Missed miscarriage - what to do

[BillyGoatsGruffalo]

Hello,

My husband and I found out on Friday that we lost our baby at 9 weeks (we thought we were 11 weeks on Friday). I haven't had any bleeding, spotting or cramping while pregnant.

At the moment we are giving ourselves some
time and opting to let nature take its course. Our other option is an ERPC under general anaesthetic. I would like to avoid this if possible.

I suppose there are two main things I am looking for advice about, if anyone is willing to share their experience with me:

1. The likelihood of having a complete miscarriage with expectant management/the wait and see approach - I have read that this happens in only about 40% of cases and am worried I will therefore end up having to have an ERPC anyway.

2. How long I might have to wait for the miscarriage to start - I know it will be different for everyone and no one can say - I'm just wondering if I could be waiting for weeks on end? Will the hospital advise me to have an ERPC before that point?

I have also thought of one more question - if I wanted to opt for the medical route does anyone know if I can pay to have this done privately? It is not offered in my area.

Thank you in advance to anyone who's taken the trouble to read and respond.

Hi, so sorry you are going through this. I may be able to answer your questions from my experience.

It can take several weeks for your body to realise that your pregnancy is not going to continue. For me, i knew at 7 weeks, but didnt mc till i was 13 weeks, the wait was torture and very very distressing.

I am not sure why your local hosiptal does not offer medical management, but i have had this and truly from my experience, it was awful. I needed to be in hospital, had to have gas & air also had to have shots of morphine as i experienced labour....even at 9 weeks. The pain was prolonged and continued up to a week after i got home. I needed strong pain relief at home, so could not drive, work or leave the house.

I have never had an ERCP so cant advise on that, but there are plenty on here who have and will be along to talk to you. From what i can gather, its all over very quickly.

Thank you for sharing your experience, it really helps to hear from those who have been through this and I appreciate your candour. I am sorry though that you too have been through this distressing experience.

i am truly sorry, i know this is a difficult, sad experience. i had a mmc at 10 weeks, the pregnancy stopped developing at 6 weeks - but i discovered the pregnancy loss through the onset of bleeding, so can't say how long you might have to wait. i let the process happen naturally, it took about a week with two pretty awful days - it did resolve itself entirely with no interventions, but the pregnancy ended earlier than yours has, which may have made a difference.

i am surprised and a bit disgusted that there's no medical management available for you, if that's what you choose.

I'm sorry for your loss.

I had a mmc in January. Thought I was 11 weeks but baby stopped growing at 6. For me, the only feasible solution was an ERPC. I was told that as 5 weeks had passed with no bleeding or indication that anything was amiss, there was no saying how long it would take. I couldn't continue with work and looking after dd whilst constantly worrying about when it was going to start so I went the surgical route. It was over very quickly and the physical side was dealt with leaving me free to concentrate on dealing with it all.

Unfortunately it's impossible to say how long it might take. I wish there was an easy answer :(

Thank you both for sharing your experiences. I had a tiny spot of pink last night which has given me a bit of hope that things might start naturally though I suppose it is still early days.

I think I an going to give myself at least a week and see if anything has happened by that point. Your input really helps, thank you. I am sorry that you have had to go through this too.

Hi

Just going through this myself, started bleeding and scan showed no development from 6 weeks and i should be ten. I am bleeding now just like a period as i opted for natural management and they said it was starting anyway with the blood loss. If not i think im going down the ERCP route as cant face the medical management as it sounded awful reading about it and gigglepin has just sealed my decision. Hopefully wont need it but it is awful the emotions are bad enough to deal with it. Hope you get through this and thinking of you.

Jo xx

I'm so sorry for the shock you've had and the loss.

Sorry, managed to post that before I was ready. Also sorry for you, chezziejo.

I went down the natuaral route when this happened to us. It did take a few weeks to fully resolve itself, and I was bleeding for a while. However, it was the right thing for me to do, I think. It's a completely personal thing, of course.

Take care X

that should have said ERPC by the way.

I also had a missed miscarriage so I understand the sadness and feeling of helplessness. I chose to have an ERPC because the thought of waiting for nature to take its course was too hard for me to bear. Also, I had to get back to work as soon as I could and because of the work I do (childmind) I could not take the risk of having a huge bleed while caring for other people's children.

