ERPC or Medically managed - Which method would you choose and why?

[iggypiggy]

Hi all,

It might seem a bit premature posting to this forum - but I was given the news at an early scan last week (7 + 4) that the baby had a very slow heartbeat and was only measuring 6 + 4. Since the scan all of my PG symptoms have gradually disappeared and I just don't 'feel' pregnant any more, I also started some spotting which has been on and off all week - so have prepared myself for the worst

So I was just wondering - if you haven't miscarried naturally - and have to have one of the ERPC or Medically managed options - which would you choose and why? And would the ERPC affect your chance of concieveing in the future? Sorry - just want to be prepared when I have scan tomorrow as I know I will have to make a decision

thanks xx

I had 2 mmc followed by ERPC both times. The second RPC was in March 2006 and DD was conceived in June 2006. I was 43.

I thought the difference between D&C and ERPC was the use of an instrument to scrape the womb vs vacuum aspiration

Things may have changed,but I was a Theatre Nurse for 15 years,and ERPC and D&C were done the same way with the same instruments.

The only time I used to see suction used was for a Termination.

ERPCs are now done with suction, certainly at all the hospitals I've worked at.

Hi,.

1st time, mc..blighted ovum (empty sac) diagnosed at 6 weeks.
Decided to let nature take control. Had a natural mc at 13 weeks, this was awful. Like a huge black cloud over my head for 7 weeks, but needed to know that if it were meant to be then it should just happen naturally.

2nd time, again empty sc at 6 week scan.
opted for medical management, because i couldnt face another 6/7 week wait.

This was traumatic, painful, distressing and very hard physically. had morphine for the pain, and was black and blue with bruisess from bloods bieng taken. Took me about 2 weeks to physically recover.
Mentally though i coped much better as it was "over and done with" in a day and a night. This meant that i could get back to normal quickly. I was grateful for this.

I felt much more in control with the medical managed mc despite the pain.

I never considered sugical intervention. Dont know why but it never crossed my mind.

Sorry that this is happening to you.
I am in the same situation (again )
have to wait another 10 days to see if there is any thing in my gestational sac.

Life is utter utter shite sometimes for some people isnt it.

mine was suction.

Thanks bruxeur. I thought things may have changed.

No probs - as I say that's only personal experience, practice may differ elsewhere of course.

Sorry to hear you are going through this, it is awful but time will heal you.

I have only had a natural mc and in my case if I had another mc I would chose an ERPC. In my personal circumstances I had 2 yound children to care for and for one of the days I was bleeding very heavily and unable to move and was on my own with them, they also witnessed some things they shouldn't have done (luckily they were too young to understand). For those reasons I would rather have gone into hospital and had it all over and done with.

Thank you all so much for sharing your experiences - is so horrible

Is just useful to get lots of input because I was to be prepared (if you can be?!) when am with the Dr tomorrow.

deanychip so sorry to hear you currently having such a rubbish time - agree life is shite sometimes.

I can honestly say that I have never cried in the way that I have cried about this. I am not a tearful person and haven't allowed myself to get upset in the day - but as soon as I get home is awful.

fattipuffs thanks for your input - and i know you are right that the risks are low - but there is still a risk - which is what is so scary... And when you have been ttc and then get PG and this happens - I am so worried about any intervention affecting my future chances

Sorry to hear you are going through this Iggypiggy.
First time I found out at 12 wk scan that baby had not grown past 6wks and had no hb. I waited for natural mc but it didn't happen so had D&C after 3 weeks. Was warned I would be very emotional but I found I had mostly dealt with that part when I first found out and the D&C actually gave me closure. (Hate that word but not sure how else to describe it!) The proceedure felt very straightforward and was over quickly.
I caught again the month after but unfortunately mc again, this time naturally.
Got pg again 4 months after that and I now have a 4m ds so all well in the end.
Good luck for tomorrow.

Iggypiggy, please do not dwell on my experience. Complications from ERPCs really are rare. There is a lot to weigh up on both sides: you may not miscarry naturally for weeks, and there is a risk of infection from this, so in lots and lots of ways an ERPC is the right thing to do. There are, unfortunately, risks in both natural management or surgical management.

If you are really worried about this, you could ask whether an ERPC will be carried out using an ultrasound. This is not standard practice, but is a 'safer' way to do it as the surgeon will see what they are doing, so will be less likely to be 'aggressive' with the instruments (this heightens risk of damage to the uterus, leading to infection or adhesions). Perhaps you can talk to the dr about this?

I also should say that even my own experience of ashermans and 3 miscarriages, I went on to have a healthy ds who is now 2, and am now 10 weeks pg (and so far all is well), so even if (what you think is) the worst thing happens, please do not give up hope. Miscarriage is so horrible and can sadly make future pregnancies a time of anxiety rather than excitement, but there is hope in the future .

