Surgical management of miscarriage

Patient Information Leaflet

What is a miscarriage?

• A miscarriage is the loss of a pregnancy before 24 weeks (5 months).
• Most occur before 12 weeks (3 months) and are often due to chromosomal abnormalities.
• Chromosomes are small structures in our cells that carry the instructions for how our bodies grow and develop.
• Sometimes there are too many, too few, or changes in these chromosomes (chromosomal abnormalities), which can stop a pregnancy from developing normally.

What are your management options?

• There are 3 options:

1. Expectant management (natural process) – This means waiting for your body to complete the miscarriage naturally. You do not have medicine or surgery to remove the pregnancy tissue.
2. Medical management (medication) – This means using medicine to help your body complete the miscarriage. The medicine helps the womb empty the pregnancy tissue.
3. Surgical management – A detailed explanation is below.

• All three options can work well. The choice will depend on:
  • Your health and medical needs
  • What you prefer and feel comfortable with
  • How quickly treatment is needed, for example, if you have heavy bleeding or an infection.

What is surgical management?

• Surgical management involves removing pregnancy tissue (the miscarriage) from the uterus (womb).
• This procedure is called ‘Evacuation of Retained Products of Conception (ERPC)’

Why might I need this procedure?

• Surgical treatment may be recommended if:
  • You have heavy bleeding or bleeding that lasts for a long time
  • There are signs of infection
  • Medical or expectant (natural) management has not worked (see explanations for these above)
  • You would prefer the miscarriage to be completed more quickly
  • Your Doctor has found a medical reason why the miscarriage needs to be treated in this way.

What does the procedure involve?

• Before the procedure:
  • You will have an ultrasound scan to check and confirm that you have had a miscarriage.
  • The scan will follow recommended guidelines for diagnosing an early pregnancy loss.
  • You will have blood tests taken (including haemoglobin and blood group)
  • Anti-D immunoglobulin may be offered if you are RhD negative blood group.
  • If you are having a general anaesthetic, you will need to fast (no food or water) beforehand.
  • Medication may be used to soften and gently open the cervix (the opening to the womb). This can help prepare the cervix for treatment.

During the procedure:

• The procedure usually takes 10–20 minutes.
• It can be performed under:
  • General anaesthetic (you are asleep)
  • Local anaesthetic with or without sedation.
• A small tube is inserted through the cervix.
• Gentle suction removes pregnancy tissue.

After the procedure

Recovery

• Most people go home the same day.
• You may have:
  • Mild cramping (like period pain)
  • Light bleeding for up to 2 weeks
  • If you experience long term bleeding after this time, please contact our unit.

You can:

• Return to normal activities when you feel ready (often within a few days)
• Take simple pain relief such as paracetamol or ibuprofen.

Risks and possible complications

• Surgical management is generally safe. It is successful in 95 out of 100 women.
• There is a small risk of complication which include:
  • Infection (fever, unpleasant discharge, abdominal pain)
  • Heavy bleeding
  • Damage to the uterus (rare)
  • Cervical injury (rare)
  • Retained tissue – This is where some pregnancy tissue is still inside the womb after a miscarriage. You may need further treatment.
  • Scar tissue formation (very rare).

When to seek medical advice after surgery?

• Contact your healthcare provider urgently if you have:
  • Heavy bleeding (soaking 2 or more pads per hour)
  • Very strong pain in your tummy (abdomen)
  • Fever or chills
  • Vaginal discharge that smells unpleasant or is different from usual.

Follow-up care

• You may be asked to repeat your pregnancy test after three weeks.
• You will have a further review if symptoms continue.
• The pregnancy tissue may be sent to a laboratory to be examined under a microscope.
• We will ask for your permission before this is done.

Future fertility

• Having this procedure does not usually affect your ability to get pregnant again.
• You can try for another pregnancy when you feel emotionally and physically ready.
• We usually recommend waiting until you have had one normal period before trying to get pregnant again.
• Ovulation may occur as soon as 2–4 weeks after the procedure.

Emotional support

• Miscarriage can be distressing. Support is available:

  • We have a counselling service. Please let us know if you would like to speak to someone and we will make a referral.
  • Miscarriage UK (formerly The Miscarriage Association): www.miscarriageuk.org/
  • Tommy’s: www.tommys.org/

• If your pregnancy ended before 24 weeks, you can choose to get a free certificate to remember your baby. Visit: www.gov.uk/request-baby-loss-certificate

Future pregnancy

• You will naturally be more anxious when you next conceive.
• We are here to support you.
• If you would like to have an early scan, please contact us so we can arrange an appointment.
• We would aim to do the scan after seven weeks when we should be able to see the pregnancy but if you are having problems, we could see you earlier.

Contact our service

Women’s Diagnostic Unit

• Call us on 020 7288 3786 Monday to Friday between 8am and 6pm