Missed miscarriage - pros and cons of surgical vs medical management

[notalwaysalondoner]

Hi all,
I found out at an early scan at 8+5 on Saturday that I have an anembryonic pregnancy - so have a normal sized growing gestational sac but no evidence of an embryo. I had no symptoms of miscarriage.

Anyway, I have my hospital appointment today where I’ll need to choose whether to have medical or surgical management. Surgical will definitely be with local anaesthetic as ventilation for general anaesthetic increases risk of coronavirus so the hospital aren’t offering this.

Would really appreciate advice on your experience of each, particularly how painful it was and how long for, how much time you needed/would recommend off work, and especially any ladies who had local anaesthetic if it was very uncomfortable or not?

Am so undecided!

Hi @notalwaysalondoner sorry to hear you are going through this. I had a similar experience, though I had a little bit of spotting which got me to the EPAU, and then found out about the blighted ovum.

I went for the MVA and had this on 1st May. I decided against medical management because I read stories suggesting it did not work more than it did. So often it seems that there are retained products or whatever and the poor women end up having to have some form of surgical procedure anyway. I also chose the MVA because I wanted it done and to know it was done, if that makes sense. I'd had enough waiting!

The MVA was painful but manageable. It was just really bad period pain type feelings for about 15 minutes during the procedure. I cramped a bit afterwards too and had very light spotting for a week or so after.

I was told by the doctors to wait a cycle for dating purposes after the MVA but I didn't. I'm now symptom spotting like a mad woman as AF is due this weekend. I wasn't much of a symptom spotter before my MC but i just desperately want to be pregnant again now.

Good luck with whichever option you choose and I hope you have better luck next time

I’m sorry for your loss.
I had medical management when I had my mmc at 12 weeks, I went Private though so my experience might not be typical but I was incredibly well looked after with an overnight stay and sent home with painkillers and antibiotics.
A good friend opted for non surgical and was just given heavy duty pads and told to take paracetamol if it “all got too much”. Her whole experience sounded awful.
Physically my ordeal was over in 24 hours (mentally not so much) and it was absolutely the right thing for me. However, the reason I went Private was that the option for surgery wasn’t available at that time in our local hospital as they “didn’t have a bed”

And also, I got pg by accident (no idea it was possible) 1 week later
She’s 15 now!

Thanks both! Did you have to take long off work? I was sure I wanted the medication option, but now am wondering if surgical/MVA will be better as it will be 100% done, and also less risk of bleeding and cramps for weeks after.

Also want to TTC as quickly as possible after.

@adventurer2020 did you have MVA with local anaesthetic?

I had a week off and then worked from home for a week
Physically I was fine within a day or so (but tired from the General) but emotionally I couldnt deal with people

I had both with an anembryonic pregnancy. Got all the way to 12 week scan before it was spotted.

Took tablets and body expelled the tissue at home. No worse than period pains, but messy, was back at work after two days.

However after a week or two things didn't smell quite right and it transpired I had an infection from retained tissue, they performed the mva procedure there and then no painkiller, that was very uncomfortable and I was crying as they did it (I can't actually remember why I wasn't given a local anaesthetic - I think possibly it was so infected). Just two more days off work.

I'd elect to have the mva first time round if I were you. Don't have to deal with any real mess and once it's over you can recover and move on.

Sorry for your loss. I went on to have a healthy baby less than a year later and rarely think about it now.

Hello,
I've had surgery twice and 2 natural miscarriages. I would suggest at 8 weeks you have surgery. I found out at my 12 week scan my baby stopped growing at 8 weeks.
No bleeding, got sent home to wait. 5 weeks later and still positive test due to retained 'products' meant surgery anyway. I also had a blighted opum - empty sac - never even heard of that prior. Just opted for the surgery.
My 2 natural miscarriages were painless and about 3 weeks of bleeding but they were really early like 5/6 weeks. I wish you all the best, whatever decision you make. Big hugs

I had medical management twice at 10 and 11 weeks and it didn't work - retained the sac and there was an infection. Had to have emergency D&C together with a blood transfusion as I lost a lot of blood. This was October last year.

I had more or less a month off work (with a couple of wfh days in between first medical management and second/surgery) due to the long drawn out process and all the various complications. I wasn't in a great state.

Sorry for your loss

I had 3 natural and 1 surgical that ended up with me having Asherman's. For my natural ones I sometimes had to wait quite a long time but, when they eventually happened, the bleeding stopped quickly afterwards. My 4th one I wanted to have the embryo analyzed and I reluctantly agreed to have one. My instinct was right, but that's my story/body and can't advice.

