What is a surgical management of miscarriage?

Many women do not need any follow up treatment after a miscarriage, however if you have had a missed miscarriage and the embryo is still remaining in the womb, surgery is one option which your hospital is likely to offer. Surgery is also usually offered for what clinicians refer to as “retained products of conception”, for example if the pregnancy sac, or parts of it, have passed yet a scan has shown some tissue still remaining behind. Due to the emotional nature of the situation, hospitals endeavour to arrange this surgery as quickly as possible, however due to NHS pressures and limitations patients do often have to wait several days for their surgery, or even a couple of weeks. The operation is referred to by clinicians as ERPC (Emergency Removal of Products of Conception) however many people call it a “D&C” which stands for dilatation and curettage (the cervix is dilated and the womb lining gently scraped)

Do I have to stay overnight for miscarriage surgery?

Assuming there are no complications, the operation performed is usually a day case. Within NHS hospitals patients are often asked to arrive early in the morning where you will be admitted to a gynaecology ward (not a maternity ward; hospitals should show consideration and tact in keeping miscarriage patients away from patients in labour or who have just had babies.) You will probably see a nurse for admissions paperwork and to secure a cannula in your arm. Following this you will see a doctor from the surgical team doing the operation, and an anaesthetist. You will have to sign a consent form. As with most operations in public sector hospitals, there is likely to be a lot of waiting around, possibly all day. If you are on an emergency surgery list rather than an elective list with a particular slot, you may well be bumped to the bottom of the list if you are clinically stable as the team will need to prioritize cases which are a medical emergency. During the wait you will not be allowed anything to eat, and very little to drink (you may be allowed a few small sips of water but check with your nurse first).

How quick is a miscarriage operation?

Eventually you will be wheeled in your bed to Theatres and put to sleep in a small ante-room. The operation itself is very quick, usually ten minutes or less. The cervix is dilated carefully and the pregnancy is gently removed via the vagina using a suction device. All pregnancy tissue is collected and sent to the lab just to confirm that it is pregnancy tissue (no testing for abnormalities is done unless previously consented for, for example if the patient has a history of recurrent miscarriage). Following the lab testing, the remains of embryos and pregnancy tissue are dealt with sensitively by hospitals. Some hospitals arrange for cremations of pregnancy tissue and some have arrangements with local burial grounds. The nurses and the hospital Chaplains will be able to advise you on what will happen.

After your operation you will wake up in a recovery room and taken back to the ward. Once in the ward you will be monitored by the nurses and once you feel more awake you will be given some food and drink. The nurses will want to ensure that you can pass urine and feel relatively alert before you go home. You must have someone to drive you home because following a general anaesthetic you may not drive for 24 hours.

How much bleeding will I have after miscarriage surgery?

Over the next week or two you will continue to bleed; however most bleeding starts to settle to brown spotting relatively quickly and the majority of patients have bery little pain following this type of operation. You should use sanitary towels and not tampons during this time to minimize the risk of infection, and take paracetamol if you need to. If you need time off work, you can self certify as sick for 7 days in the UK, however if you feel you need more time off then your GP may provide a sick note. If you do not wish your employer to know that you have had a miscarriage then most GPs are happy to be discreet about this and could write something generic on the sick note such as “hospital admission; surgical procedure”. Most women make a very quick physical recovery from this type of surgery, however the emotional side of miscarriage can often take longer to cope with and it is important to seek support if you need it.

Can I have miscarriage surgery while I am awake?

Some hospitals also offer surgical management under local anaesthetic. This procedure is known as an MVA (Manual Vacuum Aspiration) and is usually only offered to women who are under 10 weeks pregnant. This is often done in an Outpatients Department, maybe even within the Early Pregnancy Assessment Unit, and takes about 20 minutes. An MVA can be an effective option for women who are very early on in their pregnancy who wish to avoid a general anaesthetic

If you are attending hospital for an MVA, you will probably be given some vaginal pessaries a couple of hours before your procedure. These pessaries contain a medication called misprostol which softens the cervix ready for the procedure. Some hospitals ask patients to insert the misprostol at home prior to your appointment. You also may be given some pain killers. The procedure will be performed by a doctor or specialist nurse, and there will be another nurse in the room assisting, and probably a health care assistant. The doctor will inject your cervix with some local anaesthetic to make it go numb, and then the pregnancy will be removed using a suction syringe. Following the procedure you may experience bleeding and mild cramping for a week or two as you would in the general anaesthetic procedure.

What are the risks of miscarriage surgery?

Surgical Management of miscarriage does have some risks, as all surgical (and medical) procedures do, and these risks will be explained to you by the doctor beforehand. Risks include heavy ongoing bleeding, infection, adhesions and scar tissue forming in the womb, and womb perforations, however these risks are minimal (less than 1 in 100 women suffer womb perforations. Around 3 in 100 women need a repeat procedure due to retained tissue, so overall the surgery is usually considered relatively safe and effective assuming you are fit and well.

See here for details of medical management of miscarriage