Good luck, I hope it will all work out for you x

ERPC definitely - have had natural m/c and ended up needing ERPC.tehre is somethign quite final/decisive that helped my grieving and begin to move on.

also agree wtih mumsnobest that the taking the pill thing is awful (esp if its not necessarily going to fix tigs)- I had a tx due to abnormalties and of all the whole horrendous process the pill taking part was one of the worst bits

Jackstini - thanks for your story - is good to hear of people going on to have healthy babies

Fattipuffs - thanks again - will talk to Dr. At the mo have had brown discharge (sorry to share that!) every day since sun.. so wonder if is begining to happen anyway? Is also lovely to hear that you have a DS and are PG again. x

Poppy - thanks for that too - alot of people saying similar to you x

Jackstini - thanks for your story - is good to hear of people going on to have healthy babies

Fattipuffs - thanks again - will talk to Dr. At the mo have had brown discharge (sorry to share that!) every day since sun.. so wonder if is begining to happen anyway? Is also lovely to hear that you have a DS and are PG again. x

Poppy - thanks for that too - alot of people saying similar to you x

I had a miscarriage out of the blue at 12+6, It took 6 weeks to stop bleeding and numerous blood tests over 3 weeks until my HCG levels dropped enough. I got caught out a couple of times because the bleeding would calm for ages then go bonkers for a couple of hours. Foolishly I went back to work few days after(my way of coping), but thankfully I had an understanding boss (who had been through same thing) who realised why I would disappear for a while!
I realised very quickly that I just wanted it over and done with and in the past, so for that reason in answer to your question, even with a 'supprise' miscarriage I would request a D&C/EPAU just to get quick closure.

Iggypiggy, I saw your message on the Nov09 board. I am so sorry - even though you were half-expecting it I know how tough it is to have it confirmed

I hope you come to the decision that is best for you.

And wish you all the best if/when you are ready to ttc in the future x

Hi iggypiggy - have posted briefly about this on the Emmsysangels thread but will do so here as well as might help others.

I had the second part of medical management today. Pessaries at 9.30am and started to feel period-type pains within about half an hour. Was given codeine which dealt with the pain well and I started bleeding about the same time. Codeine wore off after about 3 hours and I was in quite a lot of pain then (although still bearable). I was given more painkillers (stronger, anti-inflamatories) which worked very quickly.

Four hours later, I still hadn't passed the sac and the pain had stopped so the Sister suggested that it might have come away but not passed so called the doctor to examine me. This is in fact, what had happened and it was removed manually and quickly - just slight discomfort (a bit like having a smear). I was then allowed to come home.

The whole experience was fine - bleeding was not excessive and I was in a quiet room on my own with its own bathroom.

I would, if I had to, choose this option again. I had been advised that it was less risky than ERPC - there is always a small risk with any surgery and also general anaesthetic.

It's so bad but I got most of my info from MN too! I would have known next to nothing if I went only by what the hospital told me! Worrying really. So glad I found this place!

Thanks everyone

I have actually only been given one of two options - wait for it to happen naturally (Dr reckons will be a week maximum) or take pills (I have been given them to take at home - is pretty grim as you put 4 up as pessaries, then swallow one 4 hrs later.. then another 4 hrs later if nothing happened yet.)

In case you thinking that is an odd option I guess is because I had gone for the scan privately? Not sure... so I actually haven't been near a hospital yet...

Am thinking I'll wait until after the weekend - then if nothing happened - start the pills...

BonyM - thanks so much for sharing your experince - is reassuring. x

Cupcake - totally agree - this place has been amazing - I wouldn't have had anyone to talk to about it otherwise x

Oh iggy I am so so sorry. I know how you are feeling - I was told the same thing on Saturday.

I know everyone's different, but I started brown spotting for a few days, then I miscarried naturally at home on Monday night. So I think if you feel ok to wait a few days then nature may take its course. It was horrible, but honestly it was just like a very heavy, clotty period (sorry if tmi). Make sure you're not alone, and you have some big pads and decent painkillers (I got feminax from boots which contains codeine). I have a follow-up scan on 14th to see if I need any further treatment.

cupcake is right - mnet has been my saviour these last several days. and I suppose those of us from the Nov 09 thread can be there for each other through this. It is just such a grim, awful thing to go through...

lovelypear thanks for sharing that - I have already had brown spotting since sunday - so maybe will happen soon anyway. I have been told to come in for a follow up scan too - just to check.

I don't usually have bad periods - so am hoping that means that although it will be bad - it will not be terrible - and the baby was only measuring 6 1/2 weeks - so will be very small (should have bben 9 weeks.)

xx

You will be fine. I was 9 weeks when I heard the news but baby was only 5 weeks, and so very small . This meant that although it was painful, it was manageable. Small consolation I know, but it's something.

xx

We found out at the 12 week scan that the baby had died & it was awful. They estimated that it had not developed past 6 weeks, & I couldn't therefore cope with the proposal to "wait & see". I had a D&C about a week later and although emotionally it was really tough, physically I was fine - I even went home on the tube (my partner knew better than to argue). I took the next day off work, but more to have some quiet time than anything else.

That was just over 4 years ago & we now have 2 mad boys who are just perfect.

egmontmum is so awful that our bodies hold onto them for so long sometimes I couldn't wait 6 weeks for the MC to happen.

Is nice you have a happy ending tho x