Missed miscarriage - don't know how to decide what to do

[Meandery]

I am supposed to be 10+1 today. Due to very very faint brown spotting I had a scan last Sunday that showed 2 gestational sacs but that biggest baby hadn't got past 6 weeks. Repeat scan today and still bad news.

Now decision is conservative management (wait and see), medical management with medication either in hospital or at home, or surgery.

I'd prefer to avoid surgery.

But I can't decide whether to wait and see or take the medication, and if I go with medication whether to do it at hospital or at home. Initially I felt like leaving it to be natural. Husband feels this would be better in a sense of the less intervention and medication the better (this is his general worldview and he is absolutely supporting me whatever way I decide to go). But the waiting and wondering at every twinge is crap. I feel a pressure to keep up with things at home (self generated pressure) and obviously still have to get up each day and take the kids to school, make lunches etc. Work is hard to think about too, I'm a social worker so it just builds up while I'm gone though my managers are very supportive so being off isn't a problem.

I'm just starting to wonder if going into hospital and taking the meds would be best. I could just be on my own and get it done with no thoughts about school run or after school club or dinner or whether I should return to work while I'm waiting etc.

How to decide? I feel so limp, tired and useless. I've comfort eaten all week so feel horrendous physically. I'm prone to depression, especially pre-menstrually. The intrusive thoughts and internal criticism is ramping up. But I'm not very good at showing things so outwardly I'm just quiet and, I feel, quite useless and unhelpful to everyone.

I’m so sorry to hear you’re in this situation. I’ve had 2 mmc’s - one at 6 weeks (nothing growing in the sac) and one at 10 weeks (heartbeat stopped at 9+3).

I chose medical management for both. With the first one, I had started spotting by the time I found out but that lasted for over a week with no sign of passing the tissue, and I felt like I just wanted it to be over and to stop guessing. It was also the worry of what if it happened when I was out/wasn’t expecting it, I felt like I had more control with medical. I also decided to do it at home (though you take the pills at the hospital) as I’d rather be in my own space and have the privacy. I passed the pregnancy sac about 4 hours after taking the pills. It was difficult and I’d say the worst of the pain lasted about an hour, but you are given codeine which helps and I liked being able to have a hot water bottle/walk around/curl up on the floor/get in the bath to ease the pain.

With the second, my body showed no sign of miscarrying and again, once I knew it was over I just wanted the process to be underway. It was much harder physically and emotionally, but the waitlist for surgery at my hospital was 3 weeks and I didn’t want to wait that long. Again I did it at home and this was 100% the right decision for me as it just felt so much calmer and like we could say goodbye.

Be gentle with yourself - it’s so incredibly difficult x

Hi OP. I'm so sorry you're going through this. It's devastating. I had an MMC in January. Meant to be 9+5 but baby only measuring 7 weeks. I opted for surgical management as I didn't want to wait around to see when it would happen. I wanted to have some control over it. But that's just my personality type. I did pass some naturally myself a few days before my D&C but I didn't pass all of it. The procedure itself was absolutely fine. It was quick with minimal pain and bleeding. I was back home by 3pm. The recovery was fine physically but mentally/emotionally is different.
You're not useless. You've just been told devastating news and now have to make this decision. It is incredibly difficult. Lean on whatever support you have and eat all the chocolate x

I'm so sorry for your loss -MMCs are utterly devastating in so many ways. I've had 4 and had surgical management for all of them (with zero complications and minimal pain/bleeding). For me, I like to separate the physical and mental sides of it. I like it being clean cut, going to sleep, waking up and it's over. And I can grieve and process and try to move forward. For others, medical or conservative works better because they want to go through the process, or physically say goodbye. It's such a personal choice, and there is absolutely no wrong decision. Also remember you can change your mind if you choose conservative management and go down the route of medication or surgery.

Give yourself time to process this. You are absolutely not useless. You are dealing with trauma and grief, it's so hard. Thinking of you x

I’m so sorry OP. It’s such a hard decision. I have had 2 MMC’s and had surgical option for both. I didn’t want to go through passing the baby and deal with the trauma at home. The surgery I was in at 730 and home by 2. I also got to choose what to happen with the ‘tissue’, this was cremated and scattered in their garden of memoriam. I couldn’t deal with potentially having to flush it if I passed at home. Whatever you choose I hope you get through it as pain free as possible and begin to heal emotionally soon x

So sorry for your loss.

Id strongly recommend the surgical option. Long story short, things hadn’t even started to sort themselves out naturally by 14.5 weeks so I initially opted for medical management which was a pretty horrific experience… I’ve never seen so much blood and so many huge clots so was sure I must have passed everything 😞 but no, the nurse regularly checked everything but unfortunately I didn’t. Apparently the failure rate for medical management is higher than you’d think and I wish I’d known that beforehand as wouldn’t have put myself through it for nothing.

So then I had the surgical procedure and it was so straightforward and pain free and more importantly, emotion free unlike the medical management. It was a huge relief to wake up knowing it was all been definitely sorted out and I was able to return to work the next day and start moving on.

Thank you for the responses. I went with medical management in hospital. It involved taking Mifepristone in hospital then going home and coming back to hospital 2 days later for Misoprostol. I chose this as I was worried about miscarrying while alone with my children.

However mifepristone was enough to start things and I miscarried overnight at home that night. I was glad to be at home in the end as children were asleep. However, I bled a huge amount and passed multiple clots I can only describe as 'handful' size, as well as a big sort of pile of tissue and large puddle of blood at the end. Pain levels were tolerable, I took a co-codamol and a paracetamol at the very start and that's all I needed.

I felt afterwards that it was awful but as OK as it could have been. I stopped bleeding a day later apart from spotting. However 2 days later I was still tired, with a very very high heart rate and a headache. Attended A&E as gynae ward not interested and had a temperature and very low haemoglobin. Ended up admitted for 2 nights, IV fluids and antibiotics. While taking vaginal swabs to try and find source of infection, they found pregnancy tissue remained (despite the fact I was barely bleeding at that point) so I had an emergency-ish surgery to remove it (went to theatre at 1am). They said they removed a lot which blows my mind given how much had come out. I then had two blood tranfusions to try and raise my haemoglobin. In total they think the change in haemoglobin from baseline meant I lost approximately 2 litres of blood. Not sure how I was functioning really.

I'm not sure if it was especially heavy bleeding due to the medication, though mifepristone is only meant to block progesterone. Or maybe because it was a twin pregnancy.

Still reeling a bit really.

Aww OP, I'm so sorry you went through all of that. How traumatic for you. I find it crazy that you aren't offered a follow-up scan to check if everything has passed. Since I last posted in here I discovered I have a blighted ovum. I'm back in EPU tomorrow for a scan to confirm and then have to decide treatment. I was thinking medication instead of surgery this time (presumably less to pass) but I'm not so sure.
I'm so sorry you went through all of that. I presume you're off work? I hope you have good support at home.

I'm really sorry to hear that you've found out you have a blighted ovum. It's so hard to know what the right choice is. I did a lot of reading about miscarriage once I found out but I'd say the main thing I came away with is that each experience is different. One friend described her similar gestation miscarriage as like a bad period. Another had much much worse pain than me but a more singular episode of 'pushing' and just some bleeding. It just seems to vary so much. So if you went the medication route, it could be straightforward? Good luck whatever you decide and I'm really sorry again x

Thanks for your kind words. That's it, everyone's experience is so different. I also read horror stories about the D&C but mine was smooth sailing. I'll chat to the staff tomorrow and see what they suggest x