Missed miscarriage
December 6, 2016 8:48 AM   Subscribe

I was found with a missed miscarriage last week after my ultrasound showed no fetal heartbeat or blood supply. Blood tests confirmed this. I have an appointment with my doctor today about what to do next and she told me on the phone that she is worried about doing a d&c due to possible scarring. Can you help me prepare for this conversation?

I am supposed to be at 12 weeks now but the sac is much smaller. It sounds like my options are to wait to expel it naturally, which could take awhile, or have an intervention to hasten the expulsion at home. I was really hoping to have a d&c because I am in my finals week of nursing school (great timing!) and missing my final day of clinical, or my exams, due to heavy bleeding would mean a giant extra amount of work when I am already stretched thin.

I'm having trouble weighing how detrimental scarring related to a d&c is, vs how much I don't want to deal with this at home. Can anyone help me with how to approach my doctor with this?

Additionally, of course this has been very sad and my husband is not here with me. So I just want it over and done with. I can uber to the appointment and back, rather than laying at home in a literal puddle of sadness.

Thank you!
posted by pintapicasso to Health & Fitness (21 answers total) 3 users marked this as a favorite
I am very sorry to hear this. I had a D&C at 13 weeks and had no physical troubles, and conceived naturally about 6 months later. That pregnancy turned into my healthy, perfect 3 month old daughter. I found the D&C to be physically pretty easy and there was less pain than a period. I have heard very negative things about the pill, although have not experienced it personally.

I'd explain your circumstances to the doctor and ask what her concerns are. Something you may want to consider is having genetic testing done - this is not routinely offered where I live and you have to ask for it, but it comforted me to know that a trisomy caused our miscarriage and not something I did or failed to do.
posted by notjustthefish at 9:03 AM on December 6, 2016 [2 favorites]

I'm so sorry for your loss.

Did your doctor suggest a specific reason she's worried about this? I think you should ask that. While obviously there's always a chance of scarring, there is also a similar risk from incomplete miscarriage, or from having a baby, or common uterine trouble like fibroids. Like there's lots of opportunity for damage in there and it feels sort of scaremongery to be putting this on you right now about this specific thing.

It has started to feel a little bit like, in this current political climate, doctors are becoming reluctant to do D&Cs even when indicated (and I keep hearing doctors claim that they are not trained in them unless they ask or pursue training in them for reasons) so I guess maybe ask that question as well?

I think it's fair for you to be frank and firm about it - "I don't want to do this at home, alone, during finals. I don't want to be worried about it not happening, either. I want data on this risk and not just vague discouragement."
posted by Lyn Never at 9:07 AM on December 6, 2016 [28 favorites]

I had two missed miscarriages a few years ago, and did a d&c for one of them, and a medical miscarriage with misoprostol at home for the other one. Risk aside, I preferred the medical entirely.

For the d&c, it was scary & painful, and even though I refused any drugs that weren't local pain drugs for the d&c (because i do really really badly on valium-type drugs), so my "recovery" after was better than it was for most people it still felt like (minor) surgery, and I had to recover from it like minor surgery. Despite my doctor being incredibly competent, they didn't get everything (apparently) - I bled for weeks, and then finally passed some GIANT clots, at work. It was terrible.

The medical miscarriage was much better - I inserted a few pills, and not very much later the bleeding started. I spent a while on the toilet while things came out, then huddled on the couch with the giant pads watching bad movies for a couple more, and then it was basically over - just pad-level bleeding with no pain for the next few days. If I have to do it again I will definitely pick this option.

Either way, and of course YMMV depending on how you handle these things, if there's someone around who you're close with who can come with you to the d&c and stay with you after, or hang out with you while you do the medical, I highly recommend it. I really needed someone who could calm me down during the pain of the d&c, and go get me a glass of water or whatever after I got home (and during the medical).

I do want to say that although they both felt awful at the time, they were both over with entirely in a few weeks, and I went on, just a few months after the 2nd one, to get pregnant and have a healthy baby with no complications. Either way, this will just turn out to be a memory. Good luck!
posted by brainmouse at 9:23 AM on December 6, 2016

I had a missed miscarriage at 13 weeks and did the D&C. There was no physical issues, and I have two healthy girls now. No one mentioned scarring to me, though, so I wonder if there is something unique to your circumstances (isn't there always).

