MMC - expectant management, what to expect

[Step5678]

I am having a missed miscarriage, diagnosed at 9 weeks, embryo stopped growing at 5 weeks 5 days. Bleeding started 8 days ago (at 9 weeks + 1 day) but I still haven't had any pains or anything that looks like pregnancy tissue.

The early pregnancy unit have been really unhelpful. They didn't have any appointments to see me initially, so I had a private scan to diagnose the miscarriage who then referred me back to the EPAU. The doctor from EPAU called me in response to the referral and said that I needed to Google my options and there was no point seeing me as it would just confirm what we already know from the private scan. Yesterday, a midwife from the EPAU called me to follow up, and said I can come in if I want medical intervention but no point otherwise. She did suggest I do another pregnancy test which I have today, it's still a very strong positive so seems my body hasn't accepted the miscarriage yet.

I have done some research online about what might happen next (this is the first time I've gone through this) but it's all a bit vague. I am looking for real life experiences if anyone is happy to share:

1. how long a miscarriage took after initially being "missed" by the body?

1. Whether its possible for a miscarriage to complete without pain? The absence of pain makes me worry that I'm still a long way off or that my body just won't miscarry naturally

1. Will it be obvious when the miscarriage is complete? I.e. Will I pass something which is clearly pregnancy tissue and then the bleeding stops? Or will I need another scan to confirm?

Thanks in advance, I would really appreciate hearing other women's experiences if you're comfortable to share. I have no one to ask irl.

I'm so sorry OP, what a horrible thing to happen. It sounds like you've been so badly let down by your EPAU. No woman should ever be left to Google options, you should be counselled by the doctor. Do you feel like you have enough information to make an informed decision? If not, I'd be contacting someone in charge of EPAU to complain and set up an appointment. In fact I'd be making a complaint regardless but you may not ne ready for that.
Can only speak about my own experience but was diagnosed MMC at 11 weeks with baby measuring about 7+5.. I figured if my body hadn't realised almost 4 weeks in then that was long enough. Doctor agreed. Tried med management that still didn't work so needed an ERPC.
I can't accurately answer all your questions but anyone I've known who has experienced a miscarriage definitely had pain. And I think you'd know you had passed the pregnancy tissue as opposed to just blood. But this really sounds like something the doctor should be advising about.
Again I'm so sorry for your loss and hope you get some more support💐

Hi @Step5678 I'm so sorry, I hope you're looking after yourself.

I had a MMC in the summer and this thread really helped me to work out what to expect. I didn't do expectant management but there are many on the thread that did, so sharing here in case it's helpful and a comfort. It's the reason I ended up joining Mumsnet, it was a million times more helpful than the EPU.

https://www.mumsnet.com/talk/miscarriage/1344311-Tips-for-coping-with-the-practicalities-of-miscarriage

I don't know if this because I took the pills instead of expectant management/D&C, but would say to get some strong painkillers in now - paracetamol didn't touch the pain for me and I was nearly passing out by the time my husband called the EPU and they did a prescription for him to collect.

The body is an incredible thing. This bit is so awful but you'll get through it. ❤️ Take care of yourself.

I’m sorry for your loss.

I went for a private scan at 9+0 and it was measuring 6+2 with no heartbeat. I then when to see the epu 3 days later due to it being a weekend etc. they measured it even smaller at 5-6 weeks. They said I needed a second scan two weeks later before they would confirm a miscarriage. So I waited. By 11 weeks nothing had happened, however I had also caught Covid so they wouldn’t see me. Then I started bleeding- bits of brown blood, three days later I started bleeding red blood but only small amounts. However for the following three days I had intense cramps on and off. Then at 12 weeks I finally passed the pregnancy- it was so much blood. I flooded my trousers running to the bathroom and then spent two hours passing blood and stuff on the toilet. Like a horror film.

After that the cramps went away so I assumed it was gone. The epu still said to go in for the scan the next day, at the scan they said there were still products but not much so it will likely pass. Then a few days later at a restaurant to cheer me up I had cramps again and was stuck in a restaurant toilet passing more retained products. After that I assumed it was all done.

Three weeks later (at 15 weeks) I still tested positive (we didn’t DTD inbetween so certain it was the same pregnancy). Epu scanned me again and said there were retained products with a blood supply still and said my body likely wouldn’t remove it on its own at this point. I was concerned about infection due to having stringy blood by that point too. I opted for erpc because medical option with tablets sounded like expectant and I had already tried that really. Plus I didn’t like the intense cramps. The surgery was great, no pain and it put an end to it all at 16 weeks.

So I found out at 9 weeks (it had stopped 3 weeks before that), started to pass the pregnancy at 11.5-12 weeks, then had surgery at 16 weeks.

I'm sorry for your loss.

