If a woman miscarries a pregnancy, it is usually complete, ie all the products of conception are expelled naturally from the body. This experience is much like having a heavy, painful period. If the miscarriage is complete, no further action is required, and in time, a woman may attempt another pregnancy. The diagnosis of a complete miscarriage is made by ultrasound scan.
However, sometimes a miscarriage is incomplete. If a woman has had an incomplete miscarriage, she may continue to bleed and experience pain until she undergoes a D and C. Occasionally, a pregnancy miscarries, and the woman may have no bleeding at all to signal the end of the pregnancy. This is termed a “missed miscarriage”. When a missed miscarriage occurs, it may be necessary to undergo an in-clinic procedure of dilatation and curettage (D and C), to ensure complete clearance of products of conception. This is available through public and private hospitals, but can be performed at Gynaecare’s Sydney north shore women’s health centre under IV sedation.
In the past, a D&C was also a diagnostic procedure; ie it was performed as a procedure for women who are experiencing irregular or heavy bleeding, to establish a diagnosis, such as endometrial polyp or malignancy. In recent years, diagnosis of abnormal uterine bleeding is made using endometrial biopsy (pipelle biopsy) , usually combined with hysteroscopy, when the inside of the uterus is directly visualised with a fibre optic camera. Any tissue collected can be sent away for analysis (histopathology specimen to the laboratory) to see if there is a cause for the troublesome bleeding.
If you have bleeding in early pregnancy, or suspect you have had a miscarriage, please make an appointment to discuss with one of our doctors. We can organise tests for you to find out whether the pregnancy is ongoing or not. Depending on the outcome, we can manage your ongoing pregnancy or counsel you regarding the miscarriage, to advise whether any further action is required.
Irregular or heavy bleeding commonly occurs when approaching menopause (perimenopause), and the first step in investigation is a transvaginal ultrasound scan which is easily arranged and widely available. If onward referral is required for hysteroscopy and or endometrial sampling (pipelle biopsy) then we can direct you to the best specialists for your particular problem.