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D&C (清宫)术后康复及注意事项
作者:home99
发表时间:2010-04-30
更新时间:2010-04-30
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清宫术应该就是JMs多次提及的D&C,将我看到的一些资料稍作整理后贴出来供大家参考啊,主要是关于术后的恢复及注意事项,也附上一份比较全面的英文资料。失去宝宝的痛是身心的痛,需要注意好好休养和调整,比生完宝宝所受的身体上的创伤有时可能更甚,因为经历一切的一切之后毕竟换来了可爱的宝宝。

不知JMs同意否,为宝宝再苦再痛也值啊,而且当了妈妈之后似乎比较健忘,好象不少JM早孕和孕期苦不堪言,月子里也很辛苦,但好象大宝还没到一岁甚至月子里就开始盘算要老二了,呵呵。祝不幸失去宝宝的JM早日康复&好孕!

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清宫手术


一、什么是清宫手术?

清宫手术俗称“刮宫”,即刮子宫,清宫手术就是传统的人工流产。清宫术不同于人流术,用于清除人流术后流产不全停留于宫腔内的组织,帮助子宫的修复,减少出血或感染的可能。可以选择无痛清宫术,但与你所就诊医院的医疗水平有关。

只要提到人工流产,人们自然就会想到刮子宫,因此,刮宫几乎成了人工流产的代名词了。事实也是如此,刮宫是早期人工流产最常采用的方法。

清宫术不同于现代的人流术,是用于清除人流术后流产不全停留于宫腔内的组织,帮助子宫的修复,减少出血或感染的可能。可以选择无痛清宫术,但与你所就诊医院的医疗水平有关。

刮宫虽然不用开刀,但也是一种妇科手术,一定要严密消毒的情况下进行。手术分为二个步骤进行,第一步先把子宫颈扩张到足够大小,第二步是用刮匙伸到子宫腔内,把胚胎刮下来。怀孕的时间愈久,胎儿也就愈大,这时就需要把子宫颈扩张到最大限度才能刮出胎儿,所以刮子宫也就更加困难了;同时怀孕时间愈长,子宫也会随着变得愈来愈软,手术时穿破子宫的机会自然也会增多。

因此,一般只有在怀孕三个月以内才能用刮宫的方法把胎儿刮出来,超过三个月就不宜采用刮宫手术了。

吸宫时要特别注意两侧宫角及宫底部,如感觉仍有组织,可用刮匙搔刮一遍。如感觉到子宫壁已变粗糙及观察到吸瓶内出现血性泡沫,检查子宫显著缩小,意味着子宫内已清空,可结束手术。

术后要做好严格的防护措施,以免感染,出现并发症。

二、清宫手术怎么做?

人工流产以后一些组织并没有完全的清除干净,仍旧附着于子宫内部。这个时候,就需要进行清宫手术[1]。清宫相对是较为疼痛的,清宫手术到底是怎么做的呢?
清宫手术就是用一些长柄刮匙伸入子宫内将这些残留物刮出,清宫手术之前需要先做B超的。清宫手术在之前是较为疼痛的。不过随着科学技术发展,现在有无痛清宫手术了,无痛清宫手术室使用静脉麻醉。做清宫手术需要到正规、专业的医院进行。因为无痛清宫手术对经验是很有讲究的,用力太猛会将子宫刮穿,所以请一定要去正规医院做。

三、清宫术的常见并发症及处理

清宫术虽然不用开刀,但也是一种妇科手术,一定要严密消毒的情况下进行。手术处理不当可能会引发一些并发症,虹桥医院妇科专家将清宫术的常见并发症及其处理方法介绍如下:

1、术后感染,最常见

2、宫颈撕裂

常见于未育的女性,一般发生在宫颈两侧。对于此类病人,操作时动作要轻柔。小的撕裂创口可行碘仿纱堵塞止血;对于较大的裂口,应在直视下行缝合止血。如经阴道止血无效,则需剖腹找到出血的血管结扎止血,偶有需作子宫切除者。

3、术后流血

4、子宫穿孔,操作不当造成

妊娠和肿瘤(如葡萄胎)均可使子宫壁变得脆弱,清宫术时易造成子宫穿孔。对出血较少的子宫穿孔,可行抗炎、止血等保守治疗;若穿孔较大,并发大出血,则需剖腹探查止血,行穿孔创面的修补,或行子宫切除。

5、人流综合症,出现恶心、呕吐、头晕、胸闷、气喘、面色苍白、大汗淋漓、四肢厥冷、血压下降,心律不齐等,严重者还可能出现昏觉、抽搐、休克等一系列症状

6、子宫腔粘连

如清宫时搔刮过度,会出现宫腔粘连,其后果为不孕、流产、闭经、痛经等。可在宫腔镜下分离粘连。

专家提醒:清宫术一定要选择正规的医院进行,减少意外的发生,一旦出现并发症,要及时就医诊治。

7、脂肪栓塞,很少发生

8、感染
术前准备充分,严格无菌操作,术后预防性抗生素治疗,可减少感染的发生。

四、清宫术的适应症

清宫术即刮宫,刮宫是早期人工流产最常采用的方法。清宫术虽然不用开刀,但也是一种妇科手术,一定要严密消毒的情况下进行。手术分为二个步骤进行,第一步先把子宫颈扩张到足够大小,第二步是用刮匙伸到子宫腔内,把胚胎刮下来。

清宫手术全麻或局麻,用阴道窥器暴露宫颈,消毒宫颈,麻痹宫颈管(非常规性),用一支棒状宫颈扩张器扩张宫颈,用一支末端有刮匙的细长金属棒伸入子宫腔,刮出子宫内膜并送病理检查。

适应症:
1、不全流产,延期流产。
2、妊娠早期(12周以内)人工流产。
3、葡萄胎。

术后处理:
1、组织送检。将刮取物送病理检查。
2、预防感染。口服抗生素3~5天。
3、禁盆浴和性生活。禁盆浴14天,禁性生活30天。

怀孕的时间愈久,胎儿也就愈大,这时就需要把子宫颈扩张到最大限度才能刮出胎儿,所以刮子宫也就更加困难了;同时怀孕时间愈长,子宫也会随着变得愈来愈软,手术时穿破子宫的机会自然也会增多。所以做清宫手术一定要注意手术时机的选择,术后要严格按照医生的叮嘱做好防护,以免感染,出现并发症等。

五、清宫手术后吃什么药消炎?

