Miscarriage at Hospital (D&C)
Although most women miscarry at home, with an ‘incomplete miscarriage‘ or ‘missed miscarriage’ (also known as ‘missed abortion’), you will need to go to hospital. It is preferable to contact your LMC (Leading Maternity Carer) first so that they can contact the hospital and warn them you are coming. (Incomplete miscarriages can result in infection and infertility if left untreated).
On arriving there, use the Emergency parking if nothing else is available near the door and make use of orderlies, stretchers and wheelchairs if they are needed. Some hospitals have special ‘Early Pregnancy Assessment Clinics’ which are available for treatment during the day.
Re-park the car somewhere else as soon as is practicable.
Even if the hospital has been rung to let them know you are coming in, the admitting procedure may take time; there are forms to be filled in and blood tests to be taken before being seen by a medical professional. If your blood type is Rhesus negative you may require further treatment.
The medical professional will perform an internal examination (even if your own medical professional has already done this) to confirm an incomplete miscarriage. If his assessment is that the miscarriage is complete, you will be discharged. If not or if it is uncertain, you may need to be scanned. This is not normally an uncomfortable procedure. You will be given water to drink to fill your bladder before the scan.
If the scan shows retained placenta, you may be offered 3 options;
- Natural MSG; A wait and see monitoring
- Medical MSG; Tablets to induce a natural delivery to ensure the uterus is completely empty. This requires monitoring and usually a return to hospital. Timing is dependent on individual interaction with the tablets.
- Surgical MSG; A Dilation & Curettage (D&C) operation which will require a stay in hospital afterwards for a few hours.
What is a D&C?
A D&C is a minor 10 to 15 minute operation, usually performed under a general or local anaesthetic. You will need to wait for at least 6 hours before a general anaesthetic if you have eaten. If you know ahead that you will probably have a D&C it is advisable not to smoke and drink alcohol 24 hours prior to your operation as well as refraining from eating for 6.
The D&C involves dilating (opening) your cervix, or neck of the uterus (womb), and gently scraping it with a curette (an instrument with a long handle, the end shaped like the rim of a hollow spoon). Any pregnancy tissue that is left is removed which is done to prevent infection and excessive bleeding. In some hospitals the tissue will then be sent to the laboratory to be examined under a microscope. In others this may be an option and there also may be a charge.
You could experience some cramping and period-like pain after the D&C. There will be no stitches or cuts. Panadol is recommended for relief (not Aspirin). You may eat and drink after your operation if no problems have occurred. You will normally be monitored half hourly for 2 hours and when you have passed urine and your vaginal bleeding is slight, you will be allowed home.
- Bleeding should then be light to moderate. If it lasts longer than;
- 10 days
- is heavy
- you pass large clots
- have severe abdominal cramps
- you have a temperature it is advisable to see your LMC.
After a D&C
Get a check-up between 4 & 6 weeks anyway. Use pads in preference to tampons. Shower rather than bath and avoid swimming & spa pools.
Physical activity can continue as normal but it is recommended you wait until the bleeding has stopped before resuming sexual intercourse. This is to prevent infection. You may return to work the second day after surgery. Your next period may be heavier than usual.
If you would like to have your baby’s body and/or placenta to take home for burial ask hospital staff for this before going into theatre or with tablets, before they take effect. The hospital usually disposes of everything in the hospital incinerator. Miscarriage Support Auckland strongly recommends that you ask for everything that is removed by the D&C to be able to bury later to assist with healthy grief recovery. There are no legal requirements for burial in NZ for a miscarriage.
Most women find it a great comfort to have their partner or support person with them as much as possible. One of the most important things they can do is to keep in contact with hospital staff. If you have any questions, ask someone, otherwise they may assume that you have none.
When a missed miscarriage missed abortion is discovered during a scan it is often a really traumatic time as it is so unexpected. You will be in shock initially and things can seem surreal. Contact your LMC who will usually recommend a D&C. When this situation is detected it is appropriate that you participate in the decision making process. You usually have time to think about it and to help you decide which is the best option, as there is no ‘right’ answer, talk to your support person and consider the following list we have compiled;
Differences between D&C and Natural Miscarriage
- Over quickly.
- Not as messy as a miscarriage although you will still bleed afterwards, similar to a period.
- You don’t have to walk around for days or even weeks wondering when you will miscarry.
- Even if you elect to miscarry naturally, you may still need a D&C eventually if the miscarriage is incomplete.
- If you choose to miscarry naturally, but it has not occurred within a certain period of time (usually two to four weeks), some medical professionals will strongly advise or even insist on a D&C in case infection sets in.
- This procedure can be performed under local anaesthetic if you don’t like the idea of a general anaesthetic. If you opt for this ask if you may have a support person present.
- See http://www.ncbi.nlm.nih.gov/pubmed/26534897 website if there is a choice for possible caution especially if more than one D&C is involved.
- Less invasive than an operation.
- No general anaesthetic.
- You don’t need to go to hospital and can miscarry at home.
- You may request tablets to induce delivery at hospital. Once you have taken them you will be monitored over a few days before that takes place.
- Being totally involved in the process makes it more ‘real’ for you and this makes it much easier to start the grieving process.
You do not need to make up your mind immediately, (e.g. you may wish to discuss things with others), or give it a week to see what happens. In this case agree on a day and time by which you will contact your medical professional with your decision. When that time comes, ask for an extension if you are still unsure. If you change your mind about waiting the week contact your medical professional and say, “I cannot manage this situation and I would like to discuss other options.” If you are feeling desperate which sometimes happens, and quite suddenly, please state that.
If you have had a miscarriage, tablets or D&C and the pain has not stopped immediately, and/or you are still bleeding after a week, incomplete miscarriage should always be suspected. A raised temperature indicates infection. See your medical professional urgently with these symptoms. You may need a D&C or a repeat D&C to ensure the uterus is completely empty. In this situation the medical professional’s decision will be made in your best interests. Before any procedure is performed on you, a staff member should explain to you what will happen. If this doesn’t happen, it is well within your rights as a patient to ask.