Missed miscarriage - advice on next steps

[emsler]

Hi all,

We found out this week that I have had a MMC at around 9.5 weeks. The baby had only developed to about 6.5 weeks. We're pretty devastated but feel very lucky that we at least know that we CAN get pregnant and also that it happened within the first 12 weeks and we had lots of warning signs that the pregnancy wasn't going well (constant spotting, only mild pregnancy symptoms, delayed growth etc).

I wondered if any of you ladies would be willing to share your experiences of the next steps following a MMC. I have to decide whether to let it happen naturally, take the pills, have a D&C under general or an MVA (which I had never even heard of!).

I have a high BMI so am inclined to avoid general anesthesia if I can, but having had a very traumatic botched coil insertion the idea of an MVA terrifies me. I've read that the pills can increase the pain of miscarriage and make it happen quite violently. My instinct is to let it happen naturally but the midwife said this could take anywhere up to 2 months and I'm 32 so I want to start trying again as soon as possible. So I feel a bit stuck between a rock and a hard place and would really appreciate any advice or experiences you would be willing to share.

An added complication is that I don't get sick pay (I've been in my job under a year) so although we can afford for me to have a few days off, I do need to avoid having an extended period of time off - so if you could share how much time you needed to take off work I would be really grateful.

Thanks ladies.

[AliBingo]

Sorry to hear that.

I had a mmc in July and it passed naturally a week after the scan, it was lighter and no more painful than a period, sac measured just under 5 weeks.

Got pregnant straight away and it's another mmc, diagnosed 3 weeks ago, sac measuring 6.5 weeks but it's not budging. I have had two attempts at medical management but nothing happened so am now sat in hospital awaiting an ERPC. So I'll let you know in a few hours! I have high BMI too and other kids I want to get home to.

[emsler]

Thanks Ali - best of luck with your ERPC, I hope you have a swift recovery.

[shinebright14]

Hi emasler I'm sorry you going through this.

I had a mmc in April, i was suppose to be 10 weeks but the scan showed baby stopped growing at 8weeks I waited about 2weeks to have a natural mc but it didn't happen so I decided to have the tablets inserted. I don't I could've waited any longer I just wanted it over and done with.

Half an hour after the tables were inserted I started getting really painful cramps it got a lot more painful when the bleeding started 3hours later even the strong painkillers they gave didn't help much.

I had a natural mc last month at 6weeks and it wasn't as painful I don't know if it's because I was further along.

[wowwee123]

i had a very similar experience. i was strongly advised to go own the natural route but even at 13weeks pregnant (pregnancy ended at 5weeks) nothing had happened. we discovered it at 9 weeks so it was a long and traumatic wait.

the next step was the pills. i was given to take at home. i did. they werent as bad as expected but then i didnt pass what i expected either.

i liaised with the hospital and based on what i told them they thought everything was fine. i had complications and after heamoraging on three seperate days (admitted to hospital twice) i was eventually kept in two nights for an emergency erpc.

if i had to do it all again i would either request the tablets asap under hospital supervision or the erpc.

tbh the erpc was pain free and over quickly and i wouldnt say any recovery was needed although i was tired from the ga.

my bmi was around 35 at the time.

[wowwee123]

oh and im so very sorry for your loss.

[Stealthtoast]

Hello, and very sorry for your loss. If you read the very useful threads on here you'll find lots of good advice, and people who preferred one option over another. I had an erpc a couple of months ago, and would do the same again if I had to- for me it came down to: not wanting to wait for it to happen naturally add it might take ages and reading on hospital leaflet that medical management only works 75% of the time. So I decided to have mva, and was glad I did when I got home and read about the amount of bleeding others had had. I ended up having erpc as I fainted before even getting to mva - but am glad I did now, as a friend said she thought they had tried to be quick with her mva and could take their time more if you're under ga ( no evidence here!). I was tired after erpc but back to work after a weekend.

[AliBingo]

Hi again Emsler, so I had the ERPC yesterday and would actually really recommend it.

The usual being messed about by the hilospital was a pita and meant I fasted from 7 am, admitted at 10am for my 1330 op which didn't happen u til over 5 hours later, so wasn't back in the ward until 8pm. Could have been discharged at midnight but they were reluctant. So if you do go surgical, bring a good book! Or go private if you can.

So I flagged up my weight (16st, BMI late 30s) with the anaesthetist ( they come for a chat a couple of hours before the op, loads of time to ask questions) and he wasn't very interested really. He also said it will only be light anaesthesia and only for about 10 minutes so v straightforward compared with longer ops where patients might get cold, release lots of cortisol etc. He said with modern anaesthetics, you come round quickly and recover fast.

