Unsuccessful surgical management of MMC

[Sherw00d]

I'm looking for success stories where a second surgery was needed to clear a miscarriage, and the surgery actually worked. Even better if you went on to have a healthy baby!

I had surgery on 7 November to remove a MMC which was discovered at my 12 week scan. My baby's heartbeat had stopped at 8+4 and my body showed no signs of noticing, so it was a horrible shock.

It's now been a little over 4 weeks since the op, and during that time I've continued to bleed very lightly every single day. I took a pregnancy test after 3 weeks, which unfortunately was a very strong BFP. I gave it another week before testing again, and once again it was a BFP.

I reluctantly called the hospital yesterday, expecting to be told not to be silly, but they had me in for a scan today which showed that the first surgery had missed a lot of pregnancy tissue. They showed me on the screen: there was loads!

I'm now on the list for a second surgery next week, as the consultant's view is that my body isn't likely to pass the retained tissue naturally any time soon and the medical route is also unlikely to fully resolve it.

I'm gutted. It's been over 5 weeks since we found out about the MMC and I was finally trying to start moving forward, but now I'm right back to square 1.

It doesn't help that the doctors are strongly recommending the surgical route, but also warning me that the more surgeries I have, the greater the risk of uterine adhesions, which "may prevent future pregnancies". Just what I want to hear.

So if anyone has had a failed op, followed by a successful one, I'd love to hear about it.

Sorry for your loss. I didn't have quite the same experience but I had 2 MCs in my first 2 pregnancies.
1st MC -Started naturally, opted for medical management which didn't work so i had surgical under GA.
2nd MC - Missed MC, had MVA under local anaesthetic. Bled for 2 weeks afterwards.

3rd pregnancy - no issues, pregnant in 2nd cycle of trying, now 32w no complications

Ps - find out whether the doctor will be using ultrasound throughout the procedure or only before and afterwards.

@Whataretheodds Thanks for your reply. I'm sorry for your losses but congratulations on your current pregnancy! Wishing you an easy delivery and a baby who sleeps.

How did you find the MVA? It seems less common than surgery with a GA.

Good point re the ultrasound. I'm a bit frustrated that they didn't scan me after the first surgery - it seems like such a simple step to avoid women having to go back.

They did say that they'll "try to scan" this time. I'll be asking them to try hard because this has been a complete nightmare and I just need it to be over. It's not as if there's a small amount of tissue - there are several clumps, each around 4cm x 5cm according to the ultrasound technician.

Fingers crossed this will be the end of it.

Sorry for your loss. Not quite the same, but I had 2 MMC (My first and 3rd pregnancies). The first was a failed medical management where I needed surgery. The second I opted for surgery straight away and 6 weeks later I still had some retained tissue. Luckily it came out in my first period so I didn't need another surgery.

I hope it goes well for you. Its so stressful and horrible at the time! But for a positive ending, my second and fourth pregnancies were luckily successful and I have two lovely, healthy children.

Thank you!

That's quite a rubbish response about the scanning. I'd want to ask why don't they scan throughout given what you've been through so far. It should be happening. Surely not scanning throughout (afterwards at the VERY least) would be negligent and/or wasteful.

I think the MVA (local anaesthetic) is offered in the first instance. In my first pregnancy it was offered as an alternative to expectant and medical management, but after the medical management didn't get everything rhe only option was the GA surgical. They reasoned that the remainin tissue was likely quite well adhered still, so wouldn't have been able to be as emphatic with a local anaesthetic.

I had this with my 7th miscarriage, but my body passed the retained tissue one evening in the middle of the night, I laid on the sofa thinking it was after pain at first, it got so bad for six or more hours, I couldn't even get up to call my husband, I couldn't even speak to call for him, I have never known pain like it before or since, thank god.
I know you don't want another operation but you are better off having it, than if your body ends up doing it by itself, it was ten times worse than labour.
I did go on to have two pregnancies with no problems and two healthy boys.

