Unsure if worst is over

[fullfathomfive]

If anyone could advise me, I'd be v grateful. First: the statistical bits. I should be ten wks pg, but foetus gave up at 6 wks. The first scan I had (privately, at almost 8 wks) showed a foetus of 5-6 weeks gestation with crown to rump length of 6mm. Much smaller than it should've been, and no heartbeat. The most recent scan (at 9.5 weeks) showed no foetus! Apparently, it had been 'reabsorbed' into my body. The pregnancy sac was no longer high in the womb, but lying on my cervix.

So. I started bleeding very lightly on, let's say, day 1. A sanitary towel lasted all day. I didn't have any pain. Day 2 was the same. Day 3 was a different story. I began to have very strong cramps, but they were intermittent. For a couple of hours they were more off than on, so this was manageable (but nerve-wracking, as I wondered if more of this was to come). Out of nowhere, the pain increased and - although still coming in waves of intensity - was now without any significant pauses. I was climbing the walls, actually howling (and the bathroom is fully tiled. God knows what the neighbours were thinking). It was unbelievable... abysmal. This lasted for a little more than two hours. I took plenty of dihydrocodeine but it seemed to have no effect. The pain was intense in my lower back, too. Quite abruptly, I saw blood in the bath (hadn't been bleeding during the painful part) and magically - mercifully - the pain stopped suddenly. It didn't ease off, it just stopped.

I got out of the bath and went about the house feeling extremely relieved. About 20 mins later, I distinctly felt something 'sliding' out of me. I went to the loo to investigate. There was a clot about the size of a matchbox (not cooks matches! the normal sized matchbox). Although a bit yucky, I touched it and it felt firm / meaty / fibrous-y. There were white flecks in it (sorry to be graphic). It was not jellylike. So that was obviously what was causing all that pain. That was day 3. Day 4 is today and I've had nothing! Just very light bleeding (one pad all day). No pain, not even discomfort.

I'm uncertain about what is going to happen next - and nervous about ending up in agony again. I've bled less than during a standard period. Surely this can't be it, can it? There must be more to come, surely? But perhaps this could be it, as there is no foetus to pass - just a sac? Can you pass a sac as one piece of tissue? Does it sound as though this is what happened? I'm booked to have a SMM on Monday (which will be Day 6). But I'm not sure if I need one. I know that the medics will advise me and I'll prob be scanned again, but I'd like to know a bit more, just for peace of mind.

Thank you for reading and sorry to be graphic.

Hi there, so sorry you are going through this. I've just finished MCing - dates different - but I had a v similar intense pain then huge clot passing experience. What happened then, for me, was bleeding for 1.5 weeks (change of pad every 3 hours) tailing off then peaking again following PG test going from positive to negative. After that negative test I've bled reasonably heavily for 1.5 weeks (apparently my body is purging following the pregnancy hormones crashing). This stopped yesterday, coinciding with me being v tearful/PMTy, again I think because of the hormones. It's been a physically different experience for me this time than from my first MC (DD in between) so I think it can be v different for everyone

Take care of yourself, take time out where and when you can and don't be afraid to ask questions of your local EPAC xxx

Sorry you had to face that, OP, sounds like a scary experience.
From your description that sounds like the sac that you passed and IME once that is done then bleeding settles down and pain subsides. You will probably shed the womb lining over a few days - I've had about 10 days in total of bleeding, but of period-like proportions for a few days then lighter. The hospital should offer a scan before the surgical management, if your womb is empty you shouldn't need any intervention. They like your lining thickness to be less than (I think) 15mm before they sign you off, but if you are still bleeding a bit I would imagine they will let nature take her course even if it's above their cut off level.

Thank you, Bakingtins and Flossie,

So, it sounds as though the sac was what I passed. If this is the case, then the womb lining will be next, and passing the womb lining is basically a period. So it should be less miscarriage-y and more period-y from hereonin.

Bakingtins, if what I typed in the previous paragraph is right, the womb will be empty, won't it - when I'm scanned on Monday? And hence, probably no need for SMM.

Thanks for sharing your story, Flossie. I remember feeling full of hormones nearer the start of this pregnancy (before baby died), when tiny things would move me to tears. And I often felt irritable. I was so very emotional. I'm not looking forward to going through another massive hormonal adjustment. I get so emotional!

It sounds like there will be no "products of conception" (the embryo and sac) to remove, so I think requiring SMM is unlikely.
The womb lining should be shed as your levels of progesterone and HCG drop, which as you said should be more like a period. With a missed miscarriage, where it has taken some weeks for your body to register that the pregnancy is not progressing, that might take a little while, so you may have the bleeding stop and start a bit over the coming days.
I would think even if the womb lining is still thick when you are scanned then you will be encouraged to complete the process naturally, but they may want to rescan you a week or so later to make sure it is below their threshold level, or they may ask you to take a pregnancy test to ensure that it is negative.

Thanks bakingtins. You sound very knowledgeable! Are you a medic?

I understood most of what you said, apart from the business of an Early Pregnancy Unit's notion of 'threshold level'. Do you mean that the womb lining has to be of a certain thickness for them to 'surgically manage a miscarriage'? If the womb lining hasn't thickened to that extent, or is de-thickening (thinning), then no surgery will be required and I'll be allowed to progress naturally?

A thickened womb lining alone wouldn't need surgical intervention, would it? (Assuming there's no embryo and no sac.)

There has been about a month between the start of light bleeding and the arrested development of the embryo, so it's deffo taken a while for, as you say, 'body to register'. This means bleeding could go on for some while, yes?

Sorry to sound dim by asking questions about what you have already said. I want to make sure I've understood properly.

My mmc at 11 weeks involved a week of bleeding after passing the sac, but there were some large clots left behind (seen on scan) and after these passed the bleeding tailed off over a further week. Every person has a different experience though.

Really sorry for your loss

Thanks Ruggle. So, no SMM / ERPC for you, then?

Nope. I wanted let nature take its course. I was scanned once a week until they were happy though.

I'm a vet with a lot of personal experience (4MCs)
I don't think you'll need surgery if you've passed the sac naturally. Either they will say your womb lining is thin and sign you off or, as Ruggle said, they will say it's still thick/has some clots, and monitor you at intervals.
You don't have to have surgery at any point (unless for an emergency like a ruptured ectopic) there are usually options for how your MC is managed, and I think it helps in how you mentally deal with it if these are explained and you feel you can choose whatever is least-worst for you.
I hope you get the all clear tomorrow.

Thanks everyone, and Bakingtins - SO sorry for your four mcs. I've had two. Can't imagine what it must be like to go through it four times. xx