I had 2 miscarriages last year and this is what happened with them.
1st loss, no scans bleeding started at 10 weeks arranged a scan 2 days later at the epu. The day before the bleeding went heavy and I presented at a and E. They measured my HCG and hb. The following day I had a scan at the epu and there was no sign of pregnancy. As I hadn't had a scan previously they couldn't rule out it being elsewhere. It was unlikely given I should have been 10 weeks so they monitored my HCG until it was below 20 and then I was asked to do a pregnancy test. This took 3 weeks

Loss 2. I had a scan at 7+3 measuring at 6 weeks with a heartbeat. Repeated 2 weeks later still 6 weeks no heartbeat. Scan 3 with a 2nd sonographer a week later confirmed loss. The first two scans were with the same sonographer and needed to be scanned by 2 sonographers for the loss to be confirmed. I started bleeding the night before the last scan. I asked for a few days to see if I lost the pregnancy naturally. The following day the bleeding was heavy and I believe I lost the pregnancy based on similarities with my previous pregnancy. The epu were happy with my description and said to do a test in 3 weeks if positive phone them. I had a faint test at 2 weeks (we had sex that week so wanted to see if the tests were getting lighter in case I had conceived again) and a negative test at 3 weeks

I think both pregnancy were lost at around 6 weeks gestation as the amount passed was similar. For the second pregnancy I started bleeding about 2 weeks after the pregnancy lost. Had the bleeding not gone heavy in the days after the bleeding started I would have accepted the medication to bring about the loss. The bleeding was only heavy for about 1-2h. With the first loss the bleeding continued for 7-10 days and the second only 4 or 5 days

OP I hope you don’t mind me pigging back on your post as i’m in a similar boat. We had a private scan at 6w that showed us at barely 5 weeks. We had a scan at EPU yesterday (3w later) that showed the same. We have another scan in a weeks time but we’re all certain it’s a MMC. They said then we’ll discuss options (wasn’t given any info yesterday).

Googling looks scary. I was expecting that I’ll come ‘on’ and maybe have a slightly more heavy period. People advising pain medication/procedures under general just seems frightening.

I’d happily just wait for nature to take its cause but then there’s advice against that due to infection… also when will my body recognise the MMC?!

@Bloodybrambles the leaflet I was given after my miscarriage made it clear that at any point I could change how it was managed.
For me my first scan showing I was measuring quite behind albeit with a heartbeat. The following scan showed little growth and no scan so the pregnancy was probably lost around the time of that scan. It was the 20th November and the bleeding started on the 11th December. This was the evening before my final scan at the epu which confirmed the loss. I had done some reading and had decided that I wanted to try the medication option. As I had started bleeding and in my last loss the loss had been completed within 24-36h of the bleeding starting I wanted to give my body a chance to pass the pregnancy. The epu suggested they phoned me on Monday to see if I was still happy with waiting. As it was I passed the pregnancy the evening after the scan. If the bleeding had been light still at that point I would have asked to switch to medication management

The pain perspective will vary based on the person and how far a long the pregnancy was. Both of my losses the pain and blood loss were manageable. For about an hour to so I had heavy bleeding and cramps. There was distinct pressure down below and I had to sit on the toilet due to the bleeding being heavy. I passed a few inch size lumps during this time. I needed a few hours on the sofa with a hot water bottle for the cramps and I think I took some paracetamol but the pain and discomfort were within what I was capable of managing at home with self care and standard pain relief. With the first miscarriage I went to a and E with the blood loss to make it wasn't losing too much and hadn't spoken to the epu at this point. If the bleeding had continued being that heavy beyond the hour or so I had the second time I would have called the epu or presented at a and E depending on the time of day just to be checked over.
I hope that helps to give you an idea of what might happen of course its quite varied

@Step5678 @Bloodybrambles I’m so sorry you’re both going through this, and OP, that you have been so badly let down by your EPU. It makes a difficult time so much worse to not be supported and you have my sympathy. I think this leaflet is likely to give you the most useful info on options: https://www.miscarriageassociation.org.uk/wp-content/uploads/2016/10/Management-of-Miscarriage-Sep-2022.pdf

For what it’s worth, I’ve had two MMC, both diagnosed around 11/12 weeks, one a blighted ovum where everything but the embryo developed to about the 9 week mark, and one where the embryo stopped developing around 9 weeks. My first was medically managed, but my second occurred naturally before I could have treatment. So second one it probably took just under 4 weeks for my body to recognise and miscarry.

I’d say it is painful, and there is a good deal of blood loss, but for me personally it was very manageable. The natural one was easier than the medical management and I think I maybe took paracetamol but nothing stronger. It was obvious when it was happening - I’ve given birth before and honestly it was like the very early stages of labour. I also passed a fairly large amount of tissue, almost like chunks of liver or similar (sorry). I was terrified I’d see something which looked like a baby but I didn’t. I might be a bit odd but I felt almost elated afterwards, like I’d achieved something and for both that was a sign that things were pretty much done.

Make sure you are not left alone. My EPU told me that miscarrying women are not always good at telling when they need medical assistance and for that reason they always recommend you have someone with you to get help if things do escalate (not to scare you but to cover some of the more serious outcomes).

Finally, I would recommend talking things through with either Tommy’s or The Miscarriage Association, to help you understand options and to provide support. I’ve found both to be good - I emailed and got a call back.

Take care and I wish you all the best.

I’m so sorry for your loss.

It’s a long time since my MMC, but I opted for medical management.

i remember being told by the midwife that whichever route I chose I would need to go back to the unit to be checked over for level of bleeding and also to check for and retained tissue.

I don’t know if this is still the policy now but given the risk of infection if anything is retained I’d assume it is.

Please do contact your EPU again, maybe ask to speak with a midwife who will hopefully be much kinder.

Be gentle with yourself 💐

Thank you so much to everyone for sharing your experiences, though I'm sorry you had to go through it.

I have also read through the thread suggested above which was very interesting, thank you, and had some very useful practical tips. Lots of people on that thread were talking about extreme blood loss and pain which is a bit frightening but it's interesting to see some of the responses describing it as manageable, I'm hoping for one of these at least!

@Bloodybrambles sorry to hear you're in the midst of this right now too. I hope it's as swift and pain free as possible for us both