Understanding
your care

Expectant management means waiting for your body pass the pregnancy tissue on its own, without using medicine or surgery. This is sometimes called “watch and wait.” Your doctor or midwife may suggest this if it’s safe to give your body time.

This option often works well for incomplete miscarriages, where the body has already started to pass the pregnancy. About 70–80% of people won’t need more treatment.

For missed miscarriages — when the pregnancy has stopped but the body hasn’t started to pass the pregnancy tissue — it works less often. Less than 25% of people will pass the pregnancy without extra help. Your care team can help you decide if this is the right choice for you.

What to expect

You’ll have bleeding and cramping, often like a heavy period. For some people, the pain and bleeding can be stronger or last longer than expected. This can be hard to manage — especially if you’re at home or by yourself.

Pregnancy tissue may pass all at once, or slowly over a few days. What you see depends on how far along the pregnancy was:

• Before 7 weeks — tissue may look like clots or thick discharge, It’s common not to see anything that looks like a baby, but that doesn’t make your loss any less real.
• Between 7–10 weeks — you may see some recognisable pregnancy tissue along with clots and thick discharge. 
• After 10–12 weeks — you may see a small baby-like shape — which can be confronting even if you were expecting it. This is a normal part of the process, and it’s okay to feel overwhelmed. You may also see other tissue, such as the placenta or pregnancy sac.

Many people pass pregnancy tissue while on the toilet. This is common and not something you can plan or control. It might feel upsetting or surprising, but it’s a natural part of the process.  Some people flush the toilet without looking. Others choose to collect the tissue. If you want to collect the tissue, you can put a clean container or bowl in the toilet first. You might do this to show your doctor, for personal closure, or for a special burial.  

If you’d like the tissue tested, ask your doctor or midwife how to collect and store it safely — especially if you’re at home. If you collect the tissue, your care team can also talk to you about options for testing, cremation, or burial. You may want time or space to honour the loss in your own way.

If you choose not to collect the tissue, that’s also okay. Speak with your care team about what happens next, including follow-up care to monitor your physical recovery and support your emotional wellbeing.

Expectant management means waiting. This can take a few hours, or sometimes up to 2 to 4 weeks. Everyone’s experience is different. If the miscarriage doesn’t finish on its own (for example, if the bleeding stops but tissue hasn’t passed), or if you’re unsure about what’s happening, talk to your care team. You’re not alone — there is support to help you through this.

When to get medical help

Contact your doctor or go to hospital if you have:

• Heavy bleeding — soaking one pad every hour for two hours, and/or passing large clots.
• Severe pain — that doesn’t improve with pain medicine (including the medicine you’ve been given).
• Signs of infection — such as fever, feeling unwell, or discharge with a strong, unpleasant smell.

Things to think about 

Some people choose expectant management because it feels more natural or gives them time. But it can take longer than other options, and it’s less predictable. You might not know when it will start or end.

You’ll likely need follow-up tests (like an ultrasound or blood test) to check that all the tissue has passed. After a pregnancy loss your next period may be later or different — this is common and usually settles.

This option works less often after 12 weeks, especially for missed miscarriage. Your doctor or midwife can guide you.

The risk of infection is low, but it’s still important to watch for signs like fever, pain, or unusual discharge. While bleeding continues, avoid tampons, sex, or swimming to reduce infection risk.

If you’re unsure about what to expect or what to do at home, ask your care team ahead of time. This can help you feel more prepared — especially if you have wishes around testing, burial, or how to honour your loss.

Everyone’s experience is different. If this approach doesn’t feel right for you, talk to your care team about other choices.

Medical management uses medicine to help your body pass the pregnancy. This can happen at home or in hospital, depending on how far along the pregnancy is, symptoms, and your doctor’s advice.

It’s usually offered before 14 weeks. After that, care is more often done in hospital, as the process can be more complex.

This treatment works well for most people — 80–90% of people will pass the pregnancy within one week.

What to expect

You’ll be given a medicine called Misoprostol, sometimes with another medicine called Mifepristone.

Misoprostol can be taken in different ways:

• Swallowed as a tablet.
• Placed under the tongue to dissolve.
• Placed between the cheek and gum (buccally).
• Inserted into the vagina.

