What is a Inevitable Miscarriage? A inevitable miscarriage occurs in two different situations.  The first situation in which a inevitable miscarriage occurs is when the fetus has not changed size over a two week period, the hCG levels are decreasing, and / or the physician is unable to hear or see fetal heart tones.  The second situation in which a inevitable miscarriage occurs is when the cervical os (cervical opening) is open and there is significant vaginal bleeding.  If one of these two situations occurs prior to the 20th week of gestation then it is considered a inevitable miscarriage.  Signs and Symptoms of Inevitable Miscarriage A incomplete miscarriage will have heavy vaginal bleeding which is the most common sign and symptom, but also majority will have significant abdominal / pelvic pain.  Other signs and symptoms of an inevitable miscarriage are abdominal cramping, a large amount of fluid that is discharged from the vagina, and pain or pressure in the lower back or pelvis.  Blood clots and fragments fo products of conception are usually expelled through the vagina as well.  With a inevitable miscarriage a ultrasound will show no fetal heart tones, no growth of the fetus within two weeks or the loss of amniotic fluid.  Also with a inevitable miscarriage the hCG level will be decreasing with serial blood draws.  To learn more Go To Signs and Symptoms of Miscarriage.    Causes of Inevitable Miscarriage  There are several causes for a inevitable miscarriage and it depends on when during the pregnancy the miscarriage occurs.  Because most inevitable miscarriages occur within the first twelve weeks of gestation the cause is most commonly due to chromosomal abnormalities within the fetus.  These chromosomal abnormalities can be due to several factors including poor quality sperm or egg, abnormal cell division of the fetus, and / or genetic abnormalities of either mother or father.  Other causes of a inevitable miscarriage include infection (ie. Chlamydia, Cytomegalovirus, Genital herpes, Syphilis, Toxoplasmosis, and Rubella), abnormal uterine anatomy (ie. unicornate uterus or septate uterus), abnormal hormonal levels within the mother (ie. low progesterone), systemic illnesses (ie. untreated thyroid disease or diabetes), immune disorders, and substance abuse.  To learn more about the causes Go To Cause of Miscarriage.   Treatment of Inevitable Miscarriage  A inevitable miscarriage requires medical intervention.  The treatment option for a inevitable miscarriage are observation, medical (medication), or surgical (D&C).   With a inevitable miscarriage most physicians recommend a D&C (dilatation & curettage).  A D&C entails a women going into the hospital and having anesthesia while an obstitrician dialates her cervix and curettes (scrapes) the uterine lining to ensure complete removal of all products of conception.  This is done for a inevitable miscarriage to prevent infections, severe bleeding and other associated complications.  Another treatment option for a inevitable miscarriage is medication.  A physician will place prostaglandins inside the vagina next to the cervix to allow the cervix to soften and completely dialate.  After a certain amount of time if there are no uterine contractions then the physician can start pitocin.  Once the contractions begin the woman's body will deliver the products of conception.  Again this treatment option requires the woman to go into the hospital for her care.  The third treatment option for a inevitable miscarriage is observation.  With this treatment plan the woman is sent home to allow "nature" to take its course, with follow up with her physician as instructed.  The woman will be instructed to get plenty of rest, have complete pelvic rest (nothing to be placed inside the vagina), examine vaginal discharge for any gray or white tissue which might be the products of conception, and seek medical attention if bleeding is excessive, pain is severe, and / or development of fever.  This treatment of miscarriage can take anywhere from hours to days and in rare cases weeks.  However, no matter what treatment option is decided for a inevitable miscarriage the woman must have proper follow up to ensure that all the products of conception have been removed.  This is usually done by evaluating the uterus with ultrasound to ensure there are no more products of conception and also following serial hCG levels to ensure that the levels continue to go down.  Another extremely difficult part of a inevitable miscarriage is the emotional aspect.  A woman and the couple have to cope with the inevitable miscarriage while they try and decide the best way to treat the miscarriage.  If a couple has experienced several early miscarriages (2-3) there is genetic counseling available through their physician.  To learn more Go To Treatment of Miscarriage. It is recommended that a couple wait at least one regular menstrual cycle before trying to conceive again after a inevitable miscarriage.