清宫手术后出血量少且出血时间不超过7天是正常的说明清宫手术做的很成功,清宫手术后可以吃阿奇霉素和益母草冲剂也可口服益母草颗粒加头孢呋辛及甲硝唑消炎,清宫手术后吃什么药最好到医院检查后医生根据您自身的情况判断用药.抗生素最好在医生指导下服用不能自行随意使用。

六、流产不尽须清宫手术

人工流产手术是通过手术器械,将胎囊、蜕膜或胎儿、胎盘从宫腔中“取出”,从而结束妊娠。由于手术器械在操作时有一个从宫颈进入宫腔的过程,因此有可能将宫颈管内的细菌带入宫腔,引起盆腔炎症。同其他手术一样,人工流产手术后的感染是一个必须考虑到的问题,术后需要常规服用抗生素以预防。

药物流产是通过药物作用阻止胎囊在宫腔中继续妊娠,并排出体外的过程。与人工流产手术相比,药物流产不经过手术操作,不存在人为地将细菌带入宫腔的可能,因此术后感染的机会就会相对减少。但是药物流产后出血时间比较长,平均为18天±11天。长时间的阴道出血为细菌的生长繁殖提供了沃土,而由于药物作用和不断地阴道出血,宫颈内口也处于松弛状态,此时如果有细菌上行感染,同样也会引起盆腔炎症。因此,如果阴道出血超过7天,应该常规服用抗生素3~5天以预防盆腔炎症。

必须注意的是,即使药物流产后阴道出血停止,也不能有性生活,否则同样存在着患盆腔感染的可能,因为药物流产经常有不定期的阴道出血现象,在未行经前性生活都应该被禁止。只有认真遵守药物流产术后注意事项,才能有效地防止盆腔炎症的发生。另外,药物流产还有10%的失败,10%的阴道出血量多和不全流产,发生这些情况时还需要行清宫术。

七、药物流产后的清宫术人工流产手术有何不同?

与一开始就不同,具体表现在以下两个方面:第一,药物流产中服用的米非司酮和前列腺素(米素前列醇)既可使宫颈易于扩张,又可使种植在宫壁的胚囊比较松动。因此,药流后的清宫术比一开始就做人工流产手术容易进行。第二,对于那些禁忌做人工流产手术的高危妊娠对象,如畸形子宫、近期内做过剖宫产手术、宫颈发育不良、宫颈坚韧而难以扩张者,如果药物流产不全而又必须做清宫术时,也比一开始就做人工流产手术安全。容易操作。

那么,药流后出现什么情况必须做清宫术呢:

①病人服药后通常需要留院观察4~6小时。在观察期间,不管有没有看见胚囊排出,只要病人有严重的阴道出血,都应立即清宫达到止血的目的。

②药物流产后阴道流血量较少,一周后应去医院做B超检查,以证实胚胎的情况。如果胚胎未死亡而继续生长,做清宫术可以终止妊娠;如果胚胎已死亡而未排出〔胚胎停育):做清宫术则可以清除宫腔内妊娠物,防止出血和感染。

③药物流产后,虽然看见胚囊排出,但阴道流血淋漓不净,或时多时少,时有时无,长达三周以上,经B超检查有组织物残留,需要清宫,子宫内膜才能逐渐修复。需要注意的是,由于妊娠残留物长期存在可以造成宫腔内感染,导致子宫内膜炎、子宫肌炎或附件炎,因此,清宫术前后必须应用抗生素,以预防或治疗感染。

药物流产后的注意事项:药物流产后阴道流血持续不止,或有组织物排出,或有腹痛发热者,应及时去医院检查和治疗。药物流产后血未净前,为避免感染,切忌房事及盆浴。月经未复潮之前,即使阴道流血干净了,也应禁止房事。月经复潮后,应再去医院检查一次

月经复潮后应及时落实避孕措施,切不可把药物流产当作避孕方法使用。

★药物流产的适应人群:

①正常的宫内妊娠,停经天数小于或等于49天,本人自愿要求使用药物终止妊娠的健康育龄妇女。

②对人工流产手术有恐惧心理者。

③剖宫产在半年以内,有多次人工流产手术或多次剖宫史,哺乳期妊娠宫颈发育不良或坚韧、宫体上有瘢痕等不适宜做人工流产手术者。由于负压吸宫毕竟是一个手术过程,因此对于哺乳期、剖宫产史、近期人流史或子宫畸形合并妊娠的妇女会增加手术的困难或承担一定的危险。对于以上情况的妇女,如果妊娠在7周以内,可选用药物流产、药物流产只用于终止宫内妊娠。用药前务必做B超检查,确诊宫内妊娠,胎囊大小约在1.0CM~2.5CM方可服药;胎囊排出后可服用益母草冲剂减少蜕膜残留引起出血时间长。

八、清宫手术后注意什么?

术后一个不能同房,不要洗阴道里面,防止感染,注意休息。

1、手术后应该在家休息3~5天,放松心情,避免疲劳,少看报纸及电视。

2、术后2周内,适当卧床休息,逐渐增加活动时间,不做重体力劳动和下冷水劳动,避免受寒。

3、注意增加营养,多吃些富有营养的食物,增强机体对疾病的抵抗力,使身体尽快恢复正常。清宫手术后,应多吃些鱼类、肉类、蛋类、豆类制品等蛋白质丰富的食物和富含维生素的新鲜蔬菜,以加快身体的康复。

4、保持外阴部清洁卫生,每天用温开水清洗1~2次,勤换卫生巾。

5、2周内或阴道流血未干净前不要坐浴。

6、1个月内禁止性生活,以防生殖器官感染。如果有发热,腹痛或阴道分泌物有异常气味,要及时就诊。

7、一般在3~5天阴道流血渐渐停止,最多不超过10~15天。如果阴道流血量超过月经血量,持续时间过长,这时需要及时就诊治疗。★★★

8、如果暂时没有生育计划,恢复性生活后就要采取避孕措施,避免再次怀孕。即使要生育也要待到3~6个月以后。

九、刮宫手术后多久来月经?

刮宫手术会在一定程度上影响到卵巢的正常分泌,刮宫手术后恢复也需要一定的自我恢复时期,这根据患者自身体质以及卵巢恢复有差异性而定。一般情况下刮宫手术后月经会推迟一个月左右,排卵会在一个月内恢复正常。

十、刮宫手术的危害有哪些?

刮宫可能造成的危害有:

1、子宫颈或内膜粘黏

在进行子宫扩刮术时,如果刮的太粗鲁,导致子宫颈或内膜受伤、发炎,就有可能产生术后的子宫颈或内膜粘黏、并会引起月经异常,如无月经或月经量过少。严重者会在以后产生不育症的情况。

2、不完全流产

如果手术施行不完全,少量胎儿组织残留于子宫内,可能影响子宫收缩而造成持续出血或造成粘黏、感染等情况。最好再仔细做一次手术清除残余的组织。子宫的位置或形状不正常,一般比较容易造成此后遗症。

3、细菌感染

如果器械消毒不完全,或是手术者本身未注意无菌过程,即可能造成子宫内感染,甚至继续往上传染侵犯输卵管及骨盆腔,严重时会造成以后容易宫外孕或不孕的后果。

十二、清宫手术后怎么保养

在人工流产以后子宫里一些组织并没有完全的清除干净,仍旧附着于子宫内部。这个时候,就需要进行清宫手术。在进行了清宫手术后该如何保养呢?

