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ERPC, MM or just wait and see?

(41 Posts)
AlpacaYourThings Wed 23-Apr-14 14:52:25

I've had quite a few weeks of uncertainty.

At first I was told this was a PUL and then that it was an ectopic pregnancy. I've just seen my consultant who has informed me that the baby is in the right place but is developing very, very slowly so it's not a viable pregnancy.

I had already accepted that this pregnancy wasn't meant to be when I was told this was an ectopic pregnancy. Now, I've found out that the baby is in the right place I'm not sure I feel comfortable with have an ERPC or MM. It would feel like I was having an abortion. I know it's not, but I can't shake the feeling. I would like to wait and see if my body miscarries naturally and have the decision taken out of my hands.

If I don't miscarry naturally, I would like to have an ERPC as I wouldn't want to have MM and for that to not work and then have this dragged out for even longer with an ERPC. I'm sorry if that sounds awful, it's just this has been going on for 3 weeks now and I'm not sure how much more of it I can take. sad

If you have had an ERPC or MM can you tell me about the reality of it?

Tryingno1 Wed 23-Apr-14 15:12:13

I had a missed miscarriage. Had medical management. Was admitted for it as was 9 weeks-was a bit painful and quite upsetting actually as you go to loo and pass the "products" and the nurse checks it's all passed. If your less than 9 weeks they will prob let you do it at home and won't be as distressing. Anyway it failed and I had retained products so had ercp. I was really not looking fwd to it and worried re the complications but it went smoothly and quickly and I felt fine(except groggy) when I came back around. And went home a few hrs later and had no pain the next day.
I think this time around I'm going to choose medical management as although it can be a bit distressing I get paranoid about side effects
Post op or even complications during the op so it suits me better? (Even though its small I'm from a medical background so know too much....!) and I was fine after the last one...
Either choice - none are ideal. But ercp is over with quickly and not as bad as I thought it would be. And It was horrible to find out my medical had failed 2 weeks later and I had to go through it over again. I think it's a 15 percent fail but it's lower if your early on (I think)
Sorry your going through this. It's not easy but will get better in time. Hope your ok

katandkits Wed 23-Apr-14 15:16:35

I've had both, erpc at 11 weeks, medical at 9 weeks. I found erpc to be much better personally. it was over quickly and was emotionally less traumatic.

AlpacaYourThings Wed 23-Apr-14 15:20:00

Thank you for replying. I am so sorry you have been through this too. It feels very lonely as it seems wrong to talk about it, IYKWIM.

bakingtins Thu 24-Apr-14 07:57:13

alpaca I'm so sorry you are going through this, the limbo is very hard to deal with. Are you being offered management options at the moment? I was in a v similar situation with my 4th MC and doctors refused to do anything because baby had a HB, albeit measuring weeks behind and getting further behind with each scan. I MC naturally at 9+ weeks after 3 weeks of dodgy scans. On that occasion I was desperate to have an ERPC because I wanted genetic testing on the baby, though that's not likely to be a consideration in a first MC.
I think none of the methods is great because it's just a horrible thing to go through, you just choose which is least-worst for you personally. I would suggest you need to be very very clear in your own mind that the pregnancy has ended before doing anything active, or that might haunt you later.
Natural or medical MC are going to involve heavy blood loss and cramps, it is not 'like a heavy period' unless you are very early. MM was quite painful IME, though you can ask for strong painkillers. You will pass big clots and you might recognise the sac/baby amongst them, which can be either cathartic or distressing.
I haven't had an ERPC but had placenta removed under GA after the birth of my son, which I guess is a similar procedure without the emotional baggage. The GA was fine and physical recovery rapid. Most posters who've had an ERPC find it less bad than they expected and would choose that option again.
There is a similar rate of not completing the MC with all three methods (requiring an ERPC or repeat ERPC) and MC association reports a similar complication rate with all three - mostly minor things like infection requiring antibiotics.
I've more recently become aware of women who have had problems with scarring/ashermanns after ERPC, it's difficult to get figures for that - NHS and MC ass say it's rare, ashermanns support says it's quite common....

I hope you can make a decision you feel happy with and end the limbo soon. It's often only once the physical loss is out of the way that you can start the process of emotional healing. Sending you flowers at a shitty time.

AlpacaYourThings Thu 24-Apr-14 16:58:31

Thank you for your message baking.

Your situation sounds awful, I'm so sorry to hear about it.

Yes, my consultant has offered me MM or an ERPC if I want it, but I don't feel ready to make a decision. Whilst I have accepted that I'm not going to have a baby in 7 months, my DH is finding it very difficult to deal with.

I had a few scans before they could find the baby and in between I had quite heavy bleeding and then it stopped. I thought that was the miscarriage but when I went back they found the sac so that was very weird.

Your post has made me think though, I need to consider how I will feel if I wait and see if it happens naturally and then go for a scan and the baby has developed a heart beat. I would find it very, very hard to have an ERPC or MM at that point, even though I know the sac won't develop into a baby.

