Missed Miscarriage in first pregnancy

[SingaVera]

Hi all,

We got our BFP a few weeks ago and were over the moon as it is our first pregnancy and I'm over 40!

We had a private scan on Saturday at 7.5 weeks with bad news unfortunately. Whilst everything else developed normally, the embryo is about two weeks off and didn't have a heart beat.

I'm booked for a second scan on Monday but EPU told me today that it is highly likely that this is a MMC.

She has given me loads of reading materials to take home as I wanted to inform myself of the options before the next scan...

I wanted to ask for your opinions on the options of
a) letting things pass naturally - how long will it take and how bad is it? and how tough is it to see the little bean come out and be discarded?
b) taking meds to support the natural process - I heard it only has a 50% success rate?
c) surgery either with local or general anaesthetics - I'm not a fan of general anaesthetics but worried about how much you feel and see with the local one

Whilst I think I can kind of come to terms with the loss I am really anxious about the next steps so any advice will be useful.

And are there any other ladies in my age group with similar experience??

Thank you! xx

Hi Singavera, very sorry for your news - it must be heartbreaking for you. I have had natural management and the pills so I wanted to share my experiences of both. My first miscarriage, I started spotting at about 9 weeks and went for a scan which showed no heartbeat, and I was given all the leaflets with the choices but the spotting was really the start of it as within a day the bleeding got a lot heavier and then the next day I miscarried.

I’m now going to tell you a bit of what that was like as I found it hard to find the info so I hope this isn’t distressing - I will keep it as matter-of-fact as possible. The bleeding got heavier like period cramps and then I felt something pass, and it was the sac but just looked like a red piece of tissue. I then passed what was maybe the placenta as it was greyish. Although these were bigger than normal period clots, it wasnt painful but I do suggest having some painkillers on hand just in case. The bleeding then eased off very quickly and was gone within a few days.

It wasn’t great seeing the sac, but I do think being prepared for it helps - I had no idea what to expect so had a wave of shock come over me so I hope my post helps you a little. You may want to do something like wrap bean up and bury her. I didn’t first time and flushed the toilet, and for a while I felt bad about that until someone told me that my little bean would be bobbing around in the sea under an open sky, and although these were just words it made me feel a lot better. I find a bit of ritual to be comforting in these situations so I washed some of the blood into a cup and put it in a flowerbed. That week an orange rose bloomed there (in October!) and bloomed there every autumn since.

[ill skip my 2nd miscarriage as that was so early it was just like a heavy period with no real visible products].

I’ll post a new post about my 3rd, which happened only last week and for which I opted for the pills.

Post 2, about my very recent miscarriage. I am 42 so am in a similar position age-wise but I accept I am in the very fortunate position of having 2 children.

I had an early scan at 6 weeks and everything was right for dates and there was a tiny heartbeat so I was over the moon, and was booked in for a follow up scan at 8 weeks. Unfortunately at that scan nothing looked right and there was no heartbeat. I wanted to wait for natural management so hung around waiting and got signed off for 2 weeks from work. In that time though I only had a bit of bleeding and it was very intermittent.

So I got signed off for a 3rd week and got the tablets, which are inserted by a pessary, and some Proper Drugs. One thing I didn’t realise is you need to have a pad on from then, and to go straight home and wait. I hadn’t known the procedure so had Ubered to the hospital while my husband watched the kids at home, so had a slightly hairy Uber journey home sitting on my coat in case it started! So don’t do that.

I got home and relaxed on the sofa with a hot water bottle, the lovely drugs, a cup of tea and a piece of cake, and then within about 4 hours (consisting of slow bleeding, then fast bleeding, then passing the stuff), the main event was over. The doctor who inserted the tablets said the neck of my womb was still closed at that point so it all worked quite quickly for me.

I thought that the 2 weeks of waiting would have been awful. But actually - there was something blissful about it. I just relaxed and reflected and spent time at home gently pottering and really gave my head the chance to sort itself out. So if you do decide to wait first, it isn’t inevitably just prolonging the agony. If I am lucky enough to be pregnant again, and unlucky enough to miscarry again, I think I would do the same again, and only go for medical management once I feel ready.

If you have any questions at all, about any of this, please do ask - I will help any way I can.

Hi SingaVera

I can’t give you any advice I’m afraid but just wanted to say hello as I’m also nearly 40 and going through a nearly identical situation myself. Its my first pregnancy and I went for a private scan initially at 8 weeks, when they said that the embryo looked smaller than they would expect. My midwife referred me to EPU for a follow up scan last weekend at 10 weeks when we were told that there had been no change and that I had very likely miscarried . After feeling devastated initially I am starting to wrap my head around it but I expect there will be ups and downs over the next few week and as you say there is a lot to think about in the meantime. Because my first scan was private I have to go back to the EPU next weekend so that they can do a further scan. I have had no bleeding or even spotting so far. At the moment I am veering towards surgical management because by the time I have another scan it will be 3 weeks since my first one and I am finding all the waiting quite stressful and I am concerned that things could start to happen while I am at work. I have been put off the medical management tbh because so many people seem to end up having to have the op afterwards anyway. But those are just my thought processes at the moment - I may change my mind once I have talked it through with the nurse and you should definitely do whatever you feel is best for you. Hope you are looking after yourself, take care xxx

@SecondSop thank you so much for sharing your experience and I’m sorry you have had to go through this so often! What was your reason for not doing the surgery? Part of me thinks just get it over and done with and the other part of me is really worried about the unnatural intrusion... I also heard a though that not everyone experiences the natural passing as quickly and smoothly as you have. I have heard real bad stories about it as well...