合肥丽人妇科医院妇科专家说道,女性朋友们在进行了清宫手术后,具体保养原则应注意以下几点:

1、清宫手术后6小时内禁食、禁水。

2、清宫手术后6小时未排气可进食白开水及半流食,半流食包括粥、鸡蛋面片汤、鸡蛋面条汤、鸡汤、鱼汤、猪蹄汤、蛋羹等汤类,也可将馒头泡入汤或粥中食用。

3、未排气期间请勿食用普食,如煮鸡蛋、炒菜、肉块、米饭等,请勿食用甜食,包括巧克力、红糖水、甜果汁及牛奶,以免引起腹涨。

4、排气后可进食任何食物,为了促进乳汁分泌及减少产后便秘,进食的同时多喝汤、汁、多吃蔬菜及水果。

十三、清宫手术后的饮食保养

大家都知道清宫手术后都保养非常重要,那么清宫手术后要怎样保养呢?需要注意什么呢?下面杭州虹桥医院的妇科专家就清宫手术后的饮食注意事项给大家一些提示:

必须对各种食物在数量上、质量上以及相互搭配上作出合理安排,以满足机体对蛋白质、碳水化合物、脂肪、维生素、无机盐、水和纤维素的需要。
为了促进手术后的康复,饮食调整应注重以下几点:

1、蛋白质摄入要充分。蛋白质是抗体的重要组成成分,如摄入不足,则机体抵抗力降低。人工流产后半个月之内,蛋白质每公斤体重应给1.5克~2克,每日量约100克~150克。因此,可多吃些鸡肉、猪瘦肉、蛋类、奶类和豆类、豆类制品等。

2、补充水分和维生素。清宫手术后,由于身体较虚弱,常易出汗。因此补充水分应少量多次,减少水分蒸发量;汗液中排出水溶性维生素较多,尤其是维生素C、维生素B1、维生素B2,因此,应多吃新鲜蔬菜、水果。如此,也有利于防止便秘。

3、在正常饮食的基础上,适当限制脂肪。术后一星期内脂肪控制在每日80克左右。行经紊乱者,忌食刺激性食品,如辣椒、酒、醋、胡椒、姜等,这类食品均能刺激性器官充血,增加月经量,也忌食螃蟹、田螺、河蚌等寒性食物。

总之,清宫手术后,女性朋友一定要爱护自己的身体,饮食保养是基础。

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附上一份关于清宫术后恢复的比较全面的英文资料:

dilatation and curettage of uterine,D&C(刮宫)

1、D&C procedure after a Miscarriage

Unfortunately, miscarriage is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage, and most miscarriages occur during the first 13 weeks of pregnancy.

Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed on miscarriage in the unfortunate event that you find yourself or someone you know faced with one.

The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a D&C.

★What is a D&C Procedure?

D&C, also known as dilation and curettage, is a surgical procedure often performed after a first trimester miscarriage. Dilation means to open up the cervix; curettage means to remove the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration), using a vacuum-type instrument.

★Is a D&C necessary after a miscarriage?

About 50% of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own, with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is more likely to be incomplete, requiring a D&C procedure to be performed. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice, best decided after talking with your health care provider.

Some women feel comfort in going through a miscarriage in their own home, trusting their own body to do what it needs to. Some see this as a vital part of the healing process, eliminating the question of “what if?” about the health of the pregnancy. There are also many women who miscarry who have a history of gynecological problems and don’t want to risk the possibility of any more complications occurring from having a D&C procedure done. For most first trimester miscarriages, expectant management should be a viable option.

For some women, the emotional toll of waiting to miscarry naturally is just too unpredictable and too much to handle in an already challenging time. Healing for them may only start once the D&C procedure is done. A D&C may be recommended for women who miscarry later than 10-12 weeks, have had any type of complications, or have any medical conditions in which emergency care could be needed.

★How is a D&C procedure done?

A D&C procedure may be done as an outpatient or inpatient procedure in a hospital or other type of surgical center. A sedative is usually given first to help you relax. Most often, general anesthesia is used, but IV anesthesia or paracervical anesthesia may also be used. You should be prepared to have someone drive you home after the procedure if general or IV anesthesia is used.

* You may receive antibiotics intravenously or orally to help prevent infection.

* The cervix is examined to evaluate if it is open or not. If the cervix is closed, dilators
(narrow instruments in varying sizes) will be inserted to open the cervix to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open.

* The vacuum aspiration (also called suction curettage) procedure uses a plastic cannula (a flexible tube) attached to a suction device to remove the contents of the uterus. The cannula is approximately the diameter in millimeters as the number of weeks gestation the pregnancy is. For example, a 7mm cannula would be used for a pregnancy that is 7 weeks gestation. The use of a curette (sharp edged loop) to scrape the lining of the uterus may also be used, but is often not necessary.

* The tissue removed during the procedure may be sent off to the pathology lab for testing.

* Once the health care provider has seen that the uterus has firmed up and that the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to recovery.

★What are the possible risks and complications of a D&C procedure?

* Risks associated with anesthesia such as adverse reaction to medication and breathing problems

* Hemorrhage or heavy bleeding

* Infection in the uterus or other pelvic organs

* Perforation or puncture to the uterus

* Laceration or weakening of the cervix

* Scarring of the uterus or cervix, which may require further treatment

* Incomplete procedure which requires another procedure to be performed

★What to expect after the D&C Procedure:

D and C procedures can be emotionally trying on women.Most women are discharged from the surgical center or hospital within a few hours of the procedure. If there are complications or you have other medical conditions, you may be kept longer. You will more than likely be given an antibiotic to help prevent infection and possibly some pain medication to help with the initial cramping after the procedure. Things to know about taking care of yourself at home:

* Most women can return to normal activities within a few days, and some feel good enough to return to normal non strenuous activity within 24 hours.

* You may experience some painful cramping initially, but this should not last longer than 24 hours.

* Light cramping and bleeding can be expected from a few days to up to 2 weeks. Ibuprofen is usually suggested for treating cramps.

* You should not insert anything into the vaginal area, including douche and sexual intercourse, for at least 2 weeks or until the bleeding stops. (Your health care provider should give you specific instruction for when intercourse can resume.)

* Tampons should not be used until you start your next regular period, which could be anywhere from 2-6 weeks after the D&C procedure.

* It will be unknown when ovulation will return, so once sexual intercourse is allowed, you should use a method of contraception until your health care provider says it is okay to try to get pregnant again.

* Make sure to attend your follow up appointment.

★When to contact your health care provider:

Most women experience few complications after a D&C procedure, but you should be aware of things that could signal a possible problem. Your health care provider should give you specific instructions on what you should expect, but you should contact them as soon as possible if you experience:

* Dizziness or fainting

* Prolonged bleeding (over 2 weeks)

* Prolonged cramping (over 2 weeks)

* Bleeding more than a menstrual period, or filling more than a pad an hour

* Severe or increased pain

* Fever over 100.4 °F or chills

* Foul smelling discharge

2、Procedure Descriptions

★Surgical Procedures

If you opted for a D&C or D&E, first you will have the procedure done. Remember that if you can, insist on some time to gather loved ones around you or to get yourself together before you do this. Don't let anyone panic you into rushing into a procedure you're not ready for. This is usually all done in one day, but if you were farther along than 14 weeks, it may be a two-day procedure, with the laminaria sticks being inserted the first day, the dilation occurring overnight, and the procedure being done the next day. If your pregnancy was very young, you may get a dilation cream instead, or even not need dilation if your cervix is already slightly open as the miscarriage is beginning.

