Discharge information after pregnancy loss (before 16 weeks)

If you have any questions or are worried about anything, please speak to your nurse or contact one of the services listed at the bottom of this page.

Your nurse will tell you whether you need an Anti-D injection. Before you leave hospital, they will confirm whether it has been given or is not needed.

We recommend that you avoid sex until the bleeding has stopped. If you choose to have sex before doing your repeat pregnancy test, please use barrier contraception such as condoms.

• If the test is positive, please contact the Early Pregnancy Assessment Unit (EPAU). Their number will be at the end of this page.
• If the test is negative, this means the pregnancy hormone is no longer detected. If you feel ready, you can try to become pregnant again.

If you do not want another pregnancy, you may wish to think about contraception. You can discuss this with:

• Your GP
• A local pharmacy
• Hope House (Sexual Health Clinic)

What to expect at home

Pain and bleeding

It is common to have some pain and light vaginal bleeding for up to 2 to 3 weeks. Please use sanitary pads and avoid using tampons. If the bleeding becomes heavy, prolonged, or does not settle after 3 weeks, contact the Early Pregnancy Assessment Helpline.

Your next period may start 4 to 8 weeks after your loss. Some women find that the first period after pregnancy loss can be heavier and more painful than usual. Irregular periods after a miscarriage can be very common and it can take a few months before they return to normal. If your period has not returned after 3 months, please contact your GP.

When to get urgent help

Go to the Emergency Department at Gloucestershire Royal Hospital if you have heavy bleeding, such as:

• Soaking through more than one sanitary pad an hour
• Bleeding so heavily that you have to sit on the toilet and it does not settle within a few minutes. Call 999 or go to ED urgently if you feel very unwell, including signs of infection or sepsis such as:
• Not passing urine for 12 to 18 hours
• A high temperature (38°C or higher) or a low temperature (35°C or lower)
• Feeling very hot or cold, or shivering
• Confusion, slurred speech, or not making sense
• Blue, pale, grey or blotchy skin, lips or tongue. On brown or black skin, this may be easier to see on the palms of hands or soles of feet
• A rash that does not fade when pressed
• Fast or difficult breathing

Ectopic pregnancy

If you had a confirmed ectopic pregnancy, we recommend that in your next pregnancy you arrange an early scan. You can self-refer by contacting the EPAU. Surgery

It is recommended to wait 6 to 8 weeks before trying to conceive again, to allow your body time to recover. If your medical team has advised waiting longer, please follow their advice.

Wound care

You may have dissolvable stitches. These do not need to be removed and usually dissolve within 2 to 4 weeks. If you have a dressing, keep it on for 24 to 48 hours unless advised otherwise. Once removed, leave the wound uncovered. You may shower but avoid perfumed or harsh soaps and pat the area dry. It is normal for the wound to feel warm or look slightly red.

Contact your GP or 111 if you notice:

• Increasing redness or heat
• New pain
• Swelling
• Discharge from the wound
• Fever

If you were treated with methotrexate

If you were given methotrexate for an ectopic pregnancy, the usual recommendation is to wait for 3 months from the completion of care before trying for another baby. You should use your usual method of contraception during this time. This is important because it ensures that any traces of methotrexate are removed from your system.

Once your pregnancy hormone level is below 15, and if you plan another pregnancy in the near future, take 5 mg of folic acid daily until 12 weeks of pregnancy.

You can self-refer for an early scan in your next pregnancy by contacting the EPAU.

Molar pregnancy

If you had a confirmed molar pregnancy, you will need to avoid further pregnancy until your follow-up care is complete and your pregnancy hormone levels have returned to normal. You will be referred to the team at Charing Cross Hospital, London, who are the specialist team for the South West. They will be able to advise you about when it is safe to try to conceive.

If you become pregnant before your pregnancy hormone levels have returned to normal, they would rise and it would be difficult for your nurse/doctor to know whether abnormal tissue was growing back. Therefore, we would advise you to use condoms or other forms of contraception until advised otherwise by Charing Cross. The team at Charing Cross Hospital will advise you not to use hormonal contraception until your pregnancy hormone levels are back to normal. A molar pregnancy does not affect your fertility or your ability to have a normal pregnancy. You are not at any increased risk for stillbirth, birth defects, premature delivery or other complications and the likelihood of having another molar pregnancy is only 1 to 2 in 100 cases.