@BastianBalthazarBux I’m sorry that you are also going through this! I totally get what you mean with wrapping your head around it. I have moments in which I feel super strong and matter of fact and then reality kicks in and I remember that I still need to deal with the next steps. I also had a private scan (Saturday at 7+4 weeks) but I managed to see EPU today at 7+6. The results were unsurprisingly very similar and although they managed my expectations today I was told they weren’t allowed to come to the conclusion yet that I miscarried. Apparently because the CRL was less than 7mm they have to do a second scan. But I’m under no illusion what the result will be especially since I have lost all my symptoms. The midwife said that sometimes after you hear the bad news your body will subconsciously come to terms with it and pass it out naturally so I’m a bit worried it will hit me underprepared... tomorrow I’m planning to buy some extra strength pads to have at hand just in case.
Why did your EPU not see you straight after the first scan? Or did you need a break first to deal with it?

@singavera I decided to try medical management first to see if it worked, and if it didn’t work I would have asked for the surgery then. I didn’t feel the desperate need to get it over with that I know some women (quite understandably) do, but my main reason for not opting straight for surgery was that the opportunity was there (through the medical management) to have a go at avoiding the (very small) risks from surgery / anaesthetic. I know women who have opted for surgery from the get go, though, and I can understand the desire to do so as there’s no waiting, dealing with the products etc.

@SingaVera

When I found out I was pregnant in early January I rang my GP and they gave me a first appointment with the midwife for 12 Feb. I had my private scan on 4 Feb so at that point I hadn’t had any real contact with the NHS. The EPU here only take referrals from the GP or midwife so following my private scan I did a lot of ringing around to try and speak to someone to find out what to do but without having a named contact it was really difficult. I ended up telling the midwife when I saw her on 12th and she then got me an EPU appointment for 17th. They’ve now said I have to go back for a further confirmation scan cos the first one I had was done privately and they’re not allowed to go off those results as they can’t confirm the accuracy of the equipment that’s been used and so on. There seems to be quite a bit of variation in process depending on where you live - I know that some other EPUs accept self referrals which would have made things much easier xxx

Oh that’s awful! I managed to self refer and was really happy they gave me a same day appointment. I can imagine that it mus be really tough having this waiting game for so long! x

I am really sorry to hear you are going through this.
I experienced almost exactly the same as you (aged 41) and opted for surgical management. Hope my story may help.

We found out at a 10 week private scan that there was a sac but no heartbeat and no development past 6 weeks. Had to wait a week for a second scan at normal hospital to confirm non viability then decide what to do.
I opted for surgical management because I was scared of the potential pain and distress and general unknown-ness of natural or medical management and also I just wanted it all over and done with as quickly and easily as possible.
To be honest the most difficult part was that week of waiting despite everyone knowing it was hopeless. But in hindsight I was grateful for that time because it gave me the opportunity to start to grieve and accept the pregnancy was over. It sounds as though you may be in a similar place right now?

For the procedure itself, I went in as a day patient (on my 42nd birthday 🙄) and, despite it being sad, I did not find it traumatic at all. I was treated with nothing but sensitivity and kindness by everyone at the hospital. Had everything explained to me beforehand by the surgeon and anaesthetist. Went down to surgery, was put under and was back on the ward drinking tea very soon afterwards. Home a couple of hours later.
There was some blood for a few days afterwards but no more than a normal to period. They gave me strong painkillers but I only took them for the first day and didn't need them afterwards. I actually don't remember experiencing pain at any point.

I feel very fortunate that I was able to physically and emotionally get over the miscarriage fairly quickly and move on. We left it a while before trying again but there is a happy ending as I am now 44, with my first baby on the way (expected in late April)!
I really do wish you all the best whatever you decide to do. Please don't hesitate get in touch if you'd like to talk through anything with me

I'm so sorry that you're going through this SingaVera, the limbo stage was really the worst part of my missed miscarriages.

My first, when I was 39, was discovered at around 8 weeks, no heartbeat at all, so I was told to come back in a week and I opted for an ERPC/MVA under local anaesthetic. It did hurt a fair bit, but it was quick. The consultant who carried out the procedure was incredibly kind and stopped whenever I asked him to. There was also a nurse who talked to me during the procedure, and my dp stayed and held my hand throughout. Physical recovery was quick, I went to a festival three days later, and I had minimal bleeding. My period returned exactly 4 weeks later.

I conceived six months later and had my DD with no issues.

Sadly in Dec 2016, I had another early scan at around 8 weeks and the embryo was too small (I was sure of my dates). I had two weeks of waiting until the heartbeat stopped, and opted for an MVA under local anaesthetic again. They use ultrasound to guide them, and the only downside is the noise of the vacuum. You get given a tablet or pessary an hour or so before to soften up the cervix. I had actually had some bleeding prior to the op, but there was still lots of tissue remaining so they went ahead with it anyway.

Last May I lost another pregnancy at 14 weeks due to a trisomy, and this time I opted for an ERPC under general anaesthetic. It was absolutely fine, well as fine as it could be. It's a very light general, your're not under for very long. Again, minimal bleeding or discomfort afterwards.

I always opted for surgical management because I know so many people who have had complications from natural management and ended up having erpcs anyway. I also couldn't stand any more waiting, and wanted to get back to normal physically as soon as possible. My body also seems very unwilling to miscarry on its own, so it seemed the best option for me, it's a very personal thing though.

I hope it all goes ok for you, whichever route you take, and that you have good support.

@Laurel543 Many congratulations on your pregnancy. You've inspired me to not give up hope completely.

Sorry I have been keeping quiet for a while. I have been going through the ups and downs and really didn't feel like communicating or dealing with this question really... :(
Thank you so much for sharing your stories. It really helps put things into perspective. I'm so sorry @FutureFairyCrayon that you have had so many MCs.
@Laurel so happy to see that it is all working out for you. Best of luck and hoping that the next few months go smoothly for you x