The surgery will be pretty fuzzy to you, due to the drugs and anesthesia. You may be put completely under, or you may be given a local and laughing gas. If you are awake, you may feel some pricking or sucking sensations, but it will not be uncomfortable. You will spend a couple of hours in a recovery room to wait on the anesthesia to wear off. Some doctors will prescribe antibiotics as a precaution; but many will not unless you develop symptoms of an infection.

During the next few days, you will likely experience the following:

*Mild to medium pain in your abdomen or tenderness. Most women report no pain at all, but those pain pills are not prescribed for nothing. Hopefully you will not need them.

*Deep muscle soreness in your thighs from your position during the procedure.

*Mild to heavy bleeding with some mild cramping.

*Sun sensitivity, nausea, and weakness from the strong antibiotics.

*Heavy groggy feeling, from the anesthesia and your sadness.

Call your doctor if you experience the following:

*Any sort of abdominal pain after the second day. You could be developing an infection. Don't panic though, just call and you will get a stronger antibiotic and a check up.

*A fever that starts to approach 100 degrees. Again, infection is a possibility.

*A sudden stoppage of bleeding, then severe cramps, almost as if you are in labor. This happened to me, and I can't tell you how I panicked. I ended up passing tissue, then the bleeding resumed normally. I called the doctor and they checked on me every few hours at home, but I didn't end up having to go in (good thing, since I was 150 miles away).

*Pain, flu feelings, or overall debilitating sickness that last more than a day or two.

★Natural Miscarriage

If you choose to wait it out for a natural miscarriage, you will most likely have a difficult wait. It may not seem real; you will harbor hope that it will never happen. Eventually the cramping and bleeding will begin, and you may react with severe grief and panic. You may feel ridiculous or morbid trying to catch tissue in a jar or plastic bag for testing. All these things are fine. Do the best you can. If all goes well, the cramps will subside and a regular blood flow will resume. Keep in mind that you may not pass all the tissue and will have to have a D&C to empty your uterus.

During the next few days you will likely experience the following:

*Cramps and bleeding, sometimes quite painful and heavy.

*Passage of tissue, resembling large blood clots in the earliest weeks up to pinkish/grayish material, possibly even in a discernable sack. Keep in mind that a three-week old embryo is only 2 mm long about like this: _ and you probably aren't seeing the actually baby, but only the yolk sack or placenta. A four-week old embryo is about a quarter inch long, more like this: __ , still probably impossible to see. Even a six-week old embryo is less than an inch long. Try not to traumatize yourself by searching for the baby. Believe me, I understand the impulse. Not seeing my baby was traumatizing in itself. And mine was fully formed at 20 weeks. Just do the best you can. If you collect the tissue, it may be refrigerated until you take it for testing. If this is your first miscarriage, it is not necessary to keep the tissue. It is rarely tested in this case. Any tissue that falls into the toilet is not testable, so you do not need to retrieve it.

★Call your doctor if you experience the following:

*Any sort of abdominal pain that lasts beyond the cramping stage. You could be developing an infection. Don't panic though, just call and you will get an antibiotic and a check up.

*A fever that starts to approach 100 degrees. Again, infection is a possibility.

*Cramps beyond endurance. You may need a pain medication or a D&C.

*Bleeding that comes heavy and fast, soaking a pad every few hours, for more than three days. If the bleeding does not slow down after that, you may have tissue that is causing hemorrhaging, and you will need a D&C.

*Bleeding that lasts longer than two weeks. A D&C may be necessary.

*Bleeding that starts and stops and starts and stops for weeks. Some tissue is still causing hormones to be created, and you will need intervention.

★Everyone will feel some of the following as the days and weeks wear on:

*A mild start and stop bleeding pattern up to two weeks. You should have a new cycle, unrelated to the first bleeding, between 4 and 7 weeks after the miscarriage. I didn't get a fresh cycle until the last day of the 7th week, so don't panic if you are still waiting. A few women need a Provera shot to jump start their cycle, but this is not terribly unusual. Call your doctor if you go much longer than 7 weeks, just for your peace of mind. You may want to start charting your temperatures after the bleeding stops to see where you are. Remember that you can get pregnant that first cycle, so use contraceptive. For more information, see the section on trying again.

*Snappy, unhappy, angry feelings. Wanting to be left alone or wanting to talk about what happened with everyone you know.

*A sense that it isn't real, that it never happened.

*Hypersensitivity to sad TV or reading materials, being revolted or angry about happy scenes of families, seeing symbols in everything you do, from gardening to dreams to what you eat.

*Anger at the baby, wishing you never knew about the pregnancy, wanting to throw out all the baby reminders, or clinging to the little angel you lost, thinking about him/her nonstop, wanting everyone to recognize that the baby was real.

*Anger and/or jealousy of other pregnant women, even friends and family, to the point you don't want to even talk with them. This is okay. I felt this way for several months.

3、Recovery overview

Physically, you will recover completely from a D&C or D&E in about two weeks. The bleeding should subside, your cycle will start up again, and the hormone-induced mood swings will even out. It will still take four to seven weeks to start a totally new cycle, and you should wait at least that long before trying again.

A birth takes considerably longer to recover from. You may have shaved areas that will grow out and itch or burn. You may have stitches that will be sore for a few weeks. This recovery is like any other post-partum. Check with your doctor in how long you must wait to try again. A general rule of thumb is that you must wait a cycle for every two months you were pregnant.

A natural miscarriage can take considerably longer. You may have to wait days or even a couple of weeks before the bleeding and cramping begin. (Don't go more than two weeks without talking to your doctor about possibly getting a D&C. Studies show the longer you carry a lost pregnancy, the more likely you are to get seriously depressed, and the more likely you may have physical complications.) The actual miscarriage may only take a few days, or may drag out over several weeks.

For more information on the actual passage of tissue or how a D&C or D&E is handled, see miscarriage descriptions. Usually you will have to wait four to seven weeks for a new cycle to begin regardless of how the miscarriage happens, although a birth near term can delay your first period for several months. You should not try to conceive again during this time.

The emotional recovery is another story altogether. One thing I will point out immediately is that your level of sadness is not at all tied to how far along you were. Everyone will be surprised by their emotions. Some will be near absolute despair and wish to join their baby. Some will be unpleasantly numb and feel nothing at all. Most will swing somewhere in the middle, seemingly okay one minute, then sobbing as if it were only yesterday. All the stages of grief will almost always be visited. Shock, numbness, denial, anger, guilt, depression, and finally resolution are all emotions you will experience. They do not come in order; some stages may go on for many weeks and others only a few hours. No two people grieve the same, as you will quickly see when your partner does not react the same way as you do. Don't expect that you will "get over it" in a few weeks or even months. Don't assume that getting pregnant again will turn everything around. Don't give yourself a timetable. Just let the emotions come and go and try to keep your life going.

