ERPC (scared about scarring) v medical management (scared about pain)

[AKP79]

Looking for advice/experiences. I need to decide on Thurs between an ERPC or medically managed miscarriage.

We had an internal scan Christmas Eve following a concerning private scan the day before and found that despite the sac being 9 weeks the baby had died at 6 weeks.

I don't want to wait it out for things to happen naturally, so I now need to decide between a medically managed miscarriage or ERPC. And I have concerns about both.

A very close friend of mine had an ERPC and is now infertile, she was told the fertility issues were as a direct result from the scarring from her ERPC. This really scares me.

I've read about medically managed miscarriages and I'm yet to read anything which sounds remotely positive. It sounds incredibly painful and as I am allergic to things like co-codemol this also worries me. I also have a 4 year old son who I need to look after.

Can anyone help with their experiences/thoughts. I have absolutely no gut feeling about what I want to do and am finding this an impossible decision as well as dealing with the obvious emotions of loss.

[BipBippadotta]

I'm so sorry about your miscarriage. For what it's worth, I've now had 2 ERPCs. I too was worried about scarring, and interrogated the doctor who operated on me about this. She said that she performs the op guided by ultrasound, using a suction device, and that this avoids cutting tissue or causing scarring. According to her, scarring happens when there are complications, which are more common when doctors do not perform the op using ultrasound equipment - this was more common when it was a d&c (dilation & curettage) where they just scraped out the uterus, but apparently plenty of docs will perform an erpc with suction equipment 'blind', as it were (without u/s) so they can't see what they're bumping into in there & there's more risk of nicking the uterine lining & causing scars.

I had my ERPCs done privately. I don't know if drs use ultrasound in these ops as standard in the NHS, but it is definitely worth asking. I did not like the sound of medical management either, but have no direct experience of it.

and I'm so sorry you're having to make such a shitty decision. Good luck.

[AKP79]

Thank you for your reply and support. Since posting I have spoken to a doc at the Hosp and to the Miscarriage Association. Both were incredibly helpful.

I'm petrified of the pain of medical management and there only seems to be negative reviews online of bad experiences, which doesn't help. The Dr said that pain varies massively and suggested that I went down the medical route with the option of going in for surgery if it didn't progress or if there was a problem and then that way the decision would be taken away from me.

My husbands very keen for me to have the medical management, we had so much bad luck as a couple I think we both feel that regardless of how small the percentage of scarring it would be us that it would happen to.

Just wish someone could tell me what to do!

[Luckystar1]

I had medical management. It was painful, I won't lie, but I was scared of scarring so I'm glad I did it (although glad is obviously the wrong word).

I am very, very sorry you are going through this. It is a horrible, horrible experience.

It was of no interest to me, as I had a long commute, but friends who waited to miscarry naturally seemed to experience less pain than I had (and I had no pain relief during labour so I'm not a whinge), if you wanted to wait it out.

[Ipdipdo]

I'm really sorry you're going through this.
I'm in a similar position, as yesterday had a private scan and should have been 9 weeks but measured 6 weeks with no heartbeat. I thought I'd have a d&c if this happened but have since heard it can take 3 mths before u can conceive so am now veering towards letting nature take its course. Not sure if having to wait 3 mths to try again would effect your choice of treatment?

[AKP79]

Thanks ladies this all helps. I'm don't want to wait for it to happen naturally, despite it being my first choice, because I've found it hard enough to deal with this 'limbo' period as it is. I want to get through the loss and start rebuilding and yes trying again too.

Luckystar1 - how long were you in pain for? Hours, days... ?

[AbiBranning]

Sorry you are going through this it is so cruel.

I've had 4 ERPC's (my body doesn't seem to want to let go even at 13 + 3) never had any scarring problems all on the NHS and have usually been pregnant next cycle or a few more, I've only had to wait 3 months after my ectopic. I also had a DS after the first 2 ERPCs so no issues there.

Guidelines could have changed, so my advice maybe a bit out of date, just letting you know my experiences.

[AKP79]

Thank you for sharing your experience. The Dr did say the risk of scarring is very small, but as it is still a risk and one that I am very scared about he felt it might be too much for me to take on especially if I was extremely unlucky and ended up with scarring.

I'm not comfortable with any of the choices. It's such a hideous thing to have to decide between.

[Ridingthegravytrain]

Just a slightly different slant but I had the pills. Then a few weeks later started passing horrific clumps and ended up with an emergency d&c and blood transfusion.

I would operate for sure if I needed to do it again

[BabySocks]

To add to your confusion, I am in the tiny percentage. I had an ERPC and was unlucky enough to have scarring which led to infertility, countless drugs and 2 operations. After 2 years I have a surprise pregnancy which is being closely monitored and may not progress normally.

At the time I just wanted closure but obviously I would never have an ERPC again.

[Luckystar1]

The pain was maybe an hour at its very worst. Lesser pain for probably another 2. Tbh, I was very traumatised by the whole having a miscarriage thing that that really didn't help me be more pragmatic about the pain and I just lay down and wept which was obviously the worst thing.

