Each year, around . It is estimated that 40 per cent or more of those require follow-up care. The treatments they receive are the same as those used to provide abortion.
If the legal decision protecting the right to abortion is overturned in the US, it will also jeopardise safe, timely miscarriage care. Twenty-six states are expected to severely restrict abortion access, which could impact up to 40 million women of reproductive age, according to the reproductive rights research group the . People living in those states would be at risk for delayed or withheld miscarriage care, which can result in lifelong health consequences.
There are three treatment options for a miscarriage: expectant management, which is essentially to wait and see; medical management, where a doctor prescribes mifepristone and misoprostol – also used for abortion – to expel the pregnancy from the uterus; and surgical management, in which a dilation and curettage procedure (D&C) is performed to remove fetal tissue and the placenta.
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“The way to manage a first-trimester miscarriage and a first-trimester abortion is exactly the same,” says obstetrician and gynaecologist at the University of Washington in Seattle.
“The way to manage a second-trimester pregnancy loss is exactly the same as how to manage a second-trimester abortion. And the way to manage a third-trimester pregnancy loss looks a lot like labour induction,” she says.
Medical care for miscarriage
While many miscarriages are managed without any medical intervention, more than a third routinely require follow-up care because the fetal tissue isn’t fully expelled from the uterus or the mother is at risk of haemorrhage or sepsis.
A study conducted between 2008 and 2018 by researchers in Sweden randomised nearly 200 women experiencing pregnancy loss to receive either expectant management or medical management. The researchers found that after a month, just had a complete miscarriage compared with 86 per cent in the medical group. Most of these women went on to have a D&C to complete the process.
If Roe v Wade is overturned in the US, these treatments could become harder to obtain in states where abortion is banned or severely restricted.
Fear of prosecution may already be affecting care for pregnancy loss in states like Texas, which allows members of the public to sue abortion providers. “Many providers feel concerned they could be prosecuted with the new vigilante laws if they manage miscarriage, which is having a chilling effect on timely management in states with those laws,” says Prager.
There have already been anecdotal reports of women being denied miscarriage care in Texas. One a woman’s misoprostol prescription for her miscarriage. Another woman was forced to fly to Colorado to after a physician said he was unable to treat her because a fetal heartbeat was still detectable.
Without medical care, there can be significant health complications. Last year, researchers at the University of Birmingham in the UK performed a comprehensive of 78 randomised trials comparing medical, surgical and expectant management for pregnancy loss. They found that surgery and medication were 25 to 50 per cent less likely than expectant care to result in serious complications, including blood transfusions, uterine perforations, emergency surgery and hysterectomies.
“The longer the tissue is there inside the womb, there’s an increased risk of infection,” says , an author of the meta-analysis who studies miscarriage at the University of Birmingham.
“If you get an infection, it has potential downstream effects on future fertility and increased risk of future miscarriage,” he says.
Beyond the physical risks, having to wait longer for miscarriage care can also result in worse psychological outcomes. Anxiety, depression and even post-traumatic stress symptoms are .
“The knowledge that you’re carrying around your dead baby for much longer inside of you when there are options for resolving it much more quickly” has a significant psychological impact, says Devall. He adds that more severe psychological outcomes increase the risk of miscarriage in subsequent pregnancies.
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