MVA vs medical management

[Carolinaa]

Hi, I have found out this week I had a missed miscarriage. There is a yolk sac but no embryo. As I am now over 13 weeks the hospital said I will most likely need treatment, rather than things happening naturally. Having read the information I quite strongly preferred the MVA surgical option - mostly because it is done quickly and you know when it will happen. But at my appointment the nurse said because my sac was only 25mm they’d strongly recommend medical management. She said there were higher risks of other internal damage from the MVA because of the smaller pregnancy tissue they need to remove. I have tried to find information about this online but haven’t been able to - everything I’ve read says the procedures have similar risk levels. Has anyone heard of this - ie MVA being more risky with the small sac? Thank you

Hello @Carolinaa

Im really sorry to hear about your loss.

I had a MMC last year, although at an earlier stage. I chose medical management but then had retained tissue which they said measured 13mm. I was told I could choose either medical management again, or surgery, ie both were possible options. When I asked which the recommended they said medical due to the size (but this was only because I asked, it wasn’t “strongly recommend” like you were). The second lot of medical management did not work so I had an MVA anyway.
I am wondering if they said it’s higher risk because it can be harder to find the tissue to extract when it’s a smaller size, and an MVA always comes with a small risk of scarring (which medical doesn’t) so maybe if they are looking around for the tissue this slightly increases the risk.
I’m not convinced my MVA was completely successful either as I bled for 4 weeks after and it took 4 weeks for a negative test (which happened just after a slightly heavier bleed which I think was the rest of the tissue naturally passing). I don’t know if this was related to the size though.
I also had to get scanned in France on holiday as I was still bleeding, and he said they wouldn’t have operated on such small tissue there.

There is no right answer, both procedures have positives and negatives and it’s terrible that you have to go through either, but you can choose which is right for you.

Hi @Natpat81 Thank you so much for sharing your experience. It is helpful to know the size has been mentioned to you twice - I was really struggling to find anything about it online. I am not at all keen on medical management but I feel I should give it a go first to avoid the risks of the MVA as if it did go wrong I’d feel a bit like I’d brought it on myself. I honestly didn’t realise until now how difficult and drawn out the physical side of miscarriage could be - your experience of 2x medical and then MVA which still may not have wholly worked must have been exhausting. Really appreciate your message, it has helped me decide what to do xx