Surgical management of miscarriage

If you have a missed or incomplete miscarriage, doctors will need to make sure the remains of your baby and pregnancy tissue don’t stay in your womb. This is sometimes called management of miscarriage. 

Surgical management is one way they can do this. You should be given all the options so you can make a decision that is right for you.

Making this decision may be the last thing you want to do right now. Or you may want to decide quickly and move forwards. Either way, you may be dealing with feelings of shock and grief, or other complicated emotions. 

We hope this page helps you understand more about surgical management. You may also find it helpful to look at our decision aid.

On this page we talk about your baby’s body as well as pregnancy tissue. Most people we talk to have told us this is the language they prefer. If this isn’t right for you, we’re sorry. We hope this information will still be useful.

On this page

What is surgical management of miscarriage?

What are the risks of surgical management of miscarriage?

What happens during surgical management of miscarriage?

What will happen after surgical management of miscarriage?

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

What are the signs that something isn’t right after surgical management of miscarriage?

What happens to my baby after surgical management of miscarriage?

Support for you

 

What is surgical management of miscarriage?

Surgical management means having surgery to remove the remains of your baby and pregnancy tissue through your cervix, using a suction device. It’s likely to be a planned operation so you will have some time to prepare.  

You may be advised to have surgery if:  

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

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 the operation to go ahead.

Types of surgical management

Surgical management means having surgery to remove the remains of your baby and pregnancy tissue through your cervix, using a gentle suction device.  

It can be done under general anaesthetic (you will be asleep) in an operating theatre or using local anaesthetic (you will be awake throughout the procedure) in an outpatient setting like a clinic. It’s likely to be a planned operation so you will have some time to prepare.  

You may be advised to have surgery if:  

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

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 the operation to go ahead.

If you have a general anaesthetic, you will usually be asked not to eat or drink on the day of the procedure. This can sometimes be difficult if you are still having pregnancy symptoms like nausea.

If you have a local anaesthetic, the doctor will apply anaesthetic to the cervix (neck of the womb) to numb any pain and discomfort. You will be awake during the procedure and can usually have someone with you. You should be able to eat and drink beforehand as usual.

Surgical management works for 95 out of 100 women and birthing people who have it.  If it doesn’t work you may need to have the surgery again.

What are the risks of surgical management of miscarriage?

Out of 100 women and birthing people who have surgical management:

• 95 will not have to have any further management because it works first time (95%).
• 5 will have to have surgery a second time because it doesn’t work (5%).
• 1-3 will develop an infection (1-3%). 

• 16 to 18 will have some scar tissue (intrauterine adhesions) in their womb afterwards  although this will usually only be mild or moderate scarring. Only 2 will have severe scarring. 

  More research is needed into whether small amounts of scar tissue in your womb could cause fertility problems in the future.  It’s possible that your fertility could be affected if you have a large amount of severe scar tissue from a lot of procedures on your womb.  For example, a condition known as Asherman's syndrome, where scar tissue causes parts of the wall of your uterus to stick together. Symptoms include having period symptoms but no actual bleed 2-3 months after surgery. Contact your GP if you have these symptoms.

There are some other rare complications. 

Out of 1000 women and birthing people who have surgical management:

• 1 will have an accidental hole (perforation) made in their womb (0.1%).  
• 5 will have an injury to the entrance to the womb (cervix) (0.5%).
• 1-2 will require a blood transfusion (0.1 to 0.2%).  

There is a small extra risk from having a general anaesthetic. Your doctor should talk to you about this risk. You can read more about the risks and benefits of general anaesthetic here.

The risk of infection is the same if you choose medical or surgical management.  

What happens during surgical management of miscarriage?

Most hospitals can’t specify a time of day for your surgery to take place. The order of their lists can change depending on staff and if there are any emergencies. You may have to go to the hospital first thing and wait, possibly for a number of hours. You may want to ask your doctor or nurse where you will have to wait, and whether someone will be able to wait with you.

In both cases, 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 the remains of your baby and pregnancy tissue will be removed.

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

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

What will happen after surgical management of miscarriage?

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, you may have to stay in hospital a little longer. You should still be able to go home on the same day. 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  

Vaginal bleeding will be like a heavy period for the first day or so. It may last for up to 2 weeks but should lesson and become brown. Use sanitary towels rather than tampons to help avoid infection. Your cycle may take a while to return to normal, but you can usually expect your period within 4-6 weeks. Read more here about trying again after a miscarriage.

Pain and cramps  

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 but you can also use over-the-counter painkillers if you run out.  

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  
• keeping hydrated by drinking a lot
• doing exercises when you are resting, such as moving your foot up and down and moving each foot in a circular motion.

If you are at higher risk of blood clots, 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.

Having sex and trying again

You can have sex as soon as you both feel ready and any vaginal bleeding has stopped.  

Doctors advise waiting until after your next period to start trying to conceive. This is because it helps to be able to date a new pregnancy accurately. This can reduce any uncertainty around the growth of the baby. You may not mind this uncertainty, but many people who have had a previous loss find it difficult to cope with. It is a personal choice whether to wait.  

You may find it helpful to have a look at our information on getting pregnant after miscarriage.

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

Generally, your physical recovery will depend on how fit and well you are before your operation and whether there were any complications.  

It may take you longer to recover physically and/or emotionally 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
• you felt as if it took a long time for you to get pregnant in the first place.

You may find it helpful to:

• ask for 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
• try to smoke less or stop smoking completely.  

What are the signs that something isn’t right after surgical management of miscarriage?

Speak to your GP, Early Pregnancy Unit (EPU), the hospital where you had your operation or NHS 111 if you have any of the following symptoms.

• Heavy or long-lasting vaginal bleeding and smelly vaginal discharge. If you also have a raised temperature (fever) and flu-like symptoms, you may have an infection in the womb lining. This will be treated with antibiotics. 
• Increasing stomach pain and feeling 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 need to go back to hospital.
• Burning and stinging when you wee or needing to wee a lot. This could be a urine infection. You may need antibiotics.  
• A painful, red, swollen, hot leg or difficulty standing. 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 get medical help immediately by calling 999.  

What happens to my baby after surgical management of miscarriage?

The hospital may do some tests to confirm that it wasn’t a molar pregnancy.

Find out more about what happens to the remains of your baby once they are removed from your womb, read what happens to your baby after miscarriage and remembering your baby after miscarriage.

Support for you

You are not alone in this. There is support available if you and/ or your partner (if you have one) need it. Have a look at our pages on support after a miscarriage.

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 specialists who can support you with any aspect of pregnancy loss that would be helpful for you.