So much to think about, it feels so unfair having to make these decisions...

Forester Thu 24-Apr-14 19:05:00

Yes it is rubbish having to make these decisions - when all you really want is a healthy pregnancy.

I've had two MC's and both times chose surgical management as I wanted the physical side of things to be over so that I could start to deal more with the emotional side. But it's a very personal choice so there's no right or wrong answer.


bakingtins Thu 24-Apr-14 19:29:22

Is there a foetal pole at the moment, or just an empty sac? What's the least number of weeks you could be? (if there is any potential confusion about dates?)
My situation probably a bit different, I don't want to throw more complications into the mix for you. I've been diagnosed with a condition that affects implantation and causes slow development, and my MC have all got to the HB stage and subsequently died, but that's unusual.
If you are not happy about doing anything proactive right now, what about agreeing a time limit on waiting for natural MC ( say one or two weeks) beyond which you'll go for MM or SM? You can ask for another scan at that point to be sure there's no development. The doctor must be pretty confident it's not viable or they wouldn't be offering you options at this point, they do err very much on the side of caution if there's any doubt, but you need to be completely clear that you are making the right decision for you.

AlpacaYourThings Thu 24-Apr-14 19:31:11

A healthy pregnancy wold have been amazing, but at this stage I just want it to be over. I don't want to think about the 'medical' side of it anymore.

Thank you for sharing that, Forester I'm so sorry you had to deal with this, too. I think I will talk to my Consultant about an ERPC.

I didn't realise how many women had to deal with miscarriage. It's so much more common than I thought.

AlpacaYourThings Thu 24-Apr-14 19:39:58

Sorry, I didn't see your message before I posted baking.

Thy have been doing blood tests for weeks and my hormone levels didn't really increase for the first week, and the hospital said they are meant to double every 48 hours. It was only last week that they jumped up really quickly and then they found the sac on the scan. When they scanned thus week they couldn't see anything in the sac.

I'm meant to be 10 weeks today and my scan shows that I'm about 5 weeks. Which would mean conception was about 3 weeks ago and DH and I haven't had sex for about 5 weeks. So that makes that impossible, especially as I had a positive pregnancy test 5 weeks ago.

Based on the hormone levels and my dates they are sure that it isn't a viable pregnancy.

I'm leaning towards going back next week for another scan and then booking in for ERPC if nothing has changed by that point.

bakingtins Thu 24-Apr-14 19:44:31

Might be worth seeing if you can provisionally book an ERPC assuming the scan shows no development, to avoid more delay?

AlpacaYourThings Thu 24-Apr-14 20:02:49

Yes, I'm going to phone the hospital tomorrow to discuss it. Thank you baking


juneau Thu 24-Apr-14 20:09:49

I think what the two approaches boil down are really 'Do you need to experience the loss in order to come to terms with it, or not?'. For some women its important to experience it because it allows them some closure. For others, not experiencing it and making it just go away (i.e. the ERPC route), is what suits them best. It's personal preference.

When I had a MMC back in 2010 I chose to have an ERPC as I just wanted it over and done with. I didn't want to see or feel anything. If you feel like that after your next scan then ERPC is probably right for you too.

AlpacaYourThings Thu 24-Apr-14 20:22:32

Thanks juneau I agree.

I'm actually terrified of seeing anything, I don't think I could cope with that. I think that's why I prefer the idea of the ERPC.

marshmallowpies Thu 24-Apr-14 20:52:28

Alpaca I recently had a miscarriage at 9 weeks but also with an embryo which was developing too slowly, so although I should have been 9 weeks it was only measuring 5-6wks.

It was heartbreaking, but it did mean what I had to pass was much smaller and letting it come out naturally at home felt much better to me than being in hospital - the comfort of being back in my own bed 10 mins later, having a long bath in my own bathroom to soothe the cramps, etc, really helped.

I didn't see what passed out, didn't try to look too closely, and after reading these threads I felt very prepared for what might happen. Feeling forewarned was a huge help. Hope this is useful whatever you decide to do. thanks

AlpacaYourThings Thu 24-Apr-14 21:00:40

marshmallow thank you for sharing that. I'm so sorry you have also gone through this. I think I need to have a think about this.

Thank you to everyone who has replied, it's lovely to have support from people who understand how I feel.

beachesandbuckets Thu 24-Apr-14 21:09:41

I had an erpc at 12 weeks following a MM, I went to hospital at 10am, had it at 1pm and was home by the time my kids got home from school. Everyone was really kind at the hospital, I didn't feel a thing and just fell asleep and woke up and everything had been dealt with, really sad but the best it could have been in the circumstances, a bit of bleeding afterwards and I was pregnant (with twins!) within 6 months so no long lasting side effects. Emotionally I found it quite traumatic afterwards though, but that was the thought of a loss of a baby rather than the procedure. Really sorry that this has happened to you, hugs x

AlpacaYourThings Thu 24-Apr-14 22:14:32

Thanks beaches

It's good to know that you were pregnant so quickly. I haven't decided if I feel ready to TTC after this. I don't think I could do this again.