Sorry for your loss. X

I’m sorry you’re in this position OP. I had a MMC earlier this year, had medical management but then a D&C 5 weeks after that for RPOC and another surgery 6 weeks after THAT for more RPOC! The second surgery was successful. They did a hysteroscopy (with an internal camera) instead of blind/ultrasound guided D&C - can you ask if that’s an option? I don’t know why they don’t always use an internal camera TBH. Though I haven’t conceived again since (4 cycles now) so can’t help with the at part of your question I’m afraid. Good luck.

Thanks so much to everyone who's replied, I really appreciate it.

@SnowmenMadeofIcecream Congratulations on your 2 children! I was hoping any retained tissue would come out when I have a period but there's apparently far too much of it for me to have one. I'm glad I didn't go for medical management as the success route seems pretty low. I'm extra grateful for my 6 year old daughter after all of this. She has no idea but is probably frustrated that I won't stop cuddling her all the time!

@Whataretheodds I'm stunned that they didn't scan afterwards. Presumably it's a cost-saving issue but surely it saves far more money to check rather than have to do repeat surgeries. I'm going to advocate for myself as strongly as possible and insist on being scanned during if possible or at least afterwards. There's no way I can do this 3 times. Ouch, the thought of an MVA is pretty unpleasant! Definitely seems better to be asleep.

@Copperoliverbear 7 miscarriages? That's awful, I'm so sorry. I know the pain you're talking about! The Sunday after my op, I had horrific cramps and had to go upstairs and lie on the bed in a ball until they passed. I eventually passed a clump of tissue and they stopped immediately. The pain wasn't quite as bad as labour for me, but I didn't pass much tissue and my labour with my daughter was a nightmare. I agree I'm much better off having the op, but I'll be furious if this still doesn't clear it.

@Oxalis00 I'm sorry you've been through this too and that you haven't conceived again yet, but thanks so much for this post, it's really helpful. I'm going to ask about a hysteroscopy and push for one if possible as I wasn't aware this was an option. I'm horrified by how much retained tissue there is, so I want every possible measure to be taken to avoid this happening again. It's just dragging out an awful experience when I want to move forward.

Update:

I went for my pre-op bloods today and asked what the position was in terms of scanning to make sure they get all the tissue this time.

I was told that they don't scan because it takes too much time so I won't be scanned before, during or after my surgery tomorrow to check if all the retained pregnancy tissue is gone.

I'm going to raise it directly with the consultant tomorrow. I'm torn between wanting to advocate myself and feeling like a complete arsehole for nagging about scans.

I know the NHS is struggling and I'm so lucky not to have to pay for this surgery, but it's pretty devastating if them saving 5 minutes means another 6 weeks of bleeding and positive pregnancy tests for me, with the risk of infection rising all the time. My baby passed away inside me in late September. It's now mid-December. It just feels cruel.

Oh, and the cherry on top of my appointment was the same nurse who took blood for my original miscarriage surgery taking my blood again today, and saying that she remembers me, and "it's a shame it's another miscarriage but at least you know you can get pregnant again very quickly!". I then had to tell her that this is a second surgery for the same miscarriage.

Really sorry for your loss OP.
I had surgery for MMC, like you it was unsuccessful.
Instead of second surgery I had a chemical abortion and passed the tissue naturally. It was one of the most painful experiences of my life, undoubtedly exacerbated by mental pain.
I’ve since had a healthy baby.
good luck x

I'm so sorry you are going through this op. Did the hospital mention molar or partial molar pregnancy to you? Rising hcg after the end of a pregnancy can be a sign of one and the hospital should send off some of the tissue for testing to make sure.

@spilltheteapot Congratulations on your healthy baby! I'm so sorry you've experienced a failed surgical management too. The doctor said it's highly likely that I'd still have retained tissue if I went down the medication route based on how much tissue is left and how well adhered it is. I'm almost glad as I don't want the pain!

@WonderingWanda My HCG hasn't risen, it just hasn't fallen enough and I'm still getting positive tests and bleeding 5 weeks after my surgery. The doctors aren't concerned about a molar pregnancy (my 12 week scan very clearly showed the baby) but I'm having the tissue checked this time, just in case.