Anyway my experience of the op was very good. I have been stressing for weeks about this list pregnancy, which stopped developing at 6weeks 5 days and I was 11 weeks. I was sure of my dates and had known I was carrying a non-viable pregnancy for 3 weeks by yesterday, after 2 weeks of failed medical management and constant spotting I was very fed up!

Was taken down, theatre nurse and anaesthetist team were lovely to me, had some drugs put in a line in my arm and told to breathe into an oxygen mask and that I would feel sleepy. One minute we were chatting about Poldark, the next I was having a lovely dream when someone woke me up calling my name to tell me it was all over. I sat up and felt a bit groggy for a minute or two then chatted to the chap for 10 minutes while he did my obs, then they filled in some forms and wheeled me back up to the ward where I sat reading my book and moaning I was starving (another hospital bodge - they promised me food after the op, staff had changed over and new ones said there was no dinner left and no sandwiches left and I could have a bit of toast. Which turned out to be two small rounds, one of which was the crust! Also didn't get any water for over 30 minutes after getting back to ward. This has happened before so I had food and water with me which is quite bad isn't it.

When I woke up I had a pad wedged between my legs with a bit of blood on it, there's peen virtually no bleeding, just a very light amount mainly when I wipe (sorry if TMI) and no pain last night although some very minor twinges/cramps this morning, not even worthy of painkillers.

So overall the procedure went really well. Apparently future outcomes in terms of getting pregnant again and staying pregnant are the same with any of the options, barring complications.

In my consultation I asked about MVA and they didn't recommend because hospital stay longer as you have epidural and it takes longer to recover, be up on feet, wee again etc so a longer stay. Also said not nice to be aware of what is going on.

Emsler good luck whichever option you go for, let us know how you are getting on, hope you make a decision soon and it goes well xxx if you have any questions let me know.

[thereisnocheese]

Hi, I also had a missed miscarriage which was found during dating scan. I opted for Erpc under ga as for lots of reasons I wanted this over with quickly. I had to go outwith nhs care to arrange this as my local hospital were terrible and didn't listen to me. Actually started complaints process about it all. Anyway the Erpc was fine and I was okay afterwards. But now three weeks later I'm really feeling the grief and emotional about our loss. So I'd recommend being very kind to yourself and if you need the time to get better take the time. I had some complications afterwards but really the erpc is the easy bit. I'm sorry for your loss. Miscarriage is devastating. xx

[Conflictedoncemore]

So sorry for your loss OP. Sending you a virtual hug. I suffered my second MC just under a week ago, not very pleasant and more so as I was alone. I was 10 weeks and thankfully it happened naturally without the need for medical intervention (however I did visit the hospital as I lost a lot of blood).

Perhaps give it a day or so but if there isn't any movement to contact your doctor?

xxx

[daisydalrymple]

Hi, very sorry for your loss. I too had a mmc, discovered at dating scan. I opted for the ERPC as nothing had happened for 3 weeks, and for me the waiting and not knowing when / if it was going to happen was just awful. My two DCs were 2&4 at the time and I worried what might happen if I was alone with them at the time and bleeding / in pain. Also, extremely unfairly it seemed, I continued having all the first trimester pregnancy symptoms and that was making me feel even sadder.

The procedure was very straightforward, although as pp says, understandably there are delays, as devastating as MC is, life threatening emergency ops means ERPCs can be delayed.

Had I ever been in the position again I too would choose ERPC as first choice. Once it was over it enabled me to grieve. I did feel very empty and it felt strange not having experienced the actual loss, which the 'natural mc' if it's ok to call it that, gives you, but apart from mild cramps for a couple of days, physically I was fine. Emotionally it took me a lot longer. Having had two healthy pregnancies already, it was such a shock, but I'm happy to say I did go on to have a healthy pregnancy and dc3 is two later this month.

Very best wishes to you, take time to grieve and best of luck for a happy and healthy next pregnancy very soon.

[Banana82]

Hi emsler. I'm sorry for your loss. I had an MVA back in August for my baby who stopped growing at about 8 weeks. I cannot recommend it enough. I didn't want a general anaesthetic as I had a very bad reaction to one previously and I had already waited over 2 weeks and nothing had passed naturally.