I'm so sorry. It's a hard thing. Go easy on yourself.
posted by dpx.mfx at 9:27 AM on December 6, 2016

I had a D&C under a time frame very similar to yours (37 years old at the time, no heartbeat at 10-12 weeks). My highly experienced, seen-it-all doctor did not think there were many risks, and the procedure itself was painless, during or after. There was no recovery or consequences of any sort, and I naturally conceived my perfectly healthy now 7-year-old the very next month. Good luck on your exams!
posted by rada at 9:38 AM on December 6, 2016 [2 favorites]

I had a missed miscarriage and my doctor gave me the same options (wait, insert the pills, or do a D&C), although she seemed to lean toward the D&C so that's what I did. She never said anything about scarring. I needed a couple of days at home to recover, but that was mostly because I was hit very hard emotionally (on top of the normal sadness of it, it happened to be my birthday that weekend, and my best friend had a miscarriage simultaneous to mine). The pain afterwards was pretty much like bad cramping for a couple of days. I had the procedure on a Friday and returned to work on Tuesday because we were off on Monday for a national holiday. I could have gone to work on Monday if necessary, but I wouldn't have wanted to go any sooner than that.
I am so sorry you are going through this, and without your husband there to support you. I'll be thinking of you.
posted by katie at 10:44 AM on December 6, 2016 [1 favorite]

Hi, I am so sorry to hear about your miscarriage. I hope that you have others around you who can support you while your husband is away.

Regarding the procedures: for any missed miscarriage, you options are to wait (expectant management) or intervene with medication (misoprostol) or surgery (D&C). The risk of "scarring" (Asherman's syndrome) from a D&C in the US is almost zero--so low, in fact that it's not even one of the complications that we would include in an informed consent. (NB: I am an RN/NP/CNM and have worked in a gyn OR for 10+ years and TINMA). If you are twelve weeks pregnant, I would think that the medical management (taking pills to pass the pregnancy at home) would be potentially quite painful, and a much longer procedure (e.g., several hours of cramping and bleeding at home). If you were my patient, I would also want you to have someone at home with you in case you had extra pain or bleeding that you couldn't manage yourself and needed to get extra help at a hospital. I think waiting or taking the pills is a good option if you want to avoid surgery.

Regarding the D&C, it is an extremely safe and quick procedure. If the clinic/hospital where it is performed offers sedation, they will not likely let you go home in an Uber/taxi, and you will probably want you to have a ride home. The procedure itself takes just a few minutes and you'll probably have about an hour in recovery, depending on what sort of sedation you have. Most people feel (physically) up to returning to their normal activities the next day.

It is of course your decision to do what feels the most comfortable and safe for you. In terms of talking to your doctor, I would want to know why she mentioned "scarring." Does she not do D&Cs very often, or was she was in practice back when abortion was illegal in the US and saw patients get really sick from unsafe procedures? I would also say that if you feel strongly about doing one procedure versus the other, then you should push for that. If you don't feel comfortable with your doctor doing the D&C, ask for another doctor. Depending on where you are, you may also be able to have a D&C done at a Planned Parenthood. They are great because the doctors are very experienced in doing these procedures and do many of them every day.

Wishing you well. Feel free to MeMail me if you like.
posted by stillmoving at 10:49 AM on December 6, 2016 [11 favorites]

This is tough, so sorry.

An anecdote you may find helpful: spouse and I went through a very similar thing last year. We tried "wait it out, let nature take its course", as we were a little leery of what might be an avoidable surgery. After many days of terrible pain, ended up having EMERGENCY D&C on an hour's notice -- very not fun.

So honestly, I'd seriously consider D&C, because there is at least some chance you might have to have it done anyway, and emergency surgery is even scarier and harder to manage than planned surgery.

One thing to ask doctors, especially if it is a hospital with religious affiliations: what happens to medical waste after a potential D&C? In TX, we were basically told (while under extreme duress) that we had no choice but to allow them to have a "funeral" for mass extracted via surgery, and that really pissed me off. If I had known that ahead of time I'd probably have found a different provider. Of course maybe you'd welcome such funeral services, but it's something that I wish I'd been aware of ahead of time, so passing the tip on.

Hang in there.
posted by SaltySalticid at 11:12 AM on December 6, 2016 [2 favorites]

I went through a similar experience last year, and ended up deciding to have a D&C, which I went into with quite a bit of anxiety.

