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Date issued: May 2022

Review date: May 2024

Ref: B-257 v4

PDF:  surgical management of your miscarriage final May 2022 v4.pdf[pdf] 219KB

We are very sorry you have had a miscarriage. We hope this information is useful for you in preparing to come into hospital for your procedure.

Introduction

Miscarriage of pregnancy is very common with as many as one in four to five confirmed pregnancies ending this way. Most happen in the first 12 weeks of pregnancy. This leaflet is designed to guide you through the process.

Types of miscarriage

• Inevitable miscarriage. This is when you have bleeding early in your pregnancy and your cervix is open, which means your pregnancy will be lost.

• Incomplete miscarriage. This is when a miscarriage has started but there is still some tissue left in your womb. Your cervix is usually open.

• Complete miscarriage. This means that your pregnancy has been lost. Your womb is empty and your cervix has closed.

• Delayed or missed miscarriage. This means that although your developing baby has died, you have had little or no bleeding. It is not unusual to have little or no pain or bleeding when this type of miscarriage occurs. The pregnancy may have stopped growing several weeks prior to the diagnosis. Studies suggest that approximately 60-80% of women diagnosed with a missed miscarriage will miscarry over a four-week period.

On the day of the procedure

Please come to the Early Pregnancy Unit, Lancaster Suite, Level 6 on …………………………………

We suggest you bring some essentials (sanitary towels) but leave nonessentials at home.

Do I need to bring anyone with me?

It would be a good idea to bring your partner/ supportive friend or relative with you. They are welcome to come into the room with you during the procedure if that is what you want. Alternatively, they can wait in another room during this time. Most women find it comforting to have extra support and to take you home afterwards.

What happens when I arrive?

You will be seen by a nurse in EPU to check all the details you have already given us are correct. You will have your blood pressure and temperature checked and a name band applied. The Doctor will ask you to sign a consent form once all relevant information has been given. You will be given tablets to take (antibiotics and pain relief) about an hour before the procedure. Tablets called Misoprostol will be given vaginally to help soften the cervix (neck of the womb) to enable it to be dilated (stretched) during the procedure. You will also be given a suppository which is another type of pain relief.

What does the procedure involve?

You will be positioned on a gynaecology couch (the same as when you had your scan). A speculum is placed into the vagina and local anaesthetic in injected into the cervix (opening of the womb). The local anaesthetic does have a stinging sensation briefly. The cervix is then gently dilated (stretched) and the pregnancy is removed using a hand held small suction device.

How long does it take?

The actual procedure takes about 5 minutes, but you will be in the room for about 20 minutes whilst we are getting you positioned correctly and giving the local anaesthetic. Occasionally the procedure can make you feel a little light headed and dizzy for a short while. If this happens you will need to stay lying down until this has passed. After the procedure another scan will be performed to ensure the womb is empty.

Will it hurt?

You will experience some period-like cramping during the procedure. This can sometimes be severe but only lasts for 1-2 minutes. You will have a nurse with you through out and we can give you gas and air (Entonox) if necessary to help you at this time.

What are the risks?

This is a very safe procedure, but occasionally as with any operation there can be complications. These include infection, heavy bleeding, and perforation (making a hole) of the womb. If this happened, it may be necessary to look into your tummy with a telescope and if there was internal bleeding an operation may be necessary to repair it.

What happens to the pregnancy?

All pregnancies will be treated sensitively and with the utmost respect in accordance with the choices of the mother. You will be given information about the choices available and can discuss this with the nurse looking after you.

Why do I need to have antibiotics?

When you have a procedure to remove pregnancy tissue, we routinely give antibiotics to reduce the risk of infection. The two antibiotics we use are both one-off doses. They are called Azithromycin and Metronidazole and are given an hour prior to the procedure.

Rhesus negative blood group.

If you have a Rhesus (RhD) negative blood group, you will require an injection of Anti-D. This is to prevent a condition called Haemolytic Disease of the Newborn (HDN). It is very important for the safety of any future pregnancies to have this injection when advised.

When can I go home?

You can usually go home within an half an hour or so of the procedure but this is flexible and you may want to go home sooner or stay a little longer.

How long does the bleeding last?

Bleeding is variable and can last up to three weeks but it should be light like the end of a period. Use sanitary pads and not tampons during this time. It is normal to experience some tummy cramps and even some small clots after the procedure but if:

• The bleeding becomes very heavy

• The pain becomes very severe

• You have an unpleasant smelling discharge

See your GP as you may need antibiotics

When can I resume normal activities?

Avoid intercourse until at least a week after the bleeding has stopped. Baths and showers after the procedure are fine but no swimming until the bleeding has stopped. Physically you should be well enough to return to work after a few days but some women need extra time off to recover and adjust to the loss of the baby. The loss of a baby can be a very distressing event in a woman’s life. You can self-certificate for the first week off work, and thereafter you will need to see your GP to be provided with a sick certificate. Women who work in the home also need support from partners, family, or friends at this difficult time.

There are some useful websites and contacts at the end of this leaflet if you need extra support.

When do I get my period again?

Every woman is different regarding how soon, after they miscarry, they will have their next period. This can range from 3 to 6 weeks. Remember that this can vary as you are experiencing a loss of a pregnancy, not a period, and the body and your hormones can take time to return to normal. Often the next period can be different than that which you normally experience (heavier or lighter, again this is nothing to be concerned about, unless the bleeding is very heavy and prolonged – in which case consult with your GP)

If you do not have a period, within 6 weeks of your miscarriage, it may be advisable to contact your GP.

The future

Whether you decide that you wish to try for another baby is an extremely personal decision that only you and your partner can decide.

Should you feel that at some time you may be ready to try again it is recommend that you take daily folic acid (preferably for 3 months before a pregnancy) and wait for at least one period following a miscarriage before trying for another baby. Once you have had a period then we know that your hormones are back to normal, and you are fit and healthy for the next pregnancy.

For emotional or psychological support:

Kirsty Willis (Bereavement midwife) 01752 433148

or kirstie.willis@nhs.net

www.miscarriageassociation.org.uk

www.nhs.uk/conditions/miscarriage

www.earlypregnancy.org.uk

www.pregnancycrisiscare.org.uk

Please remember that nothing is too trivial to talk about.

If you are worried we’d like to know.

Contact numbers

Early Pregnancy Unit (0800-17.30, Monday –Friday) 01752 430887/ 245212.

All other times:

Ocean Suite (Gynae ward) 01752 430026