I was given pesseries up front and back passage and the procedure started about an hour later. It wasn't the most comfortable of procedures but the worst part was the actual local anaesthetic into the cervix at the very beginning. I found the whole thing very emotional though. I thought I had accepted I had lost my baby but it wasn't until I was out of the room that it properly hit me. I bled for about 3 weeks after but. It much more than a light period after a couple of days. I was in absolutely no pain after and physically felt fine.

Good luck with whatever you decide. PM me if you want more info on the MVA. I know not many trusts offer them.

[Chinnygirl]

Placemarking to read later. Am in the same position

[eurochick]

I had similar. I gave my body two weeks to do it naturally and then I just wanted it over. It only took a few days. I undertook "project eviction" (loads of caffeine, hard exercise - basically the opposite of what I was doing in early pregnancy). I have no idea if it helped but it made me feel like I was doing something rather than just more waiting (had been waiting years by this point and this Mmc was the result of our first round of IVF). After all the interventions I had had I was relieved to avoid another.

[fuzzywuzzy]

Hello Emsler, I'm so sorry for your loss.

I had a MMC in May. I opted for SMM. Because I wanted it done with and I didn't think I could bear having it prolonged.

I was booked in the next working day which was a Monday, & put under general anaesthetic I told the anaesthetist that I do get after effects of GA's so she did something with the anaesthetic and I didn't actually have the after effects I had previously thankfully.

The op was not long and I was back in the ward about half an hour later. DP drove me home and took a day off to take care of me, although I just slept for the rest of the day. I was back on my feet immediately but took the full two weeks off as emotionally I was in bits and needed the time to get my head together.

OK for me the first SMM failed and there was product left I was in pain on and off till I called the EPAU who told me to go in straight away and scanned me, so I had a repeat SMM. The second one worked. I then had a repeat scan two weeks after the second SMM to ensure everything was OK. And the second time it was.

I was in so much pain after the failed SMM that I'm glad I did have the SMM, for me a natural miscarriage would have been too long and too painful. I also felt like I couldn't emotionally move on whilst I was still physically going thro the miscarriage.

After the second SMM I also took pregnancy tests to check to ensure they were negative as I was worried about the SMM failing again. Apparently there's a small chance of it failing the first time around.

Also if you go down the surgical management route they do ask what you want them to do with the retained product I asked the hospital to dispose of it. Just so you're not shocked when they ask you.

Post SMM if it's successful you shouldn't have much bleeding or pain. Physical recovery is quite quick.

I'm sorry you're going thro this.

[LeSquigh]

I had a medical management for my mmc and it dragged out over 6 weeks. I had to have four weeks off work. However I do a job where I cannot leave my desk sometimes (999) so that did make a difference. I have had an ERPC termination in the past and that was straightforward and back to work within 2 days. I wish I had gone for that despite them advising me strongly to go with medical.

[emsler]

Thank you all so, so much - you've been so kind to be so open about your experiences, I know it must be very painful to talk about. This has been so helpful for me, especially @AliBingo as someone else with a high-ish BMI - so great to hear your consultant's reassurances about the general anesthetic as that was what I was most worried about.

I've decided to go on the waiting list for ERPC and see if anything happens between now and then - I actually have started bleeding lightly this morning so hopefully it will happen naturally before my appointment.

I also spoke to my work who have offered to pay me sick pay given the circumstances so that's a real weight off my mind.

Thank you all again, so much - it has been such a help and relief to talk about it here and to hear from you all - I'm incredibly grateful.

[emsler]

Hmm not quite so straightforward... the clinic I should have had the SMM with said they won't treat me because my BMI is too high (above 35). The hospital have agreed to do it but now I'm really frightened that it's a bad decision and the risks are too high. And of course it's going me thinking that the miscarriage was probably caused by my weight which is breaking my heart. I actually lost 2 stone before getting pregnant but felt I couldn't wait any longer as I'm 33 - but now I'm thinking I should get my BMI down to 30 first which if my previous weight loss is anything to go by will take about a year (I have PCOS so weight loss is slow going). But then I'll be 34 and then my age would worry me even more, and I certainly couldn't see me having more than one which is what we would like. Argh, it's all so horrible. Sorry to rant, I don't really have anyone else to talk to about all this.

[thereisnocheese]

Oh I'm sorry you are having such a rough time. Have they said why it's risky? Other than high BMI? You will only be under ten mins or so. I don't understand the concerns from the clinic if they had suggested the procedure to you before. I hope that the fact they have agreed it reassures you somewhat. Xx

[emsler]

Hi @thereisnocheese, no it was just because of my BMI. This has been a bit of a recurring theme in my pregnancy - I don't look like my BMI is as high as it is because I'm quite tall and my weight is quite well distributed, so it seems like it comes as a surprise to most medical staff. E.g. I had to ask the doctor about extra folic acid because she didn't think my BMI would be high enough to need it. So when giving me the advice the nurse obviously didn't check my records so didn't think it would be a problem (she said as much on the phone). At least the hospital have agreed to it but I have to say I'm very concerned, not least because I have had an eating disorder all my life and I'm finding all of this is causing a bit of a flare up.

