When is medical management of miscarriage recommended for missed miscarriage?

A missed miscarriage is a pregnancy that has stopped developing but has not yet caused the expected bleeding or passage of pregnancy tissue. Ultrasound and clinical assessment are used to confirm the diagnosis before treatment. Medicines stimulate the uterus to pass the pregnancy tissue. Cramping and vaginal bleeding are expected, and the timing and amount vary. Your clinician will explain pain relief, how to monitor bleeding, and how completion will be checked. Waiting or a surgical procedure may be alternatives, depending on your health, symptoms, preferences, and local care arrangements.

Take medicines exactly as prescribed and arrange access to a bathroom, sanitary pads, fluids, pain relief recommended for you, and support from someone you trust. Keep the follow-up appointment or test used to check that the miscarriage is complete. Ask how long bleeding can continue, when normal activities may resume, and whom to call outside clinic hours. Emotional reactions can be intense; request support if grief, anxiety, or low mood becomes difficult to manage.

Seek urgent care for very heavy bleeding, dizziness or fainting, severe or worsening pain, fever, chills, or foul-smelling discharge. These can indicate significant blood loss or infection. Contact your maternity or gynaecology team if bleeding or pain does not follow the expected plan, or if you are unsure whether tissue has passed.

How will completion be confirmed? What bleeding and pain should I expect? Which symptoms mean I should go straight to an emergency department?