It all turned out absolutely fine. The process of checking in, answering questions, and having an IV inserted for anesthesia took longer than the actual procedure itself - my husband said the doctor came out to speak to him about 15 minutes after they'd wheeled me in. I was awake within 30 minutes, released within about 2 hours, and having brunch before noon.

Emotionally, of course, it sucked; but, physically it was much, much easier than what I've heard from friends who went through hours (or even days, weeks) of waiting for a natural or medically induced procedure to complete. I had very light bleeding for about 3 days and minimal cramping (less than period level).

It took about 6 months for my periods to regulate back to normal, but from what I understand that is typical regardless of the method you choose to deal with a missed miscarriage.

I'm very sorry you're going through this; whatever you choose, allow plenty of time for grieving, processing, and recovering.
posted by DuckGirl at 11:28 AM on December 6, 2016 [1 favorite]

I’m so sorry. It seems extra cruel to learn of a missed miscarriage just when you think that you’re nearing the second trimester.

My first miscarriage happened “spontaneously,” i.e. the first that I knew something was wrong was when I started bleeding. My second miscarriage was a “missed miscarriage.” My OB also pushed for using misoprostol (Cytotec). I wanted a D&C so that I could have genetic testing done on the tissue. Long story short, I decided to go elsewhere and found a reproductive endocrinologist who did a D&E (similar to a D&C, but the “C” is for “curettage” and the “E” is for “extraction.” So basically, suction instead of scraping). It was done with ultrasound guidance and under general anesthesia. It was about as positive as such an experience could be. I had to take the day off because of the anesthesia, but I was back at work the next day and I’m pretty sure any reduced functionality was not due to the surgery. However, I was required to have someone pick me up after the surgery. I would not have been allowed to take a cab. So you might have to find a friend to actually pick you up.

I’m glad I did it that way, because I did get the information that I was looking for. But I was lucky enough to have an excellent PPO at the time, so the cost was pretty minimal and I didn’t need referrals.

As a data point, my period returned exactly 4 weeks after the surgery and I got pregnant (successfully) during the following cycle.

In your shoes, due to timing with your finals and being alone, I would push for the D&C.
posted by Kriesa at 11:48 AM on December 6, 2016 [2 favorites]

I had two D&Es a year apart, and then conceived naturally a year after that. One was at 6 weeks, the other at 12 weeks. D&E's are apparently less likely to have lasting physical effect, I'm not sure how it is decided which option to go with.

The recovery on both occasions was surprisingly quick. I had some very mild cramping and spotting, but was fully recovered physically about three days later.

I think, as others have said, that you should ask your doctor why she believes scarring would be an issue (do you have other complications?, etc) and go from there. The additional stress of waiting it out, or doing it at home may be physically less taxing, but emotionally more so. For me at least, the D&Es were a quicker way to get things done on the physical end so my emotional healing could start as soon as possible.

I'm sorry you're going through this.
posted by Everydayville at 11:51 AM on December 6, 2016

I'm very sorry this is happening to you. My first pregnancy ended in a missed miscarriage this summer at about nine weeks. I had a D&E - my doctor said that she had no strong feeling about which method of management (waiting for things to happen naturally, medical management, or a D&E) would be best, and so I chose the D&E because I wanted to just have things over with. (The D&E ended up happening almost three weeks after I learned the pregnancy was not developing normally, and I never had any symptoms of miscarriage beyond very minor spotting, so I don't know how much longer it would have taken to happen on its own.)

My procedure was done under conscious sedation, so I was awake, but given medicine that helped me feel very calm. I have no memory of the actual procedure after lying down on the table and then getting up again to be taken back to the recovery room, which is a little strange, but I'm also grateful for it. Physically, I felt almost back to normal the next day and had bleeding for another week or so. The emotional recovery took longer, of course, and is still going on in some ways.

I am actually going through another miscarriage right now - I conceived again in November and started bleeding last week at about 5.5 weeks. My (new - due to a move) doctor and I are both hoping to have this miscarriage complete naturally, but I have another ultrasound later this week to see how things look, and may end up opting for medical management if things have not fully progressed by then. I have no reason to think that this miscarriage is in any way related to the D&E. (My doctor thinks it may be related to pityriasis rosea, so just a very unlucky turn of events.)

So, to sum up, I definitely would choose the D&E with my first miscarriage again - the physical recovery was relatively easy and it helped, in some ways, to know exactly when the miscarriage would be "done." Because my current miscarriage started naturally, I'm hoping it will be complete on its own soon, but I'm not opposed to another procedure if things have stalled.

