If you have been diagnosed with a nonviable pregnancy or impending miscarriage in the first trimester (less than 12 weeks), you have our heartfelt condolecences. This is never an easy thing to get through, and we know that substantial mourning is normal. If diagnosed, you will be given the option of passing the pregnancy naturally or undergoing a procedure called a suction dilation and curettage. If you opt to pass the pregnancy naturally, this can take a variable amount of time, even weeks. If bleeding and cramping has already started, then the end is likely in sight. You will experience a crescendo of cramping and bleeding followed by the passage of tissue and cessation of cramping and a significant decrease in the bleeding. This can be an unnerving process and many patients end up in the emergency room. The cramping is synonymous with labor pains. The cramps open the cervix so the pregnancy can be passed. Occasionally, only part of the pregnancy will be passed and the bleeding and cramping will continue. In these cases, a dilation and curettage will need to be done.
Dilation and curettage is a safe procedure, although no procedure is completely free of potential complication. Of course, medical attention should always be sought for profound bleeding and pain. Also, expectant management (passing tissue naturally) should not occur when a tubal pregnancy (no pregnancy seen in the uterus on ultrasound) is considered a possibility.