The general anaesthetic was not too bad. The whole procedure from arrival to being discharged was a matter of hours. I had the procedure on a Monday and took the rest of the week off and was back at work (though still very tearful) the following week.

sorry that you have to go through this, too.

Sorry not to have responded to these replies sooner, I am touched that you have all been willing to share your experiences, thank you.

For the moment I am going to wait and see if anything happens, then take stock next weekend. I am hoping that the doctor will sign me off for at least that long, though I am a bit anxious about asking, I don't want to have a battle on my hands. Hopefully they will be understanding.

Thank you again, reading your replies has definitely helped me.

Don't be anxious about asking to be signed off. Just say to the gp that you do not feel in a fit state to work at the moment. I don't know what job you do, but you will certainly not be able to give it your full attention. I pranged someone else's car a couple of days after I found out and I don't think I actually should have been driving. Gp signed me off for a week at least, if not two, I can't remember. And then boss at work seemed surprised that I was back so soon.

Thanks Besom, I know I shouldn't worry, I think it's because I just can't face going back to work this week. It's such a strange time, I feel quite philosophical one minute then the loss hits me all over again the next. I am also a bit anxious for the future, though again I know I shouldn't be but this was my first pregnancy and I feel that waiting for the 12 week scan is going to be that much harder next time around.

I suppose I need to stop thinking and worrying about the what ifs - I have enough to deal with right now without adding to it!

BillyGoatsGruffalo, I am so sorry for what you're going through. I think you should stay off work as long as you need to, it's a huge shock to deal with.

My situation is similar, first pregnancy and a week away from our 12-week scan when I started bleeding on Friday. Found out on Saturday there was no heart beat, baby probably didn't make it to 9 weeks. Such a huge shock. On Sunday I had really heavy bleeding and passed pretty much everything naturally. I have to go back in 10 days to check everything is ok. Feels very surreal.

On one hand I am eager to start trying again, on the other I can't imagine how worried I'll be with the next pregnancy. This time 12-weeks already felt like an eternity and I imagine next time the wait will be eveb harder.

But I think it's important to stay positive and deal with the trauma of this mc first. Have heard lots of stories about first pregnancies that end in mc and the next being successful so trying to focus on that.

Hello squidink, I am sorry for what you are going through, I hope that you are getting lots of support.

I think you are right about staying positive about the future and concentrating on dealing with the trauma from this miscarriage right now. I can't believe that it is only 3 days since we found out, it feels so much longer. I had a bit of blood earlier but no cramping yet and it seems to have gone again. It is a strange feeling - for 11 weeks I have been pleased not to have any bleeding and now I am anxious for it to start.

Thank you for posting, I really do appreciate it.

Hi BillyGoats. I'm so sorry for your loss, it is a really hard time and I think you're right just to take as much time as you need (and a bit more) away from work and other pressures. I had a mmc but, like a pp, it was found when I started spotting at 12+1. That was on the Friday and I got more bleeding and cramps on Sunday and Monday, and then fully miscarried in two episodes on the Tuesday. I did need to go to A&E for the bleeding, and they kept me in two nights and said I might need the ERPC the following day to stop the bleeding, but it resolved itself without intervention and a later scan showed everything was gone.

Have they given you lots of information about natural miscarriage, what happens, what's a normal / excessive amount of blood loss etc.? And painkillers?

Thank you philbee. I was given an information sheet about natural miscarriage but that just said that the bleeding would be heavy and that the pain could be quite severe.

From my own reading I gather that any more than soaking a pad an hour is excessive and might require going into hospital - was that your experience? I hope you don't mind me asking. I have also read about the clots and passing of the sac, which I understand could be quite large - perhaps the size of a tangerine or lemon. If you have any additional information or useful sources that would be really helpful, but not to worry if you don't.

With regard to pain relief, I have stocked up on ibuprofen as I understand this may also slow the bleeding down.

My husband is going back to work tomorrow but if/when the bleeding becomes heavy I intend to call him so that I'm not on my own - I don't want to pass out with no one around.