Your doctor or midwife will explain which method might be best for you.

If you’re at home, you may get the first dose in hospital, then go home to complete the process. You’ll need someone with you for support.

If you’re in hospital, you’ll be monitored more closely. This may be recommended if the pregnancy is further along or if you have certain health conditions.

You may experience:

• Bleeding and cramping (often strong), usually within a few hours.
• Blood clots or pregnancy tissue passing from the vagina — this is normal.
• Side effects like nausea, vomiting, diarrhoea, chills, dizziness, or a mild fever — these usually settle once the medicine has worked.

Your next period may be later or different — this is common and usually settles.

If you’re at home and want to explore tissue testing, talk with your care team ahead of time. They can explain how to collect the tissue safely if that’s important to you.

Mifepristone works by blocking a hormone called progesterone, which is needed to keep a pregnancy going. Without this hormone, the pregnancy can’t continue.

Misoprostol causes the uterus (womb) to cramp and bleed, helping the body to pass the pregnancy tissue.

When to get medical help

Contact your doctor or go to hospital if you have: 

• Heavy bleeding — soaking one pad every hour for two hours, and/or passing large clots. 
• Emergency bleeding — soaking one pad every 15–30 minutes (go to hospital straight away).
• Severe pain — that doesn’t improve with pain medicine (including the medicine you’ve been given).
• Feeling very unwell — dizziness, weakness, or fainting.
• Bleeding that lasts more than two weeks.
• Signs of infection — such as fever, feeling unwell, or discharge with a strong, unpleasant smell. 

Things to think about 

Medical management is often more predictable than waiting for the body to pass the pregnancy tissue on its own and may help avoid surgery.

It works well for most people, but sometimes the process isn’t complete. You may still need surgery to remove remaining tissue.

Follow-up care (such as a scan or blood test) is important to check everything has passed, and that your body is healing. While bleeding continues, avoid tampons, sex, or swimming to reduce infection risk.

Having someone with you can help — especially if you’re at home. Everyone reacts differently. Support is available if you need it — you can ask your care team about what to expect or what to do.

Surgery might be recommended if:

• You are bleeding heavily — soaking one pad every hour for two hours and/or passing large clots.
• There are signs of infection — such as fever, feeling unwell, or discharge with a strong, unpleasant smell.
• Pregnancy tissue isn’t passing on its own.
• You choose surgery for personal, emotional, or practical reasons.

Surgery can help prevent complications and may be the safest option in some situations. Many people also choose it because it gives a clear end point and a faster recovery. It may feel more manageable emotionally.


What to expect

The most common procedure is suction to remove pregnancy tissue from the uterus. It’s usually done in hospital under general anaesthetic, so you’ll be asleep and won’t feel anything.

A small plastic tube is passed through the cervix, and gentle suction removes the tissue. An ultrasound may be used to help guide the procedure. It usually takes less than 15 minutes, and most people go home the 
same day.

You might hear other names for this procedure:

• Suction curettage or suction aspiration.
• Uterine evacuation.
• Evacuation of retained products of conception (ERPC).
• Dilation and curettage (D&C) — now used less often, as suction is preferred.

Manual vacuum aspiration (MVA)

MVA is another method sometimes used in the first trimester. It is done:

• With local anaesthetic — you’re awake, but the area is numb.
• Using a small suction device.
• In a clinic or day surgery — no overnight stay.

Recovery is usually quick. Some people find MVA has less pain and bleeding than surgery under general anaesthetic.


What to expect after surgery

You may feel sore or tired for a few days. Some bleeding is normal and can last up to two weeks. It should slowly get lighter.

While bleeding continues, avoid tampons, sex, or swimming to reduce infection risk.

Your next period may be later or different — this is common and usually settles.

When to get medical help

Call your doctor or go to hospital if you have:

• Heavy bleeding — soaking one pad every hour for two hours and/or passing large clots.
• Severe pain — that doesn’t improve with pain medicine (including the medicine you’ve been given).
• Fever or chills.
• Unusual vaginal discharge — with a strong or unpleasant smell.
• Feeling dizzy, faint, or unwell.

