Can you insist on an ERPC?

[ZucchiniPie]

My sister-in-law found out at a 10 week scan yesterday that there was no fetal heartbeat. I've just heard from my brother that they're still waiting to hear from the GP about next steps, nearly 24 hours later. I'm worried they're just going to make her wait to miscarry naturally at home, which could take days - weeks even (I had a missed miscarriage myself at 12 weeks) and will be very distressing/unpleasant. Can she insist on having an ERPC to get it over with quickly? I wanted to check that before I tell them they're definitely entitled to it, and then find out I've raised their hopes falsely. Thanks

Hi, it's great you SIL has your support.

I'm afraid it's awful but no totally usual. before 12 weeks and for a first loss they will usually insist on a medicated miscarriage which then passes at home. I tried to insist on a D&C for my first missed miscarriage but they wouldn't have it, when I thought I needed another one last week they would have been open to me having a D&C (the midwife confirmed) but it then passed naturally in between scan 2 & 3 where I was going in for confirmation of another missed miscarriage. It's also usual to wait to speak to someone as you need to come to terms with the information youve been given that your baby isn't there any more. It's good for you to help her get prepared after she's talked to doctors/ nurses. With things like adult nappies/tena lady pants are better I found than huge pads but it's good to have some maternity pads, leggings, a new pair of pjs maybe for comfort. Stuff to watch on tv, comfort food. That kind of thing

She may well see a sac and the embryo/baby as you know so better be prepared

All the love

I had a missed miscarriage discovered at 12 weeks after Id gone in for a scan because I'd had a bit of spotting. I was talked through the options and then given some time to think about what I wanted to do. They didn't want me to rush straight into a decision having only just found out.

They said I could either wait to see if the miscarriage happened naturally, or could opt for medical management with the tablets or surgical management with the ERPC.

I was booked in for surgery a couple of days later but it all happened naturally at home in the meantime.

With any luck your sister will be given the options and allowed to choose what she feels is best for her. It's good she's got your support

Unfortunately because of the Covid situation I think hospitals are more reluctant to offer surgical management as it uses up a theatre and more resources than expectant or medical management. Saying that I was able to have surgical management 3 weeks ago - I was given all the options and they supported my decision. Hopefully it will be the same for your sil.

I was booked in for erpc 2 days after having my mmc confirmed - so it can be fairly quick.

I had a MMC in November, was offered all options (waiting it out, medical tablets, surgical under GA) and chose surgery. Hopefully she'll be offered the same

Thank you everyone and sorry for the slow reply. I'm also sorry to all of you for your losses. She's been booked in for an MVA under local anaesthetic now - for tomorrow - but really wants not to be awake for it. My brother has just asked me if she can insist on having it done under general. I assume that's the case if all options are in fact on offer?

I had to be awake for mine @ZucchiniPie as they weren't doing generals due to Covid. It was fine, the op is really quick and the nurse spoke to me and held my hand the whole time so I didn't really concentrate on what was going on.

Thank you. I’ll pass that on to them. And so sorry for your loss

But there's no harm in them asking for it under general, as it may be different in your area.
Hope she's ok.

I had a D&C under a general last March for retained products after a miscarriage and my local trust (Bristol) was doing them as normal again. Certainly some places are offering a general so if your SIL wants it she should definitely push for it.

@ZucchiniPie best to phone up in advance - theres lots of prep for a general so they wont be able to just decide to do it that way on the day. I had to have a pre-surgery appt 2 days before and also they have to line up the anaesthetist etc

Thanks. Yes I just remembered the mum of one of my daughter’s friends is a consultant gynaecologist so I called her and she said that getting on the surgical list might take up to a week (in part because of Covid reducing the number of procedures they can do in a day), which obviously is far less desirable than going with the MVA under local anaesthetic tomorrow, since my sister-in-law might start to miscarry by then. So I’ve suggested to her that perhaps it’s better to go ahead with the MVA and have shared the reassuring advice above from BaaBaaEmily.

(When I had my ERPC ten years ago it was an emergency as I haemorrhaged badly at home and had to be brought in by ambulance so there was no wait, although it did take about 12 hours to get me into surgery from A&E.)