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, often called an ERPC (but the name is changing to Surgical Management of Miscarriage, or SMM)
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 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.
Surgical management of miscarriage (SMM or ERPC)
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 has been 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, and there is now a drive to get it changed to SMM – Surgical Management of Miscarriage.
(Some people still call it a D & C, which is a slightly different procedure.)
Some hospitals are beginning to offer surgical management with local rather than general anaesthetic. This is called MVA, which is an abbreviation for Manual Vacuum Aspiration.
You can read more about surgical management in our leaflet Management of a miscarriage. (Please note that this leaflet is due to be updated with the new name SMM and information about MVA.)
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.
You may also find it helpful to read Valerie’s account of her experience
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.