Things to think about

All surgery has small risks, such as:

• Infection.
• Bleeding.
• Reaction to anaesthetic.
• (Rarely) Damage to the uterus or nearby organs.

You’ll usually be given antibiotics to help prevent infection.

Before you leave the hospital

Before going home, make sure you understand:

• What follow-up care you need.
• Who to call if you’re worried about bleeding, pain, or fever.

It’s always okay to ask questions or speak up if something doesn’t feel right.

If the ectopic pregnancy is found early, a medication called Methotrexate can be used to stop the pregnancy from growing. Your body will then absorb the tissue over time. 


Who it’s for

This may be an option if:

• You are medically stable and not bleeding heavily.
• The ectopic pregnancy is small and hasn’t ruptured.
• Your blood hCG levels are low (usually under 1,500–5000 IU/L).

What to expect 

You’ll get one injection of Methotrexate into a muscle (sometimes through an IV). A second dose may be needed, depending on your blood test results. You’ll have regular blood tests over a few days or weeks to check your hCG levels until they return to normal.

Things to think about  

This option avoids surgery and may help preserve the fallopian tube. Mild side effects are common and may include: 

• Nausea (about 1 in 4 people will experience this symptom).
• Tiredness (1 in 5 people).
• Mild stomach pain or cramping (1 in 3 people).
• Diarrhoea or mouth ulcers (1 in 10 people).
• Rarely, serious side effects can affect the liver or kidneys.

About 1 in 4 people may still need surgery if the medicine doesn’t work. You must also avoid becoming pregnant for at least 3 months after the treatment.

Your care team will explain when to seek help — for example, if you have heavy bleeding, severe pain, or signs of rupture. If the medicine doesn’t work, your doctor will talk to you about surgery. 

Surgery is used to remove the ectopic pregnancy.  It may be recommended for if:

• You are bleeding heavily or show signs of rupture.
• The ectopic pregnancy is large or hCG levels are high.
• Methotrexate isn’t suitable or hasn’t worked.

What to expect 

Most surgeries are done using keyhole surgery (laparoscopy). If there is heavy bleeding or a rupture, open surgery (laparotomy) may be needed. Both are done under general anaesthetic, so you’ll be asleep and won’t feel anything.

The two main types of surgery: 

• Salpingectomy — removes the affected fallopian tube (most common option in Australia).
• Salpingostomy — removes the pregnancy but keeps the fallopian tube (used less often due to higher risk of tissue remaining and similar fertility outcomes).

Things to think about  

• Keyhole surgery is usually quick, with a 1–2 day hospital stay and faster recovery.
• It may be the safest option if there’s internal bleeding.
• Like all surgery, there are small risks (e.g. infection, bleeding, or damage to nearby organs).
• If a fallopian tube is removed, many people can still get pregnant. Research shows that your chances of becoming pregnant are usually the same whether the tube is removed or kept.

What to expect after surgery  

After keyhole surgery, most people recover in 2 to 4 weeks. Here’s what to expect:

• You may feel sore or tired for a few days.
• Bleeding or spotting is normal and may last up to two weeks.
• You may have bruising or tenderness around the incision sites (where they operated).
• Avoid tampons, sex, swimming, or heavy lifting until your doctor says it’s safe.
• Your next period may be later or different — this is normal.
• You might be given antibiotics to help prevent infection.
• Your doctor should advise you on when to remove wound dressings before you are discharged from the hospital.

Tips for recovery:

• Rest as much as you need — ask for help with chores or errands.
• Take gentle walks to help your body heal.
• Eat well and drink plenty of water to avoid constipation.
• Keep your incision clean and dry — use mild soap and pat dry.
• Don’t use lotions or powders on the incision.
• Speak to your doctor about guidance on returning to driving.
• Follow up with your doctor as advised.

When to get medical help: 

• Redness, swelling, or discharge at the incision site.
• Fever or chills.
• Severe pain — that doesn’t improve with pain medicine (including the medicine you’ve been given). 
• Heavy bleeding — soaking one pad every hour for two hours and/or passing large clots.
• Dizziness, fainting, or feeling very unwell.

It’s always okay to ask questions or speak up if something doesn’t feel right. Your care team is there to support you — physically and emotionally.