Surgical management of missed miscarriage

[SunSparkle]

Just found out today at our 12 week scan that baby stopped growing at 6 weeks. It’s come as a huge shock as I’ve had no bleeding or cramping and severe nausea and vomiting.

I’ve an appointment at EPAU to discuss surgical management. I think I want to have it under local rather than general anaesthetic as I’ve a two year old toddler at home I’d like to be home for asap.

can anyone share their experience of surgical management with me so I know what to expect?

So sorry 😞

I had surgical management for mmc and went under GA. dh was at home, he dropped me off and went back home and then I got a taxi home. It was fine under GA, tbh the best sleep I'd had in a while! I felt pretty tender at home so best bet is to have someone look after your toddler so you can rest on the sofa with a bar of chocolate for the afternoon. I went back to work the day after teaching and was a little tender but ok.

I had one under GA, everyone was very nice. Went in at 7am and was home just after lunch time. Unfortunately they didn’t get everything out so had some retained tissue that did then pass naturally but it was very unexpected and really freaked me out so worth a mention but hopefully that doesn’t happen.
I’m really sorry for your loss, we had a toddler at home too and I think she helped distract me a lot but I’m sure I could have done with a bit more rest!

@Hairbrushhandle thank you for sharing. Did they offer you local vs general? I’ve never had a general before so I guess I’m a bit scared. I’m also very difficult to get an IV in so that worries me too. The recovery sounds manageable and my partner can take the lead with my toddler hopefully

@Elpheba thanks for sharing. That sounds more manageable that I thought in terms of time in hospital. Sorry you had such a stressful time with retained tissue. Will definitely try and get some toddler care in so I can rest a bit.

So sorry. I had surgical management under local- had some oral pain killers before-hand and local anaesthetic to cervix and found it fine.

Before you have a surgical management just look up Ashermans syndrome because I had surgical for my second MMC and ended up with this .. meant I needed to have 2 more surgeries and I'm fairly sure I wasn't told the extent of the side effects so I could make a good decision (during COVID).

I opted for ga as I just couldn't face making small talk during it tbh. I'm glad I went with surgical management though as I lecture large groups of people and didn't want unexpected bleeding and the miscarriage to start at work.

Sorry you’re going through this. I had the MVA under local anaesthetic, for a missed miscarriage picked up at 14 weeks where baby had stopped growing at 9. On the day of the procedure I had to go 2hr in advance to be given strong pain killers and medication to soften the cervix. 2hr after that the actual procedure - local anaesthetic given into the cervix/uterus, plus gas and air as needed while the procedure was being done. Because I was awake, DH could be there with me which I was very glad of. It was manageable, not pleasant obviously but more than enough pain relief was given. Procedure itself took 5min. Home after 30min of observation. Minimal bleeding for about 10 days afterwards. Was very glad I didn’t have the GA.

Sorry for your loss OP I had surgical under GA. I was out quickly and even went for lunch after. I think whatever drugs they gave me stayed in my system a while because I was crying on the way in but giddy the rest of the day. I also had a toddler at home.

Sorry you're going through this.

I've had both ERPC under general and MVA under local.

For the ERPC I was already staying I hospital for 3 nights. I'd already bled a lot and passed a lot of tissue but medical management hadn't completed so this was the only option. Because I didn't go into theatre til1.30pm they weren't able to get prescription and discharge paperwork sorted for me to leave that night, but if I'd gone in as a day case I think I'd have been OK. Didn't need any painkillers after the GA wore off.

With the MVA I was in for 8, out by 11.30am. Managed sensitively - I downloaded some relaxing music onto my phone which I was allowed to take in but not allowed eye mask or earphones as they need to be able to communicate with you.

Walked home (relaxed 30 mins), was in some discomfort for a few days afterwards but and managed by painkillers. Went to an early theatre show and drinks party that evening.

Obviously with the LA you're aware of what's happening, and there are some moments of discomfort. With the GA I had already been through the really traumatic bit when i was bleeding heavily, cramping, in severe pain so I was grateful GA was the only option they gave me.

I opted to pay privately to have the pregnancy remains tested so the sample was taken while I was in the room.

I'd choose either again over expectant or medical if I miscarry again.

Hi op sorry you are going through this! I’ve been there too and also had very bad nausea. It comes as such a shock doesn’t it and I felt very bitter that I’d felt so so unwell for no reason! It’s a lot to process, both physically and mentally. I’m so sorry.

I had ERPC under general - I’d never had a general before and was terrified but everyone is so nice and it’s nice just to go to sleep. I’ve had two - the first had retained tissue so I had to go in for a second ERPC. But the good news is that nausea lessened quite quickly after the first, even with retained tissue. My second ERPC healed well with no retained tissue. The chances are on your side for it to go well (as well as these thing can go!)

time really is the only healer for this, sending you big hugs xxx

@Greenvelvetdress what is Ashermans? What did that involve?

@Caneloalvarez im so furious about the sickness as every pregnancy I get hyperemesis and it’s horrendous. And to know I could have known baby has stopped growing at 6-7 weeks rather than go through the last 5-6 weeks of extreme vomiting is making me furious at the world. Hyperemesis is only bearable when you feel like you’re getting a baby at the end of it.

I’ve started to have some cramps (it’s funny how my body may kickstart now that I’ve had it confirmed on a scan). I am less scared now than I was about having a general and glad the pain and recovery seems to be manageable. I’ve had a lot of time off with the hyperemesis that I’m keen to just try and get on with things now.

im also grieving the plans we had and the age gap between my toddler and a new baby as I wanted them less than 3 years apart and that won’t happen now. It’s stupid I know and I will just be madly over the moon if we can ever have a second child but it’s hard to let go of all the visions you had. Loads of people around me are 3-8 months pregnant as well so it’s just everywhere.