Once I was made get up and walk around it was a lot better and it was over a lot quicker.

I took a hot water bottle which helped.

I had no other complications at all. Again I'm so, so sorry. Happy to answer any more questions.

Oh also, you have to lie down for an hour after the tablets are inserted. I found that hard as I'm a fidget.

[AKP79]

Thank you so much everyone for sharing.

Luckystar1 - that really helps to know some facts, thank you. I'm starting to feel like I have made a decision to have the medically managed option.

Ridingthegravytrain - I discussed something similar with the Dr and he said that it was a possibility. But his feeling was that if I was told that I had to have the ERPC then that would take the choice and worry away for me.

[Luckystar1]

I hope it goes smoothly for you. I just wanted it to be done with so I could move on (which was not easy!). I will be thinking of you.

And I hope you never have to go through this again.

[spilttheteaagain]

OP I'm so sorry you find yourself in this position.

I've had medical management for a missed miscarriage at 20 weeks 5 years ago, and am going through a TFMR now (medical management again at my request) at 13 weeks for an incompatible with life condition.

Even at 20 weeks it was a fairly quick process. The oral tablet to prepare the cervix, followed 48 hours later by pessaries to induce dilation and contractions. From pessaries to DD1 being delivered was only about 4 hours. For the first 1.5 hours pretty much nothing happened other than some very slight "period pain" type ache. Hot water bottle/exercise ball both quite good for this. It did get very intense later on but was only actually unbearable for less than 1 hour (bit hazy on timings due to drugs), and there are a range of drugs available up to and including morphine. It was also quite messy and the sudden whoosh of bloody waters came with no warning.
However it wasn't actually all that bad, the briefness of it was a pleasant surprise.

I'm told that my medical management this time will likely be quicker on account of being earlier. It's on Thursday so I guess time will tell.

Best wishes to you as you make your choice. It won't be fun either way round but you will be through it soon and be able to grieve then.

[Luckystar1]

Split, I think I briefly read your thread. I was too distraught on your behalf to respond as the feelings you described were so, so familiar. I hope you too begin your physical and emotional recovery soon.

And you op, my thoughts are with you both.

[Duckdeamon]

I don't think your H gets a say here.

[DownstairsMixUp]

Sorry to hear you are going through this OP. I was in the same position as you August 2013, had the option of medical management or erpc, I chose the erpc and I am glad I did. It was over very quickly, pain minimal, no scarring. I was pregnant again by December 2013 and now have a toddler from that pregnancy.

to you op.

[Duckdeamon]

Sorry, pressed post before properly writing. V sorry about your miscarriage.

If you have medical management suggest someone is around to care for your DC.

I once chose to wait and see and after lots of pain etc over three days ended up with an ERPC anyway, bad luck! But it was OK.

I've had uterine scarring caused by C-section, so understand the fear of asherman's, but the risks are small if performed with ultrasound etc.

[LumelaMme]

Blimey, I didn't even know scarring was a risk.

I had ERPC nearly 20 years ago, and went on to get pg again vv easily, no problems, several more times.

It's horrible, OP: I hope that whatever you decide, it works out well for you.

And spilt, . 10 weeks was bad enough, 13 weeks and 20 weeks don't bear thinking about.

[Bonkerz]

I have had both. My first miscarriage I decided to see it through as naturally as possible. It took days and I was in pain and emotionally it took its toll.
When I miscarried the second time I knew I couldn't do the same route again and opted for Erpc. For me this was the quicker option and I found that I was able to function better because I could focus on recovery rather than waiting for the miscarriage to happen.
It's never an easy decision :0(

[JoMalones]

I had ERPC, unfortunately haemorrhaged so then had to have medical management. I chose ERPC because I couldn't bare the thought of almost giving birth. I wanted to be numb and not be aware of the moment the baby left my body. That was a very personal choice. After the op I was fine until the haemorrhaging! No pain and home by lunch (op at 9am)

[JoMalones]

Sorry, posted too soon. Good luck with whatever you decide and so sorry you're going through this

[RoTo72]

Hi op. I had missed miscarriage. Found.out at 12 week scan baby had passed a few weeks before. I considered medical management but read up and was frightened of the pain and blood loss. I opted for eprc and it went v smoothly. Was home within a few hrs. That was 27 th Nov and took my first AF today.

[AKP79]

Hi ladies thanks so much for the support. Went into Hosp today and they discussed the fact that they were worried about some inconsistency in the scan, so there was a glimmer of hope and they rescanned me. Unfortunately they confirmed that the baby def didn't have a heartbeat.

I went for the medical management and am back at home watching rubbish box sets on the TV. Feel a bit crampy, but nothing major.

Thank you again everyone xxx

[Luckystar1]

OP I'm sorry to hear that the worst was confirmed. My thoughts are with you and your family. Try and rest, and grieve and be angry and sad and all those things. It's allowed. It's a cruel, cruel thing.

[BabySocks]

So sorry, it is such a horrible time x