Gynaecology - Surgical Management of Miscarriage

This is an operation to remove pregnancy tissue from the uterus (womb) usually under a general anaesthetic.

The procedure involves dilating (making wider) the neck of the womb (cervix) and inserting a narrow tube to remove the remains of the pregnancy. Pregnancy tissue will be sent to the laboratory for examination to check it is normal. More extensive testing would only be performed at specific request or if a molar pregnancy is suspected. If a molar pregnancy is confirmed you will be given an appointment with a consultant within three weeks to discuss findings and follow up treatment.

Risks include:

Haemhorrage - rare less than 1 in 200.

Perforation - rare less than 1 in 200.

A pregnant or recently pregnant uterus is vascular (contains lots of blood vessels) and is generally softer than when it is non- pregnant.

Infection – 2-3 in 100.

Retained pregnancy tissue or blood clots are often difficult to differentiate after a miscarriage. Localised pelvic infection can occur as a result.

Failed procedure – up to 5 in 100.

Occasionally pregnancy tissue is incompletely removed or adherent (stuck) to the uterus, which can cause persistent bleeding and infection. The need for repeat surgical evacuation in this circumstance may be required.

What to expect before surgery

You will have been assessed as fit for general anaesthetic, written consent and appropriate blood tests will be taken.

This is a day-case procedure and we would expect you to recover well and return home the same day.

Before the operation, depending on planned time of surgery you will be instructed when to remain nil by mouth (nothing to eat or drink).

You will be asked to change into a gown, remove all jewellery and nail varnish.

Basic observations (blood pressure, pulse, temperature) will be taken.

Before theatre you may be given a tablet or pessary to soften your cervix prior to dilatation.

The surgeon who is performing the procedure will speak with you to answer any questions you may have. It is a good idea to write down any questions ahead of this, as it is easy to forget them on the day.

The anaesthetist will speak with you to explain the anaesthetic.

What to expect after surgery

Bleeding

Following the procedure it is normal to have some vaginal bleeding, this can last up to two - three weeks. Bleeding during the first couple of days can be likened to a heavy period. This should lighten to brown in colour. We recommend you use sanitary towels rather than tampons to reduce the risk of infection.

Discomfort

It is common to have some abdominal discomfort; most women can manage with over the counter pain relief such as Paracetamol or Ibuprofen. If you have severe abdominal pain it is important you seek medical advice.

Recovery from general anaesthetic

Most modern anaesthetics have short lasting side effects. Your judgement may be impaired during the first 24 hours after a general anaesthetic. You should have adult supervision during this time, do not drive or make any important decisions.

Future Pregnancies

There is no evidence to suggest that surgical evacuation affects future fertility. Contraception should be considered if you are not ready to try and conceive.

It is recommended that you wait until your periods return to normal.
 
Often, emotionally, you need time to reflect on your current situation. Sexual intercourse should only resume once your symptoms settle and you are not suffering from any pain.

Unfortunately miscarriage is a common occurrence. We often don’t find a reason why miscarriage occurs, which can distress some women. Miscarriage is not investigated until three consecutive miscarriages have occurred. Your GP can refer you to your local gynaecology clinic for investigations to rule out identifiable cause for recurrent miscarriage.

You will be offered a telephone appointment 3 weeks after your miscarriage. This appointment is with a specialist nurse and is to provide you with support following your pregnancy loss.

When to seek medical advice?

If you start to become unwell, suffer from fever, excessive pain or offensive vaginal discharge you must seek medical advice. If you suffer heavy bleeding and are concerned you are advised to present yourself to A&E.

Emotionally

A miscarriage affects every woman differently and can be a very traumatic experience, both physically and emotionally.

Some women can come to terms with it within weeks, whilst with others it takes much longer. It’s a very personal and individual experience.

Advice and support can be accessed from:

• Women and Children’s Counselling Service 0161 720 2969
• Your own GP, they often have access to local counselling services
• The Miscarriage Association (miscarriageassociation.org.uk) can offer information and support to both partners. A telephone helpline (01924 200799) is available Monday to Friday 9am – 4pm
• Spiritual Care Team 0161 778 5259
• Gynaecology Assessment Unit Oldham 0161 627 8855 (24/7)
• Ward F5 Gynaecology Ward - 0161 656 1431/1432