Thanks again philbee, I am so grateful that you have all been willing to share your experiences and knowledge with me, I am sorry if it is uncomfortable or distressing.

it depends what you feel is right for you. i tried waiting for things to happen naturally, waited 7 weeks and nothing... so i opted for the medical approach. i know for a lot of people they find it horrible. but for me i thought it really helped. i was 11w5d when it stopped growing. went into the hospital on thursday, took an oral pill. then returned saturday morning. had pills inserted "down below", went for a walk round the hospital, came back, went to the loo and a big clot came out, followed by the foetus (all happened within 20 minutes of the pills being in) had VERY heavy bleeding, 2 shots of pethodine. they removed a large clot that had got stuck, and then stopped bleeding. went home the next day, and bled a miniscule amount. although i would say, go back for your check up, because i didn't, and had problems with my periods after, that weren't resolved... if your local hospital doesn't offer this service, ask about going further out. if you're keen then push to get it done. at the end of the day, it's your choice!!! Hope this helps a bit. and good luck! xx

Hi BillyGoats. I think that most of what I read and the advice I got said soaking more than four pads an hour was too heavy. It is a lot of blood, much more than a period, and clots too, as you say. When I had the main part of the miscarriage I had contractions in the morning for an hour or so, so the pain built and subsided again repeatedly and I just tried to breathe slowly through that, and then I think the sac came out, there was a big gush of liquid which wasn't blood. After that I was bleeding heavily and getting through a pad every ten minutes so we called the ambulance (on the advice of a MNer, actually), but it subsided in the hospital.

In the evening I had very heavy bleeding and lots of clots, and for several hours I couldn't really get up from the toilet because I couldn't pull up my trousers etc. without dripping everywhere. I'm sorry, it's really horrible to read, far too much information. We should have called an ambulance after half an hour of that, but I had had very unhelpful advice from the EPU so thought I should wait until I was basically passing out (not the case, so don't do that!). When I did manage to get up I realised I was getting through a pad every five minutes, and I also started to be in a lot of abdominal pain, so we called an ambulance then. After a while in A&E a very big clot came out and I immediately felt a lot better and the bleeding subsided almost straight away to normal period levels. They said that the clot would have been stuck in my cervix which causes a lot of pain and prevents the womb from tightening to stop the bleeding which was why the bleeding was so heavy.

Anyway, this just reads like a horror story, I'm sorry. Don't worry, I don't find it all that uncomfortable any more really. I think my advice is firstly to have some strong pain relief ready. They gave me codydramol at the hospital, and they should have given you something too, tbh, it's pretty shocking that they didn't. I think you can buy cocodamol over the counter which would give you something stronger if you find the ibuprofen isn't enough. Secondly, call an ambulance or go to A&E if you have any concerns, too much pain, feel the bleeding is too much, you just can't cope with it, or anything like that. They did take me seriously, and we should have gone sooner because I really felt scared by the time the second ambulance came. I think definitely call your husband if things change, you need someone around you. Mine fed me fruit pastilles on the toilet, and told me it was all going to be OK. I hope it's alright for you and I'm so sorry you are having to go through this.

That is really useful information and advice, thank you philbee. I am pleased you don't find it too uncomfortable to relive but very sorry that you had to go through it.

I saw the doctor today who was very good - she has signed me off for just over 2 weeks which feels like a huge relief. She also advised me that paracetamol is better than ibuprofen as ibuprofen can stop the cramping, which you need to continue in order to expel everything. She also prescribed codeine for me to take alongside the paracetamol.

One thing she said which I'm not sure I'll do is to keep hold of what you pass so that the hospital can see if everything is out - she did say not to worry too much as the ultrasound will show this. It is routine to have an ultrasound after a natural miscarriage isn't it? I just don't want to have to fish things out of the toilet (sorry, a horrible image) or to bleed into a bowl - and then what, transport it all to hospital in a Tupperware container or something? It just doesn't feel right to me. It isn't absolutely necessary is it? I don't think I've heard of others doing the same. Obviously some people might not want to just flush the sac away, and I understand retrieving things for those reasons, if that's what feels right for the person concerned.

Feeling quite good today, relatively speaking, the spotting/light bleeding is continuing, I am just anxious for things to start. Keeping myself occupied with Downton Abbey and learning to crochet in the meantime!

Thank you too lauren, I think yours is the first description of the medical procedure I've read that didn't advise against it. I think one of the hardest things in making a decision is that you don't know what the reality of each option would/will be for your body and your situation. I'm therefore going on a worst case scenario for each and trying to figure things out that way. I really hope my body makes my decision for me in the time I've given myself to adjust and wait and see.

