Surgical Management of a Missed Miscarriage

Insights from Dr Catriona Melville, Specialist in Sexual & Reproductive Health, and a qualified Obstetrician and Gynaecologist, background research for this episode was prepared by Stephanie Rixon

Surgical Management of a Missed Miscarriage

What to expect if you have surgical care to help your body complete the loss

Surgical care may be offered when a pregnancy loss has been confirmed but hasn’t passed on its own. It may also be recommended if medical care i.e. medication hasn’t worked, if you’re experiencing heavy bleeding, or if you prefer a quicker recovery. Some women choose this option because it feels more contained or emotionally manageable.

Surgical care is usually done under a light general anaesthetic in hospital. You’ll be asleep for a short time while your care team gently opens the cervix and  using a surgical instrument assists your body to complete the pregnancy loss.

The process itself takes about five to ten minutes. Most women go home later that day, once they’ve recovered from the anaesthetic and have someone to take them home.

This guide is here to support what your care team has told you. It’s meant as a reference, especially if it was hard to take everything in at the time. You can come back to it whenever you need to.

What to expect afterwards

Recovery is different for everyone. Some people feel tired or sore for a day or two, while others bounce back quickly. You may experience:

  • Light to moderate bleeding, which can last up to 10–14 days
  • Cramping, usually for a few days
  • Mild diarrhoea or nausea
  • Emotional exhaustion, even if the physical part feels easier

Most people need a few days off work or usual activities. Some may need longer. Pain is usually manageable with over-the-counter medication like paracetamol or ibuprofen.

Things that can help

  • Use pads rather than period underwear. This helps you see how much you’re bleeding, especially if clots are involved. Period underwear can hold a lot but won’t give you a clear sense of blood loss.
  • Don’t use tampons or have sex until the bleeding has fully stopped. This helps reduce the risk of infection
  • You’ll need someone to take you home. Hospitals don’t allow patients to leave alone after a general anaesthetic.
  • Give yourself time to rest, even if you feel physically okay.
  • Having some meals and water prepared at home can help ease your first few days.

When to seek medical help

Contact your doctor or go to emergency care if you:

  • Soak more than 2 pads an hour for over 2 hours
  • Have pain that isn’t settling or gets worse
  • Develop a fever, chills, or feel faint
  • Notice any unpleasant-smelling discharge
  • Have bleeding that continues beyond two weeks without easing

Before you go in, it’s okay to ask

Some women find it helpful to ask questions before the day of the surgery. You might want to check:

  • How long will I bleed or feel sore?
  • When can I return to work or usual activity?
  • What signs mean something isn’t right?
  • Do I need a follow-up appointment?
  • What kind of emotional support is available if I need it?
  • Can I get a certificate for work or support for leave?

Bardos J, Hercz D, Friedenthal J, Missmer SA and Williams Z (2015) ‘A national survey on public perceptions of miscarriage’, Obstetrics and gynecology, 125(6):1313–1320.

Doubilet PM, Benson CB, Bourne T and Blaivas M, for the Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy (2013) ‘Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester’, The New England Journal of Medicine, 369:1443-1451.

Jansson C and Adolfsson, A (2010) ‘A Swedish study of midwives’ and nurses’ experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan’, Sexual & Reproductive Healthcare, 1(2):67-72.

Kong GWS, Lok IH, Yiu AKW, Hui ASY, Lai BPY and Chung TKH (2013) ‘Clinical and psychological impact after surgical, medical or expectant management of first-trimester miscarriage – a randomised controlled trial’, The Australian and New Zealand Journal of Obstetrics and Gynaecology, 53:170-177.

Nynas J, Narang P, Kolikonda MK and Lippmann S (2015) ‘Depression and Anxiety Following Early Pregnancy Loss: Recommendations for Primary Care Providers’, The primary care companion for CNS disorders, 17(1):10.4088/PCC.14r01721.

Safer Care Victoria (SCV) (2019) Miscarriage, SCV, accessed 1 August 2024. https://www.safercare.vic.gov.au/sites/default/files/2019-07/Miscarriage.pdf

Schummers L, Oveisi N, Ohtsuka MS, Hutcheon JA, Ahrens KA, Liauw J and Norman WV (2021) ‘Early pregnancy loss incidence in high-income settings: A protocol for a systematic review and meta-analysis’, Systematic Reviews, 10:274.

Shelley JM, Healy D and Grover S (2005) ‘A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage’, Australian and New Zealand Journal of Obstetrics and Gynaecology, 45:122-127.

Shuaib AA and Alharazi AH (2013) ‘Medical versus surgical termination of the first trimester missed miscarriage’, Alexandria Journal of Medicine, 49(1):13-16.

The Royal Women’s Hospital (2019) Treatment for miscarriage, The Royal Women’s Hospital, accessed 1 August 2024. https://thewomens.r.worldssl.net/images/uploads/fact-sheets/Miscarriage-treatment-090419.pdf

Trinder J, Brocklehurst P, Porter R, Read M, Vyas S and Smith L (2006) ‘Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial)’, BMJ, 7552:1235.

University Hospital Southampton (UHS) (2021) Recovering well after a surgical management of miscarriage, UHS, accessed 1 August 2024. https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Womenshealth/Recovering-well-after-a-surgical-management-of-miscarriage-3047-PIL.pdf

Wu HL, Marwah S, Wang P, Wang, QM and Chen XW (2017) ‘Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis’, Scientific reports, 7(1);1664.

Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C and Frederick MM (2005) ‘A comparison of medical management with misoprostol and surgical management for early pregnancy failure’, The New England Journal of Medicine, 353:761–769.

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Need Immediate Help?

If you or someone you know is struggling during the postnatal period, it’s crucial to remember that immediate help is available. Here are steps and resources you can turn to:

In Urgent Situations:

  • Hospital Emergency: Visit your nearest hospital emergency department.
  • Ambulance: Dial triple zero (000) for immediate medical assistance.

Support Services:

  • Beyond Blue: Offers guidance for depression and anxiety. Call 1300 224 636.
  • Lifeline: Provides critical support and suicide prevention. Contact 131 114.
  • Women’s Domestic Crisis Service: For domestic violence support, call 1800 015 188.
  • WIRE (Women’s Information and Referral Exchange): For information and support, dial 1300 134 130.
  • PANDA (Perinatal Anxiety & Depression Australia): For perinatal anxiety and depression support, call 1300 726 306.
  • Parent Line: For parent support, reach out to 132 289.
  • Sands: Offers support for miscarriage, stillbirth, and newborn death issues. Contact 1300 072 637.

Remember, you are not alone, and reaching out for help is a step toward healing. Your well-being is important, and support is just a phone call away.