How did you decide between medical or surgical management? Missed miscarriage

[SP2024]

After a long battle today have finally found out my baby’s heartbeat has stopped. This was an IVF frozen embryo transfer, I had a scan at 6+5 but baby was only measuring 6 weeks and no heartbeat. Went back a week later and there was a heartbeat but no real growth. Two more scans followed and more waiting and today baby’s heartbeat has stopped. I guess I should have expected it but I’m still so floored. I have to decide what to do next and I’m honestly not sure. I know I’m not keen on “just waiting” and potentially starting to bleed when at work or out of the house. But how do I decide between medical management or surgery? My husband thinks I should opt for surgery but I’m worried about adhesions. But with medical I’ve heard it’s really painful and often people will need surgery anyway. How have people decided? And have you regretted the choice? Part of me feels like I should go medical so I can “experience” the loss physically. My husband thinks that’s just torturing myself unnecessarily. I’ve had no bleeding yet.

Hi, I’m really sorry for your loss and the grief that goes with it. Unfortunately it’s a pain I too know. I see nobody has replied to your post yet and I thought I should reply in case it helps, because I have had both. I had a miscarriage at 11.5 weeks and in what I think was a corner cutting exercise they sent me home with the misoprostol after telling me the baby had no heartbeat and she wasn’t measuring 11 weeks. Maybe because they thought she was smaller than 11 weeks they thought the tablets would be ok or maybe it was just to save time/resources by not doing surgery (probably a bit of both), but what happened to me was really scary and dangerous. I had a massive bleed, a really scary massive bleed where I thought I might die. They say anymore than filling one maxi pad per hour is too much, well I was filling maxo pads in five minutes, this went on for hours. Some of the clots were as wide as the pad and half the length. They are extremely painful to pass and I have given birth to a full term baby without analgesia so I was taken by surprise at how painful the miscarriage process was. I had been told that it would be like “a heavy period”. I also was reassured I wouldn’t see anythyng resembling a baby in the miscarriage material. Well after two trips to emergency and both times being sent home, I eventually passed my pregnancy at home and the baby was fully visible inside the sac with placenta attached. I really am not wanting to scare you as every woman has a different experience depending on how far along the pregnancy is and other factors, and you are only 6.5 weeks, is that right? So in that case, you may very well be able to efficiently pass your pregnancy after the tablets without the hemorrhagic blood loss. If you ended up in trouble they would do emergency surgery anyway. And when I say trouble, I mean that pieces of the baby or pregnancy material can get stuck in the cervix of some women and that can lead to sepsis/cervical shock. At 6.5 weeks the material will be a lot smaller than mine was (baby was about 4.5cm long inside the sac and I think just under 2cm wide). So I realised then why it was so painful, it’s actually a type of birth when you get past a certain point and the cervix has to dilate to let the pregnancy through. I was lucky I could see that everything came out in one piece, and the bleeding dramatically stopped as soon as it was out and I immediately started to physically feel better and just had light bleeding over the next week. That part was like a period. I became pregnant again after that with a little boy who devastatingly needed to be terminated for medical reasons at 16 weeks, which almost broke me. In this case I had to have a surgical D&E, and physically it was easier on my body as although I have trauma and ptsd from hospitals, once you’re asleep you don’t feel it and you wake up and it’s all over. The worry you have about adhesions can happen, but it’s fairly rare. You need to ask if the doctor is using a sharp curette or suction. Suction comes with far less risk of damaging your uterus than the curette scraping. You do still feel the loss physically, and it’s still devastating, but the surgery was less scary than what I experienced with the miscarriage. I don’t know if any of this helps at all or just makes it even more confusing, but after everything I’ve been through I’ve realised how little is actually shared with women about the reality of miscarriage or infant loss and there’s a lot the medicos just don’t even know. I’ve learned more from talking to other women who have been through it and so I share this with another woman in the hope it helps in some small way to provide more information of someone else’s personal experience warts and all. But know that every woman can have different experiences from the same event. I would get a second opinion about how big your baby is measuring so you can have more information on the size of the tissue you will be passing. If I was 6 weeks I probably would just take the tablets. But I sure as hell would never let an 11.5 week pregnancy loss run its course without intervention again. Get a second opinion and see which process you lean towards after deep reflection and try to follow your gut. Good luck, message if you have any other questions. I hope this helps you or someone else in some way.