Moffit Mon 28-Apr-14 14:59:28

Hi alpaca, how are you doing? I'm sorry you're going through this, I just wondered what option you had gone with and how you found it?

I have found myself in a similar situation, I went for an early private scan 10 days ago and the sonographer said she couldn't find a heart beat and it was a MMC, but I had to go to the NHS for management and they talked me through the options, then they called me back the next day for another scan, which they labelled as inconclusive?! (Whatever that bloody means). So after already booking me in for Medical management, they cancelled it and I have to go back Friday for another scan. The first sonographer was pretty certain it was all over, and although I did have a glimmer of hope for short while, I feel as though this is just dragging out the inevitable! (Sorry if that sounds harsh) but being "in limbo" is killing me, I just really want to know, and if it is the worst, as I suspect it will be, then I just want it over with as soon as possible iykwim.

Hope you are coping alpaca xx

RiverRocks Mon 28-Apr-14 20:38:14

Hi Alpaca,

How are you doing? I was on the November thread with you, I think.

I also had a mmc, and have been in today for erpc. My body did not notice at all despite the pregnancy failing 5 weeks ago, and I'd read a lot about people waiting or choosing mm and still having to have the erpc, so I chose that outright.

I had to wait 6.5 hours as I was last on the list but was only out for 45 mins, and home 3 hours later.

moffit I know what you mean about being in limbo, thinking of you xx

AlpacaYourThings Mon 28-Apr-14 21:12:15

Hi Moffit I'm so sorry you are in this situation. I was in limbo for 3 weeks and it was hell, so I honestly understand how you feel. I'm feeling better, just very 'empty'.

I have another scan tomorrow and I've been booked in for an ERPC on Wednesday. It feels like the right option for me. Would you like me to post afterwards to or you know how it was? Personally, I found this leaflet from Miscarrige Association really helpful. xx

Hi River yes, it was on the November thread. It is so painful to think of that now. How happy I was and how it's all over...

I'm so sorry you have been through this too. 6.5hours shock were you in a waiting room or were you in a bed for that time? That is ridiculous, as if it isn't stressful enough. xx

Moffit Tue 29-Apr-14 06:29:34

Hey Alpaca Thanks for replying. I hope the scan is ok for you today and the ERPC goes as well as can be expected on Wednesday.

Sorry that you are going through this and also sorry for you too River I recognised both of your names from the November thread, so sad to realise that we are all going through this! Hope you both get through this as well as you can and come out the other side stronger!

The hospital I am under did not really give me a choice, they explained the three options and then said, but if nothing happens naturally after an agreed amount of time we will book you in for MM and only offer an ERPC if MM fails to complete. So I dont really feel as though I was allowed to choose?! I'm dreading my scan on Friday, as I know it will be in the maternity ultrasound with all of the excited pregnant people, and I'm still too bitter to deal with that!

Thinking of you! xx

bakingtins Tue 29-Apr-14 06:52:57

Moffit NICE guidelines are very clear that expectant management is the first line option for 7-14 days unless there is a clear reason to choose another method, but then that you should have all three options offered to you and be allowed to make an informed choice, so don't be pushed into MM if you would prefer surgical.
I hope you get positive news on Friday and don't have a decision to make, but if you are in the position of having a MMC confirmed then having your choices respected is important.

alpaca thinking of you at your scan today flowers

RiverRocks Tue 29-Apr-14 09:28:56

Alpaca sending you best wishes today for your scan.

I was in a bed, thankfully, and in a private room just me and DP. Was a long day.

moffit I was very lucky in that my local hospital has an Early Pregnancy Assessment Unit, so there were no very pregnant people there. They were really good, and I was allowed to choose from the 3 options that day. I hope you get good news on Friday

The sonographer who did my scan wasn't even slightly unsure that I'd miscarried. Due to the bank holidays I had to wait 10 days for the operation, but at least it's done now and I'm not still waiting, if you see what I mean.

If the worst comes to the worst, the erpc isn't too bad - I had quite bad period cramps last night but a hot water bottle helped, and some bleeding like a heavy period, but this morning there's no cramps and very little bleeding so it's not as scary as I thought it would be.

AlpacaYourThings Tue 29-Apr-14 11:37:12

Thank you all for your messages.

Moffit I think you should push for whatever option you feel is right, taking into account the Doctors advice. Don't feel pushed into MM if it isn't right for you.

Oh, a maternity ward sad. I was dealt with by Gynae Emergency so everyone, sadly, was in the same boat as me.

River thank you for sharing your experience. It's useful to hear the 'reality' of it, rather than just the NHS leaflet.

Hope you have a speedy recovery.

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