Management of miscarriage: surgical, medical, natural

If you are told that your pregnancy has ended but that you have not had a complete miscarriage, you may be offered a choice about how to manage the situation:

Surgically: an operation called an ERPC

Medically: with a combination of pills and vaginal pessaries

Naturally: letting nature take its course

It may help to know that a large research study[1] comparing surgical, medical and natural methods came to three very important conclusions:

• the risks of infection or other harm are very small with all three methods
• your chances of having a healthy pregnancy in the future are just as good whichever method you choose
• women interviewed for the research study generally coped better when they were given clear information, good support and were able to choose the management method that they felt they could best cope with

We provide brief information below, but you can read more detail and some personal experiences in our leaflet Management of a miscarriage.

There is also more detailed information about management of late miscarriage and management of ectopic pregnancy.

Surgical management (ERPC)

This is an operation to remove the remains of your pregnancy and it is usually done under general anaesthetic.

ERPC is an abbreviation for Evacuation of Retained Products of Conception*, which means the removal of the remains of the pregnancy and surrounding tissue. Some people still call it a D & C, which is a slightly different procedure.

(*A lot of people – including some health professionals – don’t like the term “retained products of conception”. There are some moves to come up with a better description.)

You can read more about surgical management in our leaflet Management of a miscarriage.

Medical management

Some hospitals offer a combination of pills and vaginal pessaries which can “kick-start” the process of a delayed or missed miscarriage. Some women experience quite severe abdominal cramps as well as heavy bleeding with this option, but they may prefer this to an operation.

If your baby has died after about 14 or 15 weeks, you are most likely to be managed medically.

Not all hospitals offer this option and those that do sometimes differ in the way they give the treatment. You may want to ask for written information about this kind of management.

You can read more about medical management in our leaflet Management of a miscarriage.

Natural management (also called Expectant or Conservative management): letting nature take its course)

Some women prefer to wait and let the miscarriage happen naturally – and hospitals may recommend this too, especially in the first three months of pregnancy.

It can be difficult to know what to expect and when (it may take days or weeks before the miscarriage begins) but most women will experience abdominal cramps, possibly quite severe, and pass blood clots as well as blood.

You can read more about natural management in our leaflet Management of a miscarriage.