Dear Doctor Murage,
I have just been diagnosed with a miscarriage in early pregnancy. My doctor says I need surgery to have my uterus cleaned but I don’t want to undergo such a procedure. Is there another way out?
Once a miscarriage has been diagnosed, a discussion needs to take place about how to manage the situation. It’s best to discuss with your regular gynaecologist, or a nurse specialised in the management of early pregnancy problems. Understand that you are not at any significant risk, and there is usually no urgency in deciding what to do. The only exception to this principle is in cases where there is heavy bleeding, which is uncommon.
The procedure your doctor is suggesting is called uterine evacuation. It involves surgical removal of the miscarriage, and usually requires some form of anesthesia. Admission in a day surgery unit is usually required, and a discharge shortly after the procedure is completed. It’s a fairly simple procedure, with minimal risks. It will however cost more, compared to other alternatives.
Other alternatives include taking some medications or just waiting for the miscarriage to come out spontaneously. These options are suitable for the vast majority of women, and should always be offered as alternatives to surgery. You can choose to take medications, which can either be given by mouth or vaginally. The medications enhance the process of expulsion of the miscarriage, similar to having a heavy period. The bleeding takes place over several days, and stops spontaneously once everything has been expelled.
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Waiting for spontaneous resolution of the miscarriage without doing anything else is perfectly safe. Once a miscarriage has happened, biological processes kick in to initiate expulsion of the non-developing foetus. It can take several days, or even weeks, for a spontaneous bleed to occur. Cessation of bleeding is usually a sign that everything has been expelled.
Scientific studies have confirmed that all these options for managing miscarriages are safe. The most important thing is to be aware of all the options, and to select what suits your specific circumstances.
Don’t feel compelled to accept the first treatment option. Ask if other options are suitable for you, and select what suits you.
— Dr Alfred Murage is a consultant obstetrician and gynaecologist