So, you ask, when WILL I feel better? In some ways, you never will. The complete innocence and pure joy of pregnancy will not come back. But you will feel better than you do right now. Your life will go on, you will try again, and you will survive. There is much more to happen in your life. You have to keep going to see what it is. Only when you look back on where you were will you see that you do indeed feel a little bit better. For more information on emotional recovery, see "How to Cope."

★How to Cope
The emotional recovery from a miscarriage is not easy. Few people may even know about your loss, and others may brush it aside, even your partner. You are not alone, and you may be surprised to see in these topics that what you are feeling is normal and expected.

Feelings You May Have
*Despair and suicidal thoughts
*Anger
*Going crazy/Feeling neurotic
*Guilt
*No one understands
*My partner isn't supportive or grieving like me
*Jealousy of pregnant women

Dealing with Others
*Telling Your Friends and Family
*Telling Your Children
*When No One Will Talk about Your Loss
*When People Say Things that Upset You
*Mean and Petty People

Honoring Your Baby
*Ways to Memorialize Your Baby
*Naming the Baby
*Holding Services

Events to Suffer Through
*Managing the Holidays
*Going back to Work
*Baby Shower Invitations

● I feel despair.

It is natural to feel despair and incredible, debilitating sadness. You may not want to get out of bed, talk to anyone, eat, or even breathe. You may think about killing yourself to be with your baby or just lying in bed until everyone gets the point and leaves you alone. I felt all these things.

You have every right to feel this way. Let it go for a day or two, even as much as a week. By then, it should start to ease a bit. Your emotions may shift to anger or defeat. But when you cry, you do eventually stop. Your mind will drift to other things occasionally. And you will start getting better.

If in a week you are not feeling somewhat better, if you are still feeling like being with your baby would be better than being here, reach out to someone, anyone, email me, call someone you know, find a miscarriage support group, go to a church, do something. Fight to get back to the surface and out of deep despair that you feel.

Remember that you still have things to live for, things out there in a future you can't see right now--children you will eventually have, either yourself or through adoption, love you will feel, friends you will make. Don't give up yet.

When is despair dangerous? When you stop thinking about committing suicide and start planning it. If you have taken any steps toward really doing it, or sorted out in your mind what would be the easiest way, please, please, get help immediately. What is happening to you isn't just the loss of your baby, it is a hormone imbalance that is affecting your thinking. It is very possible to get out of your despair with just a little bit of help from a professional. You must do this. You have a future.

● I feel angry.

You are perfectly justified. It's hard to know where exactly to direct your anger, though. God? Fate? Your doctor? Your husband? Yourself? You wonder why in hell you had to get pregnant if this was going to happen. Why did you have to carry the baby so long? Why did it have to happen to you?

Anger is one of the natural parts of the grieving process. It is a healthy emotion right now and will get you feeling stronger. But it will probably not last. Anger usually gives way very quickly to sadness and despair. Sometimes you will feel flushed with anger, and just as quickly you will be sobbing. You may feel like you are out of control. Maybe you want to smash things. I actually did smash some things. It helped for a moment or two. Then I just had to sweep it up.

All these things are real and valid feelings. And we all experienced them. You are part of a large sorority of sad and angry mothers of angels. We all understand. And we're angry too.

● This miscarriage is my fault.

I can't tell you how many women have explained to me what they did to cause their miscarriage, or to ask if their stressful job or glasses of wine were what did it. For a long time, I blamed myself too. Then I learned I had a malformed uterus. All that guilt was for nothing.

Let me be the one to tell you: YOU DID NOT CAUSE THIS MISCARRIAGE.

I don't care if you were smoking crack--those babies are born all the time. Stand up on the job all day? Doesn't matter. On bed rest but got up a couple of times to raid the refrigerator or use the bathroom (or even to go out to dinner)? Insignificant. Nature is not perfect. Our genetic code sometimes doesn't work just right. It's terrible; it's sad. I hate it. But it has nothing to do with your sins, your stress, your mistakes, your nutrition, or your relationship. There was nothing you could have done.

I know. Some of you still feel a nagging guilt. But try to put it out of your mind. It really, truly was not your fault. And most likely, it will not happen again.

● I think I'm going crazy.

Remember to give yourself time to handle your grief. IT IS REAL AND VALID. You may want to read some of the other women's miscarriage stories here or on other web sites to help you see that the crazy things you feel are normal. I did and thought many things after my miscarriage that I thought were really unhealthy or insane, including:
■ Wanting to die to be with my baby
■ Cuddling the sonogram pictures like a baby
■ Hugging the tree we planted in Casey's memory (in full view of neighbors)
■ Getting angry with myself for laughing or having a good time
■ Picking fights with my husband for no reason
■ Telling perfect strangers about my baby

It may not get much better for a long time. There will probably be a time, about 3-4 months later, that it will actually get worse. Getting pregnant again may not give you the release from grief you seek. Just give yourself time and surround yourself with people who care and understand. Forget the rest of them, for now.

If I could make one recommendation that has helped me tremendously, it would be to put together a memory box of your baby's things, even if it is only sympathy cards and a positive pregnancy test, or just letters you are writing to him/her. For several months, I went into the nursery and opened that box and cried every single day. I found that if I didn't, I felt like I was in a grief-fog all day. The memory box validates my baby's existence. Since I don't have a grave or a container of ashes, I go to it.

● No one understands

You are right. Unless they have had a miscarriage (and fairly recently at that), people you talk to will not understand what you are going through. The average person will expect you to completely "get over" the miscarriage in about two weeks. This is about the point that things may actually get worse for you, when reality has set in, and you are failing to cope. Women suffer alone with miscarriage, and even the baby's father, your own mother, your best friend, or others you thought you could rely upon will fail you. The best course is to surround yourself for a while with people who DO understand, who are going through it right with you. You can find them in local support groups (call your doctor's office or a large OB practice in your area) or join a bulletin board. See some of the topics under "dealing with others" for other ideas on how to cope with solitary grieving.

● My partner isn't supportive or grieving like me

This is the number one complaint of women. They feel sad, overwhelmed, and grief-stricken, and their partners are still watching football, going to work just fine, or even telling them to "get over it."

There are a few critical points I want to bring up about this:

■ Almost every single woman feels this way (only a very small number mention partners that are sensitive and helpful)

■ 100% of dads I've talked to or who have gotten on the board either want to know how to be strong for their wives or confess that they are grieving deeply and don't want their wives to know

■ Men (and many women) really do believe that if you stop thinking about something, the problem goes away. Thus, they say comments like "Stop thinking about it" or "You're getting obsessed about this" or "I don't want to talk about it anymore." Truly, nothing could be further from the truth. Talking about your problems is a catharsis and will help you heal faster.

■ A very natural dynamic in every couple, particularly if you live together or are married, is that only one person can fall apart at a time. If you both fall apart, no one will be making dinner, keeping the clothes washed, or manage other children, if you have them. This is an important function of the partnership, and is very rarely breached. Whoever is less sad at the moment will swallow their grief and deal with it later. The other person will feel abandoned and alone, and the partner may recognize it, but feel helpless to really get involved due to the pressure of keeping everyday life going. This time will pass, and the acute phase is usually a month or less.

