Surgical management of miscarriage

A small number of women will have a natural miscarriage prior to their planned procedure.  If you have significant bleeding before the operation, please contact the unit. Some women may need a repeat scan to determine if the surgery is still required.  If the bleeding becomes very heavy, you should attend as an emergency via the A&E department.

What happens after the operation?

• After the operation you will need to recover from the anaesthetic and be observed for a short period of time.
• When you wake up you may have some abdominal pain or cramps for which you will be offered pain relief.
• Once you are comfortable and have sufficiently recovered from the anaesthetic you will be able to go home. You will be given a short course of antibiotics to help prevent an infection developing and some pain killers to take home with you.
• After a general anaesthetic, you must have another adult collect you and stay with you overnight after the operation. If you cannot arrange for someone to collect you, please tell the team beforehand – we cannot allow patients to go home alone after an operation.

Recovery

• After the operation you will have some vaginal bleeding which is normally no heavier than a period. This bleeding may last for 3 weeks.
• We recommend you use sanitary towels instead of tampons and do not have sexual intercourse until the bleeding has fully settled. This reduces the risk of infection.
• You may return to work after 48hours, or when you feel able. We are able to provide a medical certificate for your employer if required.
• If your blood group is Rhesus negative, you will need an injection of Anti-D. Please ask for further information on Anti-D if required. 

Please do a urine pregnancy test after 3 weeks to ensure it is negative.  If the urine pregnancy test is positive, or you have bleeding that has lasted longer than 3 weeks, please contact the Early Pregnancy Unit.

After the operation, if you experience any of the following please attend your local hospital as an emergency:

• Excessive Bleeding(for example soaking one or more sanitary towels in one hour)
• Fever (temperature greater than 38 degrees Centigrade) or an offensive smelling discharge from the vagina
• Fainting, persistent vomiting or severe abdominal pain

What are the options if I do not want surgical management of miscarriage?

Other treatment options will be discussed with you by our team.

These include:

• Conservative management (waiting for the pregnancy to pass naturally).
• Tablets to induce a natural miscarriage (medical management)
• Surgical removal of the pregnancy under local anaesthetic.

What are the possible complications of surgical management of miscarriage?

Surgical management of miscarriage is safe, but like all procedures there is a small risk of complications.

Complications related to the procedure are uncommon or rare; they include:

• Heavy bleeding (haemorrhage) (0.3%)
• Infection (4%)
• Retained placental or fetal tissue (4%)
• The need for a repeat operation if not all the pregnancy tissue is removed (0.3-1.8%)
• Perforation (tear) of the womb that may need repair (0.1%)
• Adhesions or scar tissue within the womb (16.3 – 18.5%)

The overall risk of adhesions following any method of miscarriage management is 19%.  These are normally mild and no significant differences were shown in long term fertility outcomes with either medical, surgical or expectant management as per the MIST trial. 

The risk of infection is the same with surgical (MVA or surgery under general anaesthesia), medical or conservative treatment options.

If a perforation is suspected, we may need to look to see if there is any internal bleeding or internal damage to the bowel or bladder. This is done by a small cut on your tummy (abdomen) under general anaesthetic and inserting a telescope (laparoscopy).

When can I get pregnant again?

It is important to ensure that our pregnancy test is negative 3 weeks after the operation before trying for another pregnancy.  Most women will have their next period within 4-6 weeks of the procedure. We generally recommend that you wait for this before you start trying again. 

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