I'm so sorry you are in this situation. It is shit, and there really isn't another word for it.

I had a medically managed missed miscarriage as I wanted to TTC straight away/as soon as possible afterward, and was told that with a surgical management I would need to wait longer to TTC and also that there was a small risk of uterine damage with the surgery [I want to add this is what my NHS doctor told me but I know other people who were never told those things so who knows what is true].

I did have a complete miscarriage with the medical management but it was very painful, very difficult physically and not without it's complications. I did conceive successfully afterward and now have a healthy 9yo (so this all happened some years ago).

I have advised a few friends in the same situation since that I would have had the surgical management of the miscarriage had I known how hard the medical one would be. I didn't get anything quite frankly from experiencing it physically and I still have some horrendous flashbacks to particularly difficult parts of it.

@Lemonvalley - I'm sorry you've experienced this too. I had a TFMR at 16 weeks a few years ago with my third pregnancy (so also sending you some love for that as well)

This is added with also no intent to scare the OP but it may provide some additional context. My miscarriage was a 7w pregnancy but it got stuck in my cervix as it had calcified, hence the difficulty and complications I experienced. And why I wouldn't recommend it to someone else in a hurry.

Thank you both for your responses and I’m so so sorry to hear of the experiences you’ve had. Miscarriage is so much more than just losing your baby isn’t it? I’m lucky enough to have two kids after a long fertility battle, but I really really wanted this last baby. I’m definitely traumatised from the two emergency sections I’ve had and I think that’s is part of what concerns me about more surgery. But medical management also sounds horrific. I’m meant to be 9 weeks and one day today but baby hasn’t really grown past 6 weeks, so potentially small but obviously my body hasn’t decided to let it go yet either.

I am so sorry for your loss. I lost 2 babies to missed miscarriages and have done both options. With my first I chose the medical and for me this was very painful and traumatic. I was in hospital for a number of hours (I think about 14). Emotionally it was very hard BUT I was only 17 so that may have been a factor. My second (I was 20) I had the surgical management and I laid in the bath the night before and said goodbye to my baby. The surgeon who walked me down to theatre was absolutely lovely and put me at ease. Whilst I was a little sore after the pain was minimal.

Ultimately only you can decide what is best for you. You don’t need to experience the physical loss, please don’t feel that you do, either way you have lost your dreamed for baby and your emotions and grief are just as valid regardless of your choice.

please be gentle with yourself.

i have gone on to have 2 healthy boys despite the surgical management - the eldest of which was conceived a year after the surgical management

I had a missed miscarriage at about 8 weeks in 2024. After an unsuccessful period of watchful waiting I opted for medical management, as apparently the surgical management is associated with a very small increase in the future risk of preterm labour, and I already had a history of preterm labour.
My experience with medical management could not be more different than the previous comments. I had mild cramping pain, and bleeding like a normal period. In fact, I was booked back in for a follow up scan as it was so much less than I was expecting that I thought it must have failed. Then after about 3 days I finally passed the intact gestational sac into the toilet when I went for a pee. I ended up fishing it out of the toilet, and we buried it under a rose bush in the garden. It might be worth having a think about what you want to do with the embryo once you pass it. Flushing it down the toilet is 100% fine, if you’re happy with that, but worth thinking about it in advance so you’re not caught off guard when the time comes.

I’m so sorry for your loss.