● I am so jealous of pregnant women, even family and friends

This is perfectly natural, and is reported by 100% of women who have lost babies. Why you and not them? Why does your teenage niece get to have a baby when you don't? Or that woman who is still smoking? Or the five friends of yours who are pregnant right now?

You will feel surrounded by babies and pregnant women. You will see reminders of your loss everywhere. This is something you are going to have to tough out. Here are some things that might help:
■ Buy something for your baby. Or better yet, make a little memory box. (See memorializing your baby.) You will feel comforted and more like a mom yourself--because you are one!

■ Don't feel obligated to go to baby showers. Don't bother with excuses, or to explain yourself. Just send a lovely note with a gift certificate to the mall, or Target, or an online baby store, and say, "Wish I could have made it. Best wishes." Will some people be upset? If it is your best friend, or your sister-in-law, maybe. But that's okay. One of the two of you were going to get bent out of shape with this situation, so let it be the one who is about to have a joyful moment and will forget all about it in a few weeks.

■ Don't bottle it up. If pregnant co-workers or friends talk incessantly about babies, just say, "I am so happy you all have so much to look forward to. I can't wait until it is one day my turn." Then walk away! There is no need to stand around and endure the conversation. Even if they say something negative about your sensitivity, they are just projecting how guilty they feel for upsetting you. They know it's their fault. And they have no idea how hard this is for you. Often you'll find out who has had a miscarriage before, because they will seek you out with a sympathetic, understanding ear.

■ Remember that this is a joyful time for them. You too will want to shout to the rooftops when your healthy baby is born. They are having a happy moment, and in the momentum of their anticipation, they don't always remember that you are grieving that very thing that they have. When women are pregnant, and blissfully ignorant that anything could ever go wrong, they don't always put others' feelings first. Forgive them, and don't seek their company if you cannot handle it. Joining in their joy will be one of the last things you will be able to do as you heal from your loss. Laughing at a baby shower will be a sign that you are moving through your healing stages and looking forward to a happier future. This is going to be a long way down the road, and may not happen until your own little one is safely delivered. It's okay, and don't beat yourself up about it. You're a survivor, and sometimes survivors can't always act the way everyone else does.

4、The First Few Days after a Miscarriage

At this point, you will have either gotten through the surgery or the worst of the tissue passage and bleeding from a natural miscarriage.

It is best, if you can, to take off work, or enlist help with children. The more active you are in the 72 hours following the miscarriage, the heavier you will bleed. Your recovery will take longer if you cannot spend most of your time sitting or lying down. (We'll allow you to sit here and read this, but if you feel any gushes of blood while you are here, print it out and take it to bed.)

★Here are symptoms that are normal:

*Additional passage of tissue a few days after things seem to have settled down, along with strong cramps and renewed bleeding

*Start and stop bleeding patterns

*Spotting

*Residual cramps, sometimes quite painful

*Minor abdominal pain or muscle soreness

*Sudden stoppage of bleeding (which may return)

*Sun sensitivity or nausea if you were given antibiotics

*Continuation of pregnancy symptoms for a week or so, including breast tenderness, nausea, and frequent urination

*Grogginess, inability to get out of bed (usually due to sadness or post partum depression)

*Increased tenderness in breasts, even leakage of colostrum, or pre-milk

*If you were in the 2nd trimester or later, you may experience engorgement, which is swollen breasts filled with milk. Ease this with hot showers or bags of frozen peas. Do not pump milk out.

★These symptoms warrant a call to the doctor:

*Bleeding so heavy that you constantly change pads or feel faint

*Labor like contractions that do not go away with rest

*Fever above 100 degrees, especially if you also have flu-like symptoms of weakness or clamminess

5、Waiting for your first period

Technically, when things go perfectly, your first period will not arrive until four weeks after your hCG levels reach zero. Since most women will not be tested all the way to zero (which on your forms would show as "less than 5"), you will not know exactly when this will happen. In a normal recovery, it can take three weeks for the hormone chain to fire up again, and it will not be marked by bleeding or any physical symptom. You will only know that the new cycle worked by having a period at the end of it, between five and seven weeks after your miscarriage.

Here are the most common scenarios and symptoms that go with them. They come from a decade's worth of collecting women's experiences, from the easiest and quickest recoveries to the most elongated and complicated ones.

Remember that the day you found out about the loss is not a benchmark, nor is the day you began bleeding. The actual hormone change begins to take place either during the D&C or when the placenta pulls away from the uterus during the natural miscarriage, which is usually when the cramps and bleeding are at their worst. That is Day 1 of the recovery (but not Day 1 of a new cycle, as you will see.)

Here are the scenarios:

★The most common recovery goes like this:

Your bleeding will taper off to spotting within a week, and maybe random spotting will continue for another week. Your hCG drops steadily, usually hitting zero during the end of the spotting, or about 10 days after the miscarriage or D&C. When the spotting ends, you will get strange symptoms. If you use a fertility monitor, it may say you are ovulating, but you are not. You may see lots of cervical mucus coming out, sometimes still brown or yellow, but it is not a fertility sign either. In fact, most of the time, you will not ovulate in this cycle. You should not be trying to get pregnant, either. For why, visit the trying again section.

Some women find they have mild pregnancy symptoms, or little ovulation cramps. Many many women think they could be pregnant, because strange things are happening and their period is "late" (although almost every post-miscarriage period is late.) These symptoms are due to the body's attempts to regulate its hormones again. It may kick into gear right away, and you will get a new period in four to five weeks, or it may struggle a bit, and the period will not come for seven weeks. If you chart your temperatures, they will be all over the place. This is all perfectly normal and expected. Eventually your period arrives and can be either light or heavy. There is no "normal" right now. For more on this, or to spot trouble, see the next section on Your First Period.

★A less common, but still normal, recovery goes like this:

Your bleeding tapers off quickly, but with some spotting. You think it is over. Perhaps a week or even two will pass, and you begin to wait for your period. Then suddenly, it begins again. Strong cramping, heavy bleeding, and pain. You are scared and shocked and sad all over again. You hope it is just your period, but it is not. (You must not bleed at all for about 20 days for it to be a real period, otherwise you have not gone through the hormone chain properly.) You call your doctor, who may or may not be responsive. Most will just tell you to call them in a few days if it doesn't stop. You hang up very upset, and don't know why they don't care more about you and your predicament.

That's because within a few days, it does stop, and you are just spotting again. Here is what happened, some tissue was missed during your D&C or natural miscarriage.A bit of placenta clung to the wall of the uterus. It continued to draw a little blood, and the body continued to create very small amounts of pregnancy hormone. Eventually the body realized no baby was there and turned loose of this last bit of tissue. The miscarriage process begins again. Only now will your levels drop to zero and a new cycle begin. You cannot expect a normal period any sooner than four weeks from this, and up to seven weeks could still be normal. Your total wait time from original miscarriage to first period can creep up to nine or ten weeks and still be normal.

