Q: What happens next after I lost a pregnancy? Should I visit my doctor for a follow-up?

A: If a patient does not know that she has suffered a miscarriage, that is, her condition is not diagnosed before she comes into the hospital, she may bleed suddenly and experience severe cramps. This is usually due to womb contractions that are pushing the failed pregnancy out.

Heavy bleeding may result and usually the miscarriage is not completely emptied out of the womb at this point. The patient must seek medical attention and upon admission to the hospital, a procedure to clear out the remaining parts of the failed pregnancy, which is called an evacuation of the uterus, is usually arranged so that the bleeding is controlled.

If a patient has been assessed by a gynaecologist and has been informed that she has a miscarriage, then usually the procedure of evacuation of the womb is offered so that this can be arranged at a convenient timing for the patient.

Sometimes while waiting in the few days before the procedure, actual bleeding may take place. The procedure may then have to be expedited and performed that day.

Sometimes for an early pregnancy failure, spontaneous expulsion takes place at home and by the time the patient is seen and assessed at the clinic, bleeding has already stopped. If the ultrasound scan then shows the womb lining is thin and this implies that the contents has been emptied, an evacuation of the womb may not be necessary and a "wait and see" approach may be acceptable.  

Got a question on pregnancy or your reproductive health? Email it to us at Just Woman and we will get it answered by Dr Fong Yoke Fai, a consultant Obstetrician and Gynaecologist at the National University Hospital.