@notalwaysalondoner yeah I had local anaesthetic with my MVA. I think there were maybe 2 or 3 injections and I only felt the last one.

Luckily it was during lockdown so I worked from home and didn't take any time off as I hadn't told work that I was pregnant or about the MC. If I had been working in the office I would have had a day or so off maybe, just to get my head around it? But physically I was absolutely fine and even went for a run the next day x

I had this exact thing, then medical D and C. The following month I was pregnant with DD, who is now adult (just!).

Thanks all!
Frustratingly my hospital is insisting on doing a second scan in a week (well, third scan if you count the private one) to confirm, even though the gestational sac is well over 25mm (mine is 33mm) which is the cutoff point where there is a risk you are just wrong about your dates and they just can't see the embryo on the scan yet. So I have to wait a week for another scan...

But at least the nurse was nice and so she is trying to schedule the surgical procedure the same day as the scan next week (I think she could tell I was very frustrated that no-one had mentioned two scans was their protocol when they called me to make the appointment). So at least I won't have to go in twice next week.

I think I'll go for the procedure as it just seems so so common for women to have the pills and then still need the procedure a few weeks later anyway.

I've told work I have been diagnosed with something needing urgent medical treatment and I will probably need a week off - luckily I work somewhere where if you are vague about medical things no one will pressure you to give more information. Maybe someone will figure it out but I don't really care.

Yes I think the second scan thing is standard practice, as it's happened in the past that they've accidentally aborted a living embryo.

I had to have one too.

Yeah I had a second scan too and then the MVA was 5 days after that. The waiting and limbo is arguably worse than the procedure - you just can't start to get your head around it until it's done.

Glad you've told work and glad they've not asked any questions!

I keep reading that we are meant to be super fertile following a MC so hopefully it will be your time soon, if you are ready.

I'm not allowed the surgery option as my hospital has stopped it because of covid. So I'm getting the medication. Hopefully it works.

I am going through a miscarriage now and I decided on letting nature take its course. Weeks later it is still not over and I wish it was. if this happens to me again I will choose an MVA.

My bleeding has almost stopped now and I'm worried that it's not completed. But I was in more pain than I was told I would be and I did have lots of very big clots yesterday.

I had my surgery on Wednesday under a general, just wanted it all over and couldn't face waiting and the pain etc. Sorry you're going through this x

caramelbun, I decided to let nature take its course too. It took a little while but it was fine. I hope it's over soon for you.

Well I’ve got the second scan tomorrow at 0930 then the lovely nurse managed to schedule the surgical procedure at 1200 (assuming scan confirms blighted ovum) so at least I won’t have to go in again. I’m planning to take at least the rest of the week off and maybe next week too. Luckily I’m in between projects at work so won’t have a big impact. I’ll report back on it after! Thanks everyone for your advice.

So I had the surgical management under local anaesthetic yesterday. I had to take a pill to soften my cervix two hours before and also they took some blood. I took some painkillers one hour before. The actual procedure was pretty uncomfortable for the first few minutes- injecting the local anaesthetic into the cervix (2-3 injections) hurt quite a lot for a few seconds each and then the first few minutes of the manual vacuum aspiration were also unpleasant enough that i really had to do some deep breathing and whimpered a bit - maybe the local anaesthetic hadn’t had fully enough time to act. The majority of the rest of the time it was ok and the nurse was able to distract me enough to talk about weddings, although I could still feel some tugging down there but it wasn’t really painful. They then did a quick scan while the equipment was still in there to check they’d got everything out. The final 30 seconds or so were also uncomfortable as they really check the edges and top of your uterus to ensure it’s all clear.

After they take your blood pressure and then give you something to drink and monitor you for 15 minutes or so, plus they’ll give you an injection if you’re rheusus negative.

Even though DH couldn’t come in with me i had a super lovely support nurse as well as the consultant nurse doing the procedure. She was great at distracting me, holding my hand, getting me to do deep breathing etc. I felt a bit battered/invaded afterwards but only had minimal cramps for less than 24 hours and bleeding seems to already have stopped. Overall I’m glad it’s over with and despite the slightly painful procedure I still feel I made the right decision over expectant and medical management as there is more rapid closure, and I have taken the rest of the week off and have a sick note from the nurse for next week if I want it.

I'm glad it went as well as possible OP take care of yourself and rest.

Glad to hear all went as well as could be, @notalwaysalondoner. Hopefully next time you get your BFP it will be a positive experience ❤️