Managing Early Pregnancy Loss: Medication vs. Surgical Options

Management of miscarriage at eight weeks of multiple gestations?

Hello, doctor.
I am currently 10 weeks pregnant, and during my examination, it was found that the embryo stopped developing at over 8 weeks (measuring approximately 1.97 cm).
During my last check at 7 weeks, there was still a heartbeat.
I consulted two obstetricians: Doctor A believes I can try a medical abortion (Misoprostol), but if the abortion is incomplete, I would need surgery or continue medication.
Doctor B recommends proceeding with a surgical abortion.

This is my second miscarriage; the first was a natural miscarriage of a blighted ovum, and I quickly became pregnant again a month later.
Currently, I have not experienced any bleeding or other symptoms of miscarriage, but I am concerned about having recurrent miscarriages.
If I choose surgery this time, I worry that in future pregnancies, if the gestational age is too advanced for a medical abortion, I may need to undergo multiple surgeries, which could harm my uterus.
However, it seems that medical abortion is more likely to fail at this gestational age compared to before 7 weeks.

Additionally, both Doctor B and I suspect that I may have a thyroid autoimmune issue, but we need to wait until the miscarriage is complete to conduct tests.
I would like to ask for your advice.
Also, if I do have a thyroid autoimmune issue but am currently untreated, is it safe to take Misoprostol?

uyh, 30~39 year old female. Ask Date: 2019/12/14

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Currently, I am 10 weeks pregnant, and the examination showed that the embryo stopped developing at over 8 weeks (approximately 1.97 cm in size).
During the last check at 7 weeks, there was still a heartbeat.
I consulted two obstetricians: Doctor A believes I can try medical abortion (Misoprostol), and if the miscarriage is incomplete, I would need surgery or continue medication.
Doctor B recommends proceeding with a surgical abortion.
This is my second miscarriage; the first was a natural miscarriage of a blighted ovum, and I quickly became pregnant again a month later.
So far, I have not experienced any bleeding or other miscarriage symptoms, but I am concerned about having recurrent miscarriages.
If I choose surgery this time, I worry that future pregnancies may require multiple surgeries as the gestational age increases, which could harm my uterus.
However, it seems that medical abortion is more likely to fail after 7 weeks.
Additionally, both Doctor B and I suspect that I may have thyroid autoimmune issues, but we need to wait until the miscarriage is complete to conduct tests.
I would like to ask for your advice.

Answer: I recommend proceeding with the surgical abortion and, if there are thyroid autoimmune issues, to wait until the miscarriage is complete before testing to confirm any thyroid autoimmune problems.
Regarding the use of Misoprostol while untreated for potential thyroid autoimmune issues, it is advisable to consult with your healthcare provider before proceeding.

Reply Date: 2019/12/14

More Info

Managing early pregnancy loss can be a challenging and emotional experience, especially when faced with the decision between medical management (medication) and surgical options. In your case, you are currently 10 weeks pregnant, and the ultrasound has indicated that the embryo stopped developing around 8 weeks. This situation can understandably lead to feelings of anxiety and uncertainty, particularly given your history of previous pregnancy loss.

When considering the options for managing a miscarriage, it is essential to weigh the benefits and risks of both medical and surgical approaches. Medical management typically involves the use of medications such as misoprostol (often referred to by the brand name "Mifepristone" or "Mifeprex") to help the body expel the pregnancy tissue. This method can be effective, especially in early pregnancy, and allows for a more natural process. However, as you mentioned, there is a risk of incomplete miscarriage, which may necessitate further medical treatment or surgical intervention later on.

On the other hand, surgical management, such as dilation and curettage (D&C), is a more definitive approach that can ensure the complete removal of pregnancy tissue. This method is often recommended when there is a concern about incomplete miscarriage or if the patient prefers a quicker resolution. While surgical procedures can carry risks, including potential damage to the uterus, they are generally safe when performed by experienced practitioners.

Given your history of recurrent pregnancy loss, it is crucial to consider the underlying causes that may be contributing to these experiences. You mentioned concerns about possible thyroid immune issues, which can indeed play a role in pregnancy outcomes. Thyroid disorders, particularly autoimmune conditions like Hashimoto's thyroiditis, can affect fertility and pregnancy. If you suspect that you have a thyroid issue, it is advisable to pursue testing and evaluation as soon as possible, ideally after the current miscarriage is complete.
Regarding the use of medications such as misoprostol (喜克潰), it is essential to discuss any potential risks with your healthcare provider, especially in the context of existing medical conditions like thyroid issues. While misoprostol is generally considered safe for use in early pregnancy loss, your specific health circumstances should guide the decision-making process.

In summary, the choice between medical and surgical management of early pregnancy loss should be made in consultation with your healthcare providers, considering your medical history, personal preferences, and any underlying health issues. If you opt for medical management, be aware of the signs of incomplete miscarriage and be prepared for the possibility of needing further treatment. If you choose surgical management, ensure that you are comfortable with the procedure and discuss any concerns you may have about future pregnancies.

Ultimately, it is essential to prioritize your emotional and physical well-being during this difficult time. Seeking support from healthcare professionals, counselors, or support groups can also be beneficial as you navigate this challenging experience. Remember that you are not alone, and there are resources available to help you through this process.

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