In any pregnancy following a molar pregnancy, we will offer you an ultrasound examination at around 8 weeks to make sure all is well. You can self-refer by contacting the EPAU. Contact details are below.

Contact information

Early Pregnancy Assessment Unit (EPAU)

Tel: 0300 422 5549

Monday to Friday, 08:00 am to 4:00 pm

Early Pregnancy Assessment Helpline

Helpline: 0300 422 6729

Available 24/7

Hope House (Sexual Health Clinic)

Tel: 0300 421 6500

Emergency contraception is available for all ages

Remembrance and spiritual support

Hospital Chaplaincy (all faiths and none)

Tel: 0300 422 6200

Monday, Wednesday, Thursday and Friday, 9am to 5pm

Pregnancy Loss Certificate

You can request a baby loss certificate from the government. Please type the following link into your

internet browser: www.gov.uk/request-baby-losscertificate

Hospital Remembrance Book

There is a remembrance book in the hospital chapel where you are welcome to write a message for your baby. If you would like to do this, please ask the ward staff for help.

Annual Baby Remembrance Services

There is an annual remembrance service held for parents, family and friends.

• Gloucestershire Royal Hospital: last Friday in September
• St Luke’s Church, Cheltenham: first Friday in October

Forget-me-not Garden

The Forget-Me-Not Garden at Gloucestershire Royal Hospital is a peaceful place where families can come to reflect and find comfort. You can dedicate a leaf on the memory tree in the garden. Your leaf will stay on the tree for two years, then it will be given back to you to keep at home.

Children’s Memorial Garden

There is a memorial garden at Cheltenham Cemetery.

Tel: 01242 244 245

Feedback

Pregnancy loss is a difficult experience to talk about. We appreciate any feedback you can offer, or recollections of moments in your care that stood out to you. Please visit: https://ex.civicamysay.co.uk/EolwHZLvtjr

Organisations that can offer support

You may find the following organisations helpful. They offer support, care and information to make things a bit easier. For more information, speak to your clinical team or see the details below

Tommy’s

Website: www.tommys.org/babyloss-support

Provides help and advice to anyone who has lost a baby, whether it happened during pregnancy, at birth, shortly after birth, or for medical reasons.

Miscarriage Association

Helpline: 0303 003 6464

Monday, Tuesday and Thursday 09:00am to 4:00pm. Wednesday and Friday 09:00am to 8:00pm.

Website: www.miscarriageassociation.org.uk

Provides help and information by calling their helpline, chatting online, sending emails or messages. There are also support groups you can join, both online and in person.

Ectopic Pregnancy Trust

Helpline: 020 7733 2653

Website: www.ectopic.org.uk

Provides information and support on ectopic pregnancy.

Aching Arms

Website: www.achingarms.co.uk

This charity gives comfort bears to hospitals and hospices so that midwives and nurses can offer them to parents who have lost a baby. They also provide support to parents after their loss.

4Louis

Website: www.4louis.co.uk

This UK charity helps people all over the country who have experienced miscarriage, stillbirth, or the loss of a baby or child.

Holding Hearts

Website: www.holdinghearts.org

Provides books about baby loss, helpful resources, and special memory hearts for families at this hospital.

Miscarriage Mumma

www.miscarriagemumma.com

This self-carefocused support hub is a place where anyone who has lost a baby during pregnancy can find support.

CRUSE Bereavement Care:

Tel: 0808 808 1677

Website: www.cruse.org.uk

Provides counselling and support for people who are grieving.

Samaritans

Tel: 116 123 (24 hours)

Website: www.samaritans.org

Offers people help in serious emotional distress, 24 hours a day.

The British Association for Counselling and Psychotherapy

Tel: 01455 883300

Website: www.bacp.co.uk

Can help you find a counsellor or psychotherapist.

Forget Me Not (local support group)

It is a local support group for those who have experienced a loss in pregnancy, birth or postnatally. Takes place on the first Friday of each month, 7:30pm to 9:30pm at Pineholt Village Hall, Hucclecote.