I wish you the very best in what I know is a really, really hard time. Please take good care of yourself and feel free to me-mail if you need to talk.
posted by Synesthesia at 1:00 PM on December 6, 2016

Thank you everyone for sharing. I ended up seeing a different provider this time and she presented all three options and said that it was up to me. I said that I wanted the d&c and that was that. I'm scheduled for one tomorrow. Thank you all!
posted by pintapicasso at 1:25 PM on December 6, 2016 [17 favorites]

Anecdata: I had two missed miscarriages back to back (within 6 months of each other), at 7 weeks and 9 weeks. I had D&C's both times. Multiple fertility treatments afterwards including a few dozen ultrasounds and no one ever mentioned scarring or any other residual evidence of the D&C's. But I was never able to conceive again, and none of my IVF embryos ever took.

I don't have any reason to believe the D&C's were responsible. The process was emotionally awful, but physically only uncomfortable. I don't think letting things play out naturally would have been easier on either count. There was heavy bleeding after the D&C for at least a day, so if that's what you're trying to avoid I don't know that you will achieve that with the surgery.

But I still wish I had let the second one go naturally.

Sending heartfelt good thoughts to you and anyone else going through this.
posted by Mchelly at 1:27 PM on December 6, 2016 [2 favorites]

oops - should have previewed. Glad you are able to get the opinion you needed -- best of luck to you.
posted by Mchelly at 1:28 PM on December 6, 2016

Also glad to hear a second opinion helped. A friend went through a similar situation recently. I'm sorry for your loss and wish you better luck (as trivial and momentous as luck is) in the future.
posted by maryr at 1:59 PM on December 6, 2016

I had a d&c in similar situation and then had two healthy babies who are now both wonderful men in their forties. I wish you similar good fortune.
posted by mareli at 3:00 PM on December 6, 2016 [1 favorite]

I am so sorry to hear of your loss...I'll be thinking of you tomorrow. Wishing you the best for a speedy and smooth physical recovery, and hoping you have the time and space to grieve as you need to.
posted by hurdy gurdy girl at 7:24 PM on December 6, 2016

So sorry for your loss. I too had a missed miscarriage last winter, and it only started to get easier for me to process after the due date passed. Hang in there.

Sleep. Cry. Have patience with the grief. Let it flow through you, even when it feels unbearable. You are stronger than it feels on those days. When it was very bad, I found this Dear Sugar column helpful.

Your husband will not process this the way you will, and that may be very difficult for you. I have found it most helpful to talk to other women who have had miscarriages.
posted by sadmadglad at 4:10 AM on December 7, 2016

I'm so sorry for your loss, but I am glad you had a chance to speak with a different provider and get the care you have decided on.

I do have to respectfully disagree with a few things on this thread. Full disclosure: I'm an OB/Gyn resident, so have had this same conversation many many times.

It is true that D&Cs are very rarely associated with Asherman's syndrome, but it is definitely something I counsel my patients on (contrary to what stillmoving states). Also, with regards to the difficulty of passing the tissue via medical management, we judge that based on the size under ultrasound as the sac may have stopped growing weeks before. As you said you were 12 weeks, but measuring smaller, that is likely why you were considered a candidate for medical management.

In the United States D&C stands for dilation and curettage, which can be done either with metal instruments (a curette) or plastic suction tubing (suction curette). Any OB/gyn will be competent in performing this as it is a simple procedure done for many many women unfortunately in your situation, whether or not they have had further training specifically in terminations.

A D&E, by comparison, is a procedure performed for termination or a pregnancy loss measuring beyond around 16 weeks which requires more specialized training and is a higher risk procedure. It stands for dilation and extraction.

Big hugs and know many people are thinking of you in this difficult time.
posted by eglenner at 2:22 PM on December 7, 2016

I just wanted to follow-up for anyone in the future who is in the same predicament and finds this question - I'm very happy with the D&S (suction, instead curettage). It was performed under general anesthesia so I have no memory of anything after being wheeled towards the OR and waking up in PACU. Very minimal pain last night, 1 out of 10. And not disruptive, in fact I'm off to clinical this morning and am in no pain.

Thank you, thank you, thank you for all of your answers. This was the worst askme I have ever had to ask but I truly would have wound up in a much worse place without your advice. Thank you from the bottom of my heart.
posted by pintapicasso at 1:31 AM on December 8, 2016 [5 favorites]

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