Surgical management

If you miscarry early, it’s possible that the pregnancy will come away from the womb naturally and you won’t need any treatment. This is called a complete miscarriage.

But if you have a missed miscarriage or incomplete miscarriage, there are 3 ways this may be managed:

• expectant management
• medical management
• surgical management.

Your doctor should talk with you about what may be the best option for you. You should be given some time to think about the diagnosis and what you want to do.

It is rare, but some women may have a late miscarriage. Find out more about treatment after a late miscarriage.

What is surgical management?

Surgical management means having surgery to remove the pregnancy using a suction device. Surgery will usually take place within a few days of your miscarriage. But you may be advised to have surgery immediately if:

• you are bleeding heavily and continuously
• there are signs of infection
• medical treatment to remove the pregnancy has been unsuccessful.

Manual vacuum aspiration (MVA)

Alternatively, many hospitals now offer a process called manual vacuum aspiration (MVA). MVA uses a narrow tube to enter and empty the womb using aspiration (gentle suction). You may prefer to have an MVA if you want surgical management but want to avoid having a general anaesthetic. If you have an MVA, the doctor will apply a local anaesthetic to the cervix (neck of the womb) to numb any pain and discomfort. You will be awake during the procedure.

It is likely to be a planned operation so you will have some time to prepare.

Your doctor should tell you about what the procedure will involve and what the risks are. You will need to sign a consent (permission) form for surgical management to go ahead.

What happens during surgical management?

The surgery may be carried out under general or local anaesthetic so you will be admitted to hospital.

Before the operation, you may be given tablets to swallow or vaginal pessaries to soften your cervix. During the operation, your cervix will be gently opened with a small tube and any remaining pregnancy tissue will be removed with a suction device.

If you are rhesus negative, you’ll be be given an injection of anti-D medication before surgery. This will help prevent your baby from getting rhesus disease if you get pregnant again.

Are there any risks with surgical management?

The surgery is safe, but like any operation there is a small risk of complications. These include:

• heavy bleeding
• infection
• damage to the womb.

These risks are also possible if you have a manual vacuum aspiration (MVA).

The risk of infection is the same if you choose medical or surgical treatment. Your doctor should talk to you about any possible risks before you have surgery.

Is the surgery always successful?

It is successful in 95% of cases. If it isn’t successful you may need to have the surgery again. Most women who have an MVA will also not need to have surgery again.

How long will I be in hospital for?

You’ll usually be able to go home on the same day.

How will surgical management affect me?

If you had an MVA and a local anaesthetic, your healthcare professional will monitor you for an hour after the procedure. You will be able to leave the hospital when you feel well enough to go home.

If you have a general anaesthetic and were asleep during the surgery, the after-effects shouldn’t last for more than a day after your operation. During the first 24 hours, you may feel a bit sleepy so you shouldn’t drive. It’s a good idea for someone to stay with you.

Vaginal bleeding

This will be like a heavy period for the first day or so. Vaginal bleeding may last for up to 2 weeks, but should lesson and become brown. Use sanitary towels rather than tampons to help avoid infection.

Discomfort

You will probably have some cramps (like strong period pains) in your lower stomach on the day of the operation and milder cramps for a day or so afterwards. You’ll be given some painkillers before you leave hospital.

Starting to eat and drink

Once you have woken up from the operation and are not feeling too sick, you will be offered a drink of water or cup of tea and something light to eat. Once you are home, you can eat and drink as normal.

Washing and showering

You should be able to have a shower or bath as normal after the operation. It’s best to have someone at home with you to start with so that they can help you if you become dizzy or feel faint.

How to reduce the risk of blood clots

There is a small risk of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis) after any operation. These clots can travel to the lungs (pulmonary embolism), which could be serious.

You can reduce the risk of clots by:

• • being as mobile as you can, as early as you can, after your operation
• • doing exercises when you are resting, such as moving your foot up and down and moving each foot in a circular motion.
• You may also be given:
• • daily heparin injections (a blood thinning agent), which you can give yourself at home
• • graduated compression stockings, which should be worn every day and night until your movement has improved and you are mobile again
• • special boots that inflate and deflate to wear while you are in hospital.

How long will it take me to recover from surgical management?

This is difficult to answer because everyone is different. Generally, your recovery will depend on:

• how fit and well you are before your operation
• whether there are any complications
• your way of coping emotionally with the loss of your pregnancy and your circumstances – for example, if you have support from a partner, family or friends.

It may take longer to recover if:

• you had health problems before your operation, such as diabetes
• you smoke – you’ve also got a higher risk of getting a wound or chest infection
• you were overweight when you had the operation – you will also have a higher risk of complications such as infection and thrombosis (blot clots)
• there were any complications during your operation
• you’ve had a miscarriage before
• it took a long time for you to get pregnant.

You may find it helpful to:

• ask for practical and emotional support from your family and friends, like shopping, housework or preparing meals – family and friends can read our information about supporting someone who has had a miscarriage
• eat a healthy, balanced diet
• stay active – you can exercise, but if you’re in pain, stop and try something less active for a few days
• not smoke.

When to get medical advice

Speak to your GP, Early Pregnancy Unit, the hospital where you had your operation, NHS 111 or NHS 24 if you have:

• Heavy or long-lasting vaginal bleeding, smelly vaginal discharge and abdominal pain. If you also have a raised temperature (fever) and flu-like symptoms, you may have an infection in the womb lining. This is rare and is treated with antibiotics.

• Increasing stomach pain and you feel unwell. If you also have a temperature (fever), have lost your appetite and are vomiting, this may be due to damage to your uterus. You will be readmitted to hospital.

• Burning and stinging when you pass urine or pass urine frequently, which could be a urine infection. You may need antibiotics.

• Painful, red, swollen, hot leg or difficulty bearing weight on your legs. This may be due to a deep vein thrombosis (DVT). If you have shortness of breath or chest pain or cough up blood, this could be a sign that a blood clot has travelled to the lungs (pulmonary embolism). If you have any of these symptoms, you should seek medical help immediately by calling 999.

What happens to my baby after surgical management?

The hospital may do some tests to confirm that the pregnancy was inside the womb and not:

• an ectopic pregnancy 
• a molar pregnancy.

Find out more about what happens to your baby after miscarriage.

Will they do any tests to find out why I miscarried?

Unless this is your third miscarriage in a row, it’s unlikely you’ll receive more tests. This is because most women will go on to have a successful pregnancy in future. Find out more about tests after miscarriage.

Your emotional health after a miscarriage

Losing a baby can be heart breaking. Your feelings and emotions are your own and no-one can tell you how you should or shouldn’t be feeling. There is no right or wrong way to feel about pregnancy loss. 

Everyone is different. Some women come to terms with what happened within a few weeks, for others it takes longer.

Taking the time you need to grieve may help you move on and think about the possibility of trying again, if that’s what you want to do. There is support available if you need help.

You can also talk to a Tommy’s midwife free of charge from 9am–5pm, Monday to Friday on 0800 0147 800 or you can email them at [email protected]. Our midwives are also trained in bereavement support.

Can I have a memorial for my baby?

If you lose a baby before 24 weeks, you won’t be given a legal certificate for the loss. This can be very upsetting for some parents because there is no legal recognition that their baby existed.

There is no legal requirement to have a burial or cremation, but some women find that having a memorial for their baby helps them to cope with their grief. You can ask your nurse, midwife the hospital chaplain, PALS (Patient Advice and Liaison) officer or hospital service about the arrangements at your hospital. For example, some hospitals have a book of remembrance.

There are lots of other ways to commemorate your loss. Find out more about remembering your baby after miscarriage.