756 | doi = 10.1002/14651858.CD001779.pub2 | pmc = 12013248 }}</ref> Others recommend delaying attempts at pregnancy until one period has occurred to make it easier to determine the dates of a subsequent pregnancy.<ref name="misorg" /> There is no evidence that getting pregnant in that first cycle affects outcomes, and an early subsequent pregnancy may improve outcomes.<ref name="misorg" /><ref>{{cite web |title=Trying to conceive soon after a pregnancy loss may increase chances of live birth |url=https://www.nih.gov/news-events/news-releases/trying-conceive-soon-after-pregnancy-loss-may-increase-chances-live-birth |website=National Institutes of Health (NIH) |access-date=1 September 2019 |language=EN |date=12 January 2016}}</ref>

===Support===
Organisations exist that provide information and counselling to help those who have had a miscarriage.<ref name="NHS-Miscarriage-Afterwards"/> Family and friends often conduct a memorial or burial service. Hospitals can provide support and help memorialise the event. Depending on the locale, others desire to have a private ceremony.<ref name="NHS-Miscarriage-Afterwards"/> Providing appropriate support with frequent discussions and sympathetic counselling is part of the evaluation and treatment. Those who experience unexplained miscarriages can be treated with emotional support.<ref name="jeve"/><ref name=Chris2014/>

===Miscarriage leave===
Miscarriage leave is a [[leave of absence]] concerning miscarriage. The following countries offer paid or unpaid leave to women who have had a miscarriage.
* The Philippines – 60 days' fully paid leave for miscarriages (before 20 weeks of gestation) or emergency termination of the pregnancy (on the 20th week or after)<ref>{{cite web |title=REPUBLIC ACT No. 11210 |url=https://lawphil.net/statutes/repacts/ra2019/ra_11210_2019.html |access-date=2021-03-25 |website=lawphil.net}}</ref> The husband of the mother gets seven days' fully paid leave up to the 4th pregnancy.<ref>{{cite web|url=https://www.ilo.org/dyn/travail/docs/1206/Republic%25252520Act%25252520No%252525208187%25252520-%25252520Paternity%25252520Leave%25252520Act%25252520of%252525201996.pdf|title=Republic Act 8187|access-date=2021-03-25}}</ref>
* India – six weeks' leave<ref>{{cite web|url=https://labour.gov.in/sites/default/files/TheMaternityBenefitAct1961.pdf|title=Maternity Benefit Act of 1961|access-date=2021-03-25}}</ref>
* New Zealand – three days' bereavement leave for both parents<ref>{{cite news|url=https://www.bbc.co.uk/news/world-asia-56521171|title=New Zealand to allow bereavement leave|work=BBC News|date=March 25, 2021|access-date=2021-03-25}}</ref>
* Mauritius – two weeks' leave<ref name=":7">{{cite web|url=https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---publ/documents/publication/wcms_242615.pdf|title=Maternity and paternity at work|access-date=2021-03-26}}</ref>
* Indonesia – six weeks' leave<ref name=":7" />
* Taiwan – five days, one week, or four weeks, depending on how advanced the pregnancy was<ref>{{cite web |date=May 12, 2022 |title=Maternity & Paternity Leave in Taiwan |url=https://ins-globalconsulting.com/taiwan-business-guides/learn-about-taiwan-labor-law/taiwan-guide-maternity-paternity-leave/ |website=INS Global}}</ref>