[wowwee123]

emsler i am in your position. my bmi was 35 in both pregnancies. my first pregnancy ended in mmc and second in stillbirth.

i know everything suggests that weight has an impact on these but the increase in risk is usually minimal. after my son was stillborn i saw a gp about when we would be ready to try again and about my weight and trying to loose some.

she basically said its nothing you did or didnt do and its not related to ypur weight as that mostly affects your maternal health, not the baby. it really made me feel a little better.

she also said make small changes. any weight off is better than no weight at all. that's really helped me. please done blame yourself.

im 32 too. aiming to ttc again after christmas and still around 35bmi but like u time is catching up on me. i have made changes tho. i wear a fitbit and do 20mins cardio exercise twice a week which i didnt do before. i think linking the two is helping me a little to stay focused bt the gps words mean i am not being ruled by it.

dont be so hard on yourself.

i had the erpc too and would request it again in future. everyone is different and i think they sometimes put too much focus on bmi.

[Helbelle75]

So sorry to hear this Emsler. Please don't be blaming yourself. As my sister said to me - it's very complicated making a human.
I had a mmc in May, went to 10.5 weeks, but baby had stopped developing at 8 weeks. It was devastating. It passed naturally, although I did have to go into hospital for fluids.
We were lucky enough to conceive again 2 months later, and I'm now 14 weeks pregnant, and all looking healthy on the scans. Don't worry too much about your age - I'm 41. And I'm sure eating healthily and being active is much more important than BMI.
Be kind to yourself.

[emsler]

Thank you both so much. It's really hard not to latch on to whatever cause you can identify and end up blaming yourself. The irony is that I do have a very healthy diet (although one thing I can definitely increase is my exercise) - I lost the weight through extreme calorie counting (essentially starvation). I think my metabolism is a bit dodgy after years of ED. I know you're right though, I need to just carry on eating well and step up my activity. Thank you for posting - I really needed to hear these things. So sorry to hear of your losses - it's a really hard, hard thing.

[AliBingo]

That sounds very odd, although sometimes clinics won't deal with "high-risk" cases and a BMI over 35 is automatically considered high risk in some circumstances, I was classed as high-risk for all three of my children's births due to my BMI, which meant a bit of extra monitoring and no home or water birth etc.

My understanding is that the main effect of a high BMI is on getting pregnant, so I really doubt it caused your miscarriage. Having just had 2 MMC in a row, I have been reading up a bit and it seems like most of the time a MMC is a random event of bad luck with chromosomal issues, I have never heard it linked to BMI, so please don't beat yourself up.

I had my three babies at 37, 39 and 40, and the with first two I think I weighed about 18 or 19 stone, had no problems, no diabetes, too big/too small babies, or any of the other problems that can sometimes be attributed to a higher BMI. So I really wouldn't worry too much about your age or weight too much.

If you do go for the ERPC at the hospital, the anaesthetist will come and chat to your beforehand and should be able to allay any concerns.

I was so fixed on my BMI when I had to have an operation in 2011 that I told the consultant that I would lose weight before having the op, he told me I was at far higher risk of dying of the condition than because of the GA and that I should definitely not postpone it.

Please try not to worry, just try and get this next bit out of the way, try and keep eating healthily and being reasonably active and I am sure you will be lucky next time. With my last pregnancy, aged 40, I was climbing around the local soft play after the other two, the day before DD2 was born. High BMI doesn't automatically mean problem pregnancies, immobility, or problems with GA. I hate being this overweight but it's not all that big in the grand scheme of things either, don't forget there are lots of pregnant women with BMI in the 40s and 50s, my friend was one of them.

Thinking of you, let us know how you get on x

[wowwee123]

i always weigh it up with my friend who is very slim and also had an mmc. the support group i attend for my stillborn son, all the women look to be healthy weights.

i really dont think it attributes that much.

as others have said the erpc is a quick procedure, you will be fine.

hope it goes ok and again very sorry for your loss it is such a devastating time.

[emsler]

Thank you all so much, I can't tell you how much this has helped. I really appreciate it. I'll let you all know how it goes!