★A recovery that should be monitored looks like this:

The main bleeding seems to have ended, and you are spotting. And spotting, and spotting. Three weeks pass and you are still wearing panty liners. (You call your doctor, and they said give it another week.) Spotting ends. You are relieved. A few days later it begins again. You are crushed. Sometimes you get slightly heavier bleeding. You hope it is your period, then read that you have to have NO bleeding for almost three weeks first. You are crushed again. Your ordeal seems like it will never end.

You should go in for an hCG blood test. If your doctor won't do it, take a home pregnancy test. If it is still positive, call them back. Your levels should be at zero by now.

Your levels may come back at 100, or even higher. It may be zero. Your doctor still wants you to wait and see. If your levels were high and things go well, you will suddenly get another big passage of blood and tissue, and it will be over. You will still have a good case for requesting one more blood test to be sure. If this pattern continues, you may need a D&C, or in some cases, a drug called Cytotec, to induce cramping to push out left tissue.

If your levels were zero or not very high, and you still just keep spotting and spotting, you should be able to request a shot of provera or some other form of progesterone. This big dose will put your body into thinking it is nearing the end of a cycle. When the dose is done, the sudden drop in progesterone should trick your body into thinking it is time for a period, and you will bleed. This period can be terribly heavy or light, but it counts. If this has happened, it is still a good idea to wait one more cycle before trying to conceive. If it doesn't work, your doctor may put you on birth control pills for a couple of months to get your cycle regulated.

★A cycle that indicates a serious problem looks like this:

The bleeding tapered off, but then got heavy again. You are going through several pads a day. After two weeks of this you call the doctor. They tell you to see what happens. You may get a little reprieve of no bleeding or just spotting, then it begins again, as heavy as ever. You call and insist on being seen. You are feeling exhausted from the constant loss of blood and the sad ordeal just going on and on.

A blood hCG comes out high, 500 or more. The doctor tells you to wait and see, or maybe schedules another test. Your bleeding is still heavy, and sometimes you see big black gunk or tissue coming out. You feel panicky every time you go to the bathroom.

A second hCG test comes out only slightly lower than before or even higher than before. The doctor asks a few questions to rule out a new pregnancy and may do a sonogram.

The cause of this can be one of two things:

●Leftover tissue that refuses to budge. You may need a D&C or methotrexate to kill the tissue and make it come away. If left untreated, you could hemorrhage badly, eventually losing consciousness or becoming seriously iron-deficient. Scar tissue can also form should the left tissue become infected.

●Molar or partial molar pregnancy. It is very important to follow up on this and get a concrete diagnosis. Molar pregnancy can persist for months, and you absolutely cannot attempt another pregnancy until you have been without any hCG in your system for several months. Read more about molar pregnancy.

If you have start and stop bleeding for several months, I have a more complex description of the relationship between progesterone and bleeding down below.

★About follow up exams:

If you had a D&C, you will usually be called back in two weeks for a follow up exam. If you miscarried naturally, you may not need a follow up, or it could be at two or six weeks.

This exam is most likely going to hurt some. The cervix has been open and will be very tender for a while. Taking a couple of ibuprofen before you go can help. If you are able, having sex the night prior to the exam will help "break things in." You can control penetration with sex, and do it slowly, rather than have a metal speculum suddenly open you up.

This exam is your chance to ask questions. Don't be surprised if it is quick, your doctor does not have many answers, or you do not get any tests. This is pretty normal after a first miscarriage, where it is assumed you will be in the category whose next pregnancy will go perfectly (about 80%). For more on testing, see the diagnosing section.

The hardest part of the exam will be seeing other pregnant women around you, and perhaps returning to the room where you learned you lost the baby. Be prepared for this, and if you have an option (particularly in bigger practices), ask if you can be seen in the Gynecology slots, rather than the OB slots, where you should be waiting with women getting mammograms or annual exams, rather than prenatal visits. These are scheduled differently in most practices, as OB visits are short-notice slots, and annuals are set slots done in advance.

★About sex:

You should probably avoid sex while you are actively miscarrying, and certainly use a condom if you have sex within two weeks of the loss. This is because your cervix is slightly open and you are very susceptible to infection.

Sex will often hurt for a few weeks after the loss, although it often gets progressively better, because your cervix will be tender from being open and closed through the miscarriage. Sex can also be very emotionally difficult, as it will remind you of the whole process of pregnancy and conception. It is pretty important not to try again until you get a regular period. You can read why at the trying again section.

★Why do I start and stop bleeding and the hCG refuse to fall? It's been several months now!

Let's start with why we bleed at all. Our body, during our cycle, makes progesterone. This causes the lining in our uterus to thicken and prepare for pregnancy. When we do not get pregnant, the body cuts the progesterone level suddenly, and this dramatic loss of hormone makes us bleed.

When we are pregnant, we make even MORE progesterones, levels that go from an ordinary 12 in a cycle to 30 or more. Some get even way way higher. It varies from woman to woman. While you are pregnant, if you get any sort of hormone flux, let's say it drops temporarily from 30 to 25, you will bleed a little. This often happens when you would have expected your period. Your pregnancy can be fine as the body goes OOPS and makes more progesterone to cover the loss and baby goes along happily growing as the part of the lining he or she is using is not affected.

When the baby dies, or the body figures out it is a blighted ovum and no baby is growing, in some people it will cut off the flow of progesterone immediately. These women suddenly cramp and bleed and the body gets it all out in one shot. This is a complete miscarriage.

Other times, the body turns the tissue loose slowly, and the progesterone drops a bit, and some bleeding occurs, maybe even part of the chorion comes out as tissue, but then the body senses hCG still, so it says OOPS and boosts that progesterone again, and you stop bleeding. This is a missed miscarriage.

After a few days or a week or more, once again the body realizes no baby is growing, so it drops it again. More tissue comes out, but if the hCG is still high enough, the cycle of correcting itself continues.

Most women will get a D&C at this point, and the scraping of the uterus gets rid of all placenta, which is putting out the hCG, and so the body gets no more baby signals and you have your period.

If any placenta is left, though, the body is going to get fooled again.

At this point, usually the woman, if she has already had a D&C, will be given either:

●a shot of progesterone, to create a false "drop" so the body will start cramping and bleeding and pushing out whatever might be in there.

●birth control pills, to do the same thing when she stops taking them

In one special case, hCG's failure to drop can be caused by a molar or partial molar pregnancy. If your hCG ever goes UP after a loss, this is very likely the case. If your hCG stalls out, it might be the case and your blood hCG should be monitored by your doctor. It is unusual for molars to fall below 100, however.

6、Your First Period after a Miscarriage

One thing that is certain is that your first period will not resemble anything you've had before.

To make sure this is really your first period, make sure it has been at least four weeks since your miscarriage AND you have had about 20 days of no bleeding or spotting. For the estrogen threshold to be met, you should not be bleeding anymore. Otherwise the lining is not being rebuilt, and you are still experiencing progesterone withdrawal.