Thank you for posting.

Hi Billygoats I was signed off to miscarry naturally, it happened at home and wasn't phsyically too long or too painful. I called the EPU to confirm I'd passed everything and ask whether I should go in, I probably I should have gone in sooner but I wanted to miscarry at home rather than in hospital, just a personal decision.

They asked me if I'd saved the sac to bring it in with me. That felt incredibly weird as I couldn't bare to look at it let alone bring it to hospital. Eventually my DH and I decided to take it in though we both found it quite upsetting as we had to sit in the waiting room for 2 hours with our bag of remains.

I later found out you don't have to bring it in. If you do they will run tests and only contact you if there's something really the matter, in most cases there's not of course. I know of some people who have had the tests run and then had everything returned to them from the lab. I think do what feels right for you.

An ultrasound after a natural miscarriage is normal, they have to check that all the products (horrible clinical term) have gone.

Hi Billygoats - very sorry to hear your sad news. I recently had a missed miscarriage. Baby stopped developing at 6 weeks but I didn't find out until 10 weeks. I had some very very light bleeding which I had hoped was nothing to worry about but sadly it was not to be. I found out at 10 weeks because I had some slightly heavier bleeding and went to the EPU - but that bleeding also fairly quickly stopped altogether. I opted to take the natural management route as that felt like the right thing to do at the time, but a week and a half on (and therefore almost 6 weeks since the MMC) I was not bleeding and nothing was happening at all. I am self employed with a very busy job where I am not based in an office so could not go back to work while I was waiting and just did not feel I could continue to put my life on hold. Also, I found that the waiting and not knowing actually, in the end, made the experience much harder for me. So, having tried that route, I decided that I would have the ERPC. I was worried that I might feel that I had let myself down in doing that, but it turned out to be the best thing I could have done. It was all over with quite quickly with very little discomfort and I then really felt like I could move on. Also during the ERPC the consultant said that he noticed some signs of possible endometriosis which I had been completely unaware of so has scheduled a follow appointment to discuss with me - which wouldn't have happened otherwise. It has now been 3 weeks since my ERPC and I have been able to get on with my life. It was my first pregnancy so not sure what to expect next really but trying to stay positive. Be kind to yourself, follow your heart as to what you feel you should do and that will be the right decision. All the best x

I'm glad it was helpful. I do remember a nurse in A&E asking if I'd passed the sac, or maybe if I'd brought it with me and I just said that I didn't know, and no, I hadn't brought it (was feeling fairly arsey by that time). They should scan you afterwards to see that it's all gone, I don't see how they'd know that from you keeping everything that comes out, because people build up different amounts AFAIK. Perhaps the doctor meant that you could keep the sac and foetus and bring those in, not everything - I have heard of that. But I don't know if they do tests with a first miscarriage anyway. If you feel up to it maybe you could ring the EPU and ask for clarification about what they'd do so you can decide. I would have found it very upsetting to have to do that, but in our case there was no foetus anyway. I think you have to do what's right for you, and don't feel under pressure to follow instructions that upset you. Hope your crochet's going well.

Hi Hun, I'm so sorry for your loss, I'm just recovering from an ERPC myself after finding out the baby had stopped developing - I opted for the op and went to a private consultant at our local Nuffield Hospital who was so kind and amazing. If you don't want to messed around by the NHS this might be a good place to start as they have Nuffields evywhere. I had the op on the NHs tho for the sake of speed. It's taking me so much longer to get over physically than I expected, had to have antibiotics after a few days for an infection. In spite of the unexpected recovery time (the nurse told me an the hospital I'd have trailing off period kind of bleeding for a couple of days and I'd be able togo back to work after 2 days!!!)
I'd still opt for this rather than wait - 50% have to anyway and the waiting was so emotionally traumatic, I was a total mess and my poor husband didn't know what to do. I simply could face waiting weeks, plus I work in a shop selling baby clothes and the thought of miscarrying whilst at work was just hideous.
Anyway, lots of love and thinking of you, whatever you decide both the options are far from great and I'm just hoping in a fewweeks I feel a bit less crap about the whole thing.