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, usually called Surgical Management of Miscarriage, or SMM.

Medically: with medication to begin the process of miscarriage.

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 of miscarriage (SMM)

This is an operation to remove the remains of your pregnancy and it is usually done under general anaesthetic (but see MVA below).

For many years, surgical management of miscarriage was called ERPC, an abbreviation for Evacuation of Retained Products of Conception, which means the removal of the remains of the pregnancy and surrounding tissue. Many people find this term distressing, which is why it should not be used any more, but it’s possible that you will still hear it or see it written.

(Some people still call it a D & C, which is a slightly different procedure.)

Some hospitals offer surgical management with local rather than general anaesthetic. This is called MVA, which is an abbreviation for Manual Vacuum Aspiration.  You may find it helpful to read Karen’s experience of MVA.

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.

Hospitals sometimes differ in the way they give the treatment – for example, whether treatment is carried out in hospital or at home.  In all cases, though, they should give you clear information about what to expect.

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.  You may also find it helpful to read Keri’s account of natural management of her missed miscarriage.

In some cases

You may opt for one method of management but find that things change. Laura talks about her missed miscarriage, which started naturally but required some hospital treatment too.

[1] The MIST (Miscarriage Treatment) Trial. J Trinder et al: Management of miscarriage: expectant, medical or surgical? Results of a randomised controlled trial (miscarriage treatment (MIST) trial). BMJ 2006;332:1235-1240 (27 May).