You can expect this first period anywhere from four to seven weeks in most normal cases, although you have to restart the counter if you have a renewed case of serious bleeding. See "Waiting for Period" for more on this.

There really is no "normal" for this first period. It can be:

●Very heavy (but not making you feel faint)

●Very light (but more than spotting). There should be a fair amount when you wipe.

●Terribly crampy, or not at all

●Be heavy and drop off immediately to spotting

●Be light and drop off to spotting

●Spot for several days, stop, then come full-blown with heavier bleeding

These periods are not normal, and are not actually a period:

●Light spotting that only spots for days on end

●Light spotting that comes and goes

●Heavy bleeding that makes you go through a pad every hour or two for more than a week.

Those scenarios mean the miscarriage may not have completed or your hormones are not getting back to normal and may need help.

7、New Cycles

Sometimes even if the first cycle seems normal, you start to see your cycles elongate or shorten. First remember that your cycles have changed now. Every pregnancy, regardless of outcome, changes your hormonal makeup. As long as your cycles are at least 24 days and not more than about 45, you are in the range of normal. Your cycles do not have to be the same every month, and most often they will not be.

About 60% of women will get pregnant again within the next four months, especially with earnest work toward that goal with the help of the Sperm Meets Egg Plan. Your fertility may not return immediately, but you should hold off on Clomid or other reproductive assistance for six months. After that point, you can ask for help from a doctor to see what is going on. It is not unusual to meet women who tried for a year before getting pregnant again. I personally did not ovulate in my first two cycles following my miscarriage, and got pregnant first try on the third.

It is very disheartening to see month after month go by without getting pregnant again, especially when your cycles are not the same as before. You will constantly feel you are pregnant but test negative, and you will feel certain you are having early miscarriages. This is a very very common feeling, but usually it is not true.

You will also face another problem. Post miscarriage cycles are all over the place, sometimes coming on day 22 (making women think they have a luteal phase defect) and other times coming weeks late (making women spend a fortune on pregnancy tests.) This is all a very common scenario in the months following the loss. It happened to me too. Just keep trying, and trust the pregnancy tests. They are accurate. Your hormones right now, however, are not. You should call a doctor when you go for seven weeks without a period. They can (sometimes, if they will) put you on a dose of Provera to bring on a period, or if worst comes to worst, put you on birth control pills to regulate you.

At this point, you are ready to look over the Trying Again section.

8、Trying Again after a Miscarriage

This can be the most difficult topic of all, because everyone has an opinion, and your doctor and your friend's doctor, and internet sources, and your mother, and your partner will all say different things. You will personally go from wanting to try again RIGHT NOW to never wanting to try again, sometimes in the span of five minutes. You may not agree with your doctor. Your partner may not agree with you. You are already grieving, and upset, and feeling like a failure, and thinking too long about this topic can make you feel so very much worse.

Accept that there are many opinions. Let me tell you a bit about why.

Doctors are trained to recognize that a woman needs emotional healing, but not really to help them or explain it to them, since it goes beyond their "bones and tissues" type of practice. Three months is considered the average amount of time a women will grieve hard over a loss, and will have a difficult time (and be a difficult patient) if she gets pregnant prior to that. While there are a few doctors who believe that your uterine lining must take three cycles to get back to rebuilding itself fully each time (especially after a D&C, where it gets scraped pretty thin), most doctors know that it doesn't really matter in about 80% of the cases, and getting pregnant again right away does not carry any increased physical risk or miscarriage risk.

So even among doctors, some will say the standard "wait three cycles" and might even scare you into thinking you'll have another miscarriage if you don't wait, and others will say go ahead and try again now.

As for my opinion, I've been running this site for three years, and have talked to about 2,000 women who have had miscarriages. From what I've seen, you really should wait for one cycle to complete, because if you do not, you will experience one of two situations, both of which will cause you much unnecessary grief and pain:

●If you do get pregnant again before having a period, you will not establish a reliable Last Menstrual Period date (your miscarriage date is of no use). You will run into lots of problems when you go in for your first prenatal sonograms and blood tests, causing you tons of grief (often for nothing) and can wreck your relationship with your doctor (supporting the "difficult patient" theory.)

For example, the blood test will say you are six weeks; you will insist you are eight. The sonogram will not show a fetal pole yet, but you have read that you should see a baby by now. You will think your doctor should do something, but he or she will just say your date is wrong and come back in a week. You will spend a week of torture, wondering if the baby is dead, and why do you have to wait for answers. All these things can be avoided by knowing your LMP, or preferably ovulation. Most of the time, the babies are fine, but sometimes you are having another miscarriage. Everything is murky because you don't know for sure when you got pregnant, because you didn't complete a full cycle.

●If you have retained tissue, your period will be "late" (although all post-miscarriage periods take more than four weeks and are late) and you can even have a POSITIVE PREGNANCY TEST, but you are not pregnant. This is hCG left in your system from the miscarriage, which has not completed. You may begin bleeding and cramping and think you are having another miscarriage, but you are just still going through the first one. We have had women on the site grieving over a 2nd lost baby, naming it and everything, when it turned out she only had missed tissue from the previous loss.Having a D&C does not guarantee that all the tissue was taken. About 1/4 of the women on this site with missed tissue had a D&C. If you did not wait for a real period, you will not know if a pregnancy test really means you are pregnant again, or if your loss has become a long drawn-out ordeal.

Additionally, charting and even ovulation predictor kits are not reliable tools during that first cycle after a miscarriage, and the body will put out lots of signs of fertility or lack of it as it tries to adjust itself. Women may be absolutely sure of their pregnancy's gestational age, and still be wrong! Once you get past that point, try the sperm meets egg plan to see if you can speed up the trying again process.

On the other extreme, not getting pregnant that first cycle, or for the next few, when you are fervently trying, will actually push your grief further down the line, month by month, and it can really be detrimental to healing, your life, and your relationship. Often your life will completely revolve around trying again and you will feel even more a failure, more unable to cope. This may also happen if you wait, but is more likely to pull you into a clinical depression if you are not yet dealing with your loss and are still having some hormonal upheaval.

Even if you feel like you are fine, the grief is really out there, and you need to work directly through it. I don't worry about the women who write about crying and saying they can't go on. They are working through their pain and grief. I worry about the woman who just wants to try again, and doesn't mention or think about the pain of losing a baby.

In the end, this is your life and your body, your baby, your future, and your decision. Make your choices well, and try not to look back.

★Monitoring a New Pregnancy

Some doctors will respond to your worries and bring you in for additional hCG tests and early sonograms to monitor the new baby more closely. Most will not do anything. It can be frustrating and scary to think about waiting until 8 or 9 weeks to see the doctor, when every day brings a new twinge or cramp or cervical discharge that makes you panic.

I think it is reasonable, if you have had only one loss, to still request an early blood test and a sonogram at 7 weeks to see the heartbeat. This will reassure you. If you have had more than one loss and no healthy babies yet, then you should be able to request more frequent monitoring of your hCG and progesterone levels, just to see where the pregnancies are failing. This could help give you a clue as to a cause.

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