@SunSparkle it's basically where the surgery causes scar tissue and adhesions in your uterus. I went to see a consultant after my second miscarriage and he luckily picked up on my light periods and did a few scans which showed suspected Ashermans. I then had two hysteroscopies and freeing of the adhesions both under GA.

Just something to bare in mind when weighing things up. When I recently had my third miscarriage I opted for medical management because I didn't want to risk surgical again.

If people on this thread don’t mind me asking, did you go on to have another miscarriage or was your next pregnancy a live birth? How long did it take to get pregnant again?

Hi @SunSparkle I have had 2 MC out of 2 pregnancies. I'm now pregnant a 3rd time.

1st pregnancy was 1st month we tried properly (ie sex more than once in the fertile window). 2nd was 2nd month, 3rd was 2nd month. I'm 42.

I left longer after 2nd MC than 1st Mc before trying again because the bleeding continued for 2-3 weeks and I just generally wasn't feeling great.

I had quite a few very early miscarriages after the mmc but I took aspirin and finally got one to 'stick' about 9 months after the mmc. The age gap between DC worked out very well in the end and whilst I wasn't glad I had the mmc it probably wasn't the right time for us so it worked out in the end.

I've had the op twice under general. They only give you a bit of anaesthetic as it's a short op. I was OK on the evening. I had a week of bleeding which was quite intense on the day of the op but not that bad after that.

Having it under local sounds a bit grim.

So sorry for your loss OP. Chances are that you'll go on to have an LO, having had a miscarriage is just one of those things. It's only after having 3 or something that they investigate it, as having one or two is not unusual and not usually predictive of issues. X

GA here. In and out within a few hours. It was fine.

i conceived again after first cycle post-op.

That was my 4th miscarriage, after which I decided I wouldn't try anymore. I had an appointment at the recurrent miscarriage clinic which I almost cancelled because I thought what's the point. Even after the appointment we didn't try (but didn't prevent either) after 18 months I got pregnant and now I have the most beautiful daughter. The break did me and my body good but you do whatever you feel is right for you. Good luck

Thank you so much for all your support and sharing your experiences. Got surgery booked for next week and chose general anaesthetic option after discussion with the team.

I’m also feeling a little better (I don’t know why) as they confirmed it was 9 weeks not 6 weeks that it stopped developing. It makes me feel like my body tricked me a little bit less.

hoping I can make peace with it and try again when we feel ready. Hopefully our time will come.

Hi @SunSparkle I was on the verge of tears all the time and that was just with severe nausea and a bit of gagging… I didn’t actually throw up! I really don’t know how anyone gets through hypermemesis! What I can say is that the bitterness about feeling so rough will fade with time, even though you feel SO angry about it right now. And I get that you feel a bit less “tricked” knowing that it stopped developing a bit later. It’s still shit though isn’t it. I just felt so sorry for myself, hearing that news, feeling so rough… it is awful. But the pain of it will lessen with time.

I have a 3yr old, i had one chemical before that but then everything with that pregnancy was straightforward! Since then I’ve had 2 “proper” miscarriages. 1st one I had an ERPC, and then had to have a second ERPC as there was retained tissue. This was in oct - dec 2021. Had a break from trying (my dd is a handful which is a great distraction!) then had another chemical Oct 2022. Fell pregnant again in Feb this year, but mmc discovered at 10 weeks (stopped at 7wks). The tissues were tested and this one was actually a partial molar pregnancy, which I was told is very rare (lucky me!!) I’m now having blood tests to make sure my hcg is normal before trying again.

all in all it’s been rubbish and there have been points where I thought, shall we just stop at 1? I’m also approaching 40 so time not on my side! But I think I’m willing to give it another go. There are lots of positive stories on here , even after multiple mmc… it is just a shame that we have to endure these things. I try to think of it as just “nature” and it’s not personal or anything we’ve done wrong.

sorry it’s all a bit sad news here! But I think the stats are on your side to have a successful pregnancy in the future!

i have an appointment with the miscarriage clinic in august but very often they don’t find a real cause .. it’s just random!! Xx

Hi @SunSparkle just wanted to check in and see how you are doing? Hope you are ok xxx

Hi @Caneloalvarez . that’s really lovely to check in on me.

I had a really rough time. Went in for surgical management and while they were trying to cannulate me I had two seizures and I’ve never had one before in my life. It meant I couldn’t have surgical management as they wouldn’t consider general or spinal anaesthetic because of the seizures. So I had medical management which wa a quicker than expected but lost quite a lot of blood and that combined with the pain of the seizures was a rough week after.

it’s been two weeks today and I am trying to decide if/when I want to try to conceive again and I’ve also got to have a follow up on what the seizures were (could be benign and related to the stress I was going through at the time rather than epilepsy).

i don’t even know if I need to wait til I’ve had a period. I want a baby desperately, but I’m not sure I want to be pregnant and I’m worried it will all go wrong again.

Give yourself time to recover, and try not to get hung up on age gaps. We ended up with a bigger age gap because of miscarriages/sub fertility,( 5 years in the end) but they are lovely sibs and get on really well. So hard when you are in the midst of it all though, and pregnancy after miscarriage is always a nervous thing. You are grieving and need to give yourself kindness and time. 💐