Good advice about thinking about hat you may want to do with the embryo as I know of some women who have been so shocked at the time they flushed without thinking and were sorry later. I actually had both my little babies cremated and I’m not sure what to do with the ashes yet but I’m glad I have a choice.
Women certainly can have very different experiences. There’s a risk with any procedure so you have to weigh it all up as best you can and go with what feels like the most suitable option and hope for the best, as shit as it all is.
Thank you @OkayyThen for your empathy, I too am sorry for your losses and what you’ve gone through. The TFMR can feel like the cruellest joke the universe can pull, especially straight after a miscarriage. Us women can really go though a lot.
I hope these different takes help form your decision a bit more OP. Nobody can know which way the cards would fall for you for sure but maybe you can ask more about the surgery and what implements they would be using. I know that in Australia where I am some doctors are still using sharp curettes and it’s outdated and riskier. I think NHS better when it comes to this stuff. Ask them all the questions, as many as you need.

I opted for surgery but started having contractions while in hospital waiting for surgery. I was sat on the toilet In the hospital and started passing big clots. It was very painful. I still had to have the operation in case I hasn't passed everything. I'm so sorry for your loss

I have had surgical twice, because emotionally I needed everything to be over and done with as quickly and as efficiently as possible...I couldn't bear the idea of more waiting (after having to wait for the mmc to be confirmed each time), or of having something else unpredictable to "go through".

The hospital team were very reassuring, and I was able to go home within a few hours. Not knowing anything about the process was helpful emotionally, as I didn't have that to deal with on top of the loss.

Take whichever option feels the least onerous for you, I am so sorry for your loss.

I am so sorry for your loss @SP2024 I'm another who has had both, Medical management due to MMC and a surgical TFMR, If I was to have to do it again it would be surgical, I ended up in hospital for 4 days with the medical management and the mental trauma was so much harder to manage. With the surgical I was 14 weeks and the staff couldn't have been more accommodating, it was such a completely less traumatic experience for me personally.

I’m so sorry to hear this OP.

I had a v similar experience recently in terms of dates, although I was 10.5 weeks when miscarriage confirmed, embryo never grew beyond 6 weeks.

I chose medical management for other health reasons related to general anaesthetic - plus like you I was worried about adhesions/scarring.

I don’t regret it. It was obviously deeply unpleasant and yes it was very painful but it felt manageable. I took the tablets (pessaries) at 9.30 in the morning and by dinnertime was feeling okay again. Happy to share more of the actual details if that would help.

I asked for anti emetics (cyclizine) as my EPU didn’t offer as standard and was very glad I did that (after taking them I had no nausea at all). They also gave codeine which really helped, alongside paracetamol and ibuprofen, plus a hot water bottle (technically 2 as I swapped between them).

Sending you all the strength for whatever you decide!

Thank you to everyone who has taken the time to comment. I’ve decided to go with the surgical option and am booked in for tomorrow. For those who chose this option how long did you take off of work afterwards? The midwife was talking about taking 2 weeks but that seems like a lot. The leaflet says 2 days which seems the other end of the spectrum! Just trying to prepare myself.

I was given a 2 weeks sick note, spoke to my boss when I went to hand it in - at which point they told me I didn’t need one and to just take the time I needed. I actually took a full week off and then went back in for shorter days the 2nd week. I was genuinely exhausted and glad they allowed me to do that ease in.

I’m a few days late on this, have you already decided? I had a MMC recently thought I was 12 but lost at 8 and had the tablets? Was reading lots of things expecting lots of pain with tablets but I had paracetamol and codeine before the main tablets and it was relatively painless but obviously still quite sad

I had the surgical option yesterday. It was scary but I was allowed to go home mid afternoon. They gave me some dihydracodeine (ironic as I had to fight tooth and nail for it after my c section) but I’ve not needed to take any painkillers. Bleeding is also significantly less than I expected. Eaten lots of chocolate and been taking it easy. They’ve signed me off for two weeks but I’m currently feeling like I may go back to working from home next week. Only so much day time telly I can stomach and feel like it would be good to take my mind off it. I’m waiting for the hormone crash though before deciding. I do think the fact I knew this was likely to be coming over the last 3-4 weeks means I’ve done a lot of the grieving and coming to terms with it before the actual operation.