Surgical management of miscarriage (SMM)

We are so sorry you are having a miscarriage.

Even though this is a difficult time, it is important to consider the different ways to manage a miscarriage.

Some women choose to wait and allow a natural miscarriage to take place. Some choose medical management which starts or speeds up the process of miscarriage. Some prefer surgical management of miscarriage, and you can learn more about this below.

About this surgery

Surgical management of miscarriage (SMM) is a procedure to remove pregnancy tissue, while you are under general anaesthetic (asleep).

When you have decided on surgical management, we will arrange a pre-assessment appointment for you.

Your pre-assessment will take place in Kingston Hospital's Jasmine Unit. We will assess your suitability for surgery and discuss your medical history and any medicines you take. We may also give you a blood test.

Prior to surgery, we may ask you to take a medicine called Misoprostol. This helps to prepare your uterus (womb) and the neck of your womb (cervix). We will discuss this with you at your pre-assessment.

During this appointment, you can ask questions about the surgery.

Preparing and when you arrive

To prepare for surgery, do the following.

• Remove all make-up, nail varnish, and jewellery. (You can still wear your wedding ring).

When you arrive 

Arrive at 7am to check in for your surgery. Go to the Admissions on the Day lounge (AOD) on Level 2 Esher Wing.

Your surgery will take place between 8.30am and 11am.  You will be able to go home on the same day if there are no complications.

When you arrive, tell the nursing staff if you are experiencing cramping and bleeding. This may happen if we have asked you to take Misoprostol to prepare for your surgery. The nursing staff will give you some pain relief if you need it.

The anaesthetist and surgeon will discuss the procedure with you and ask you to complete the consent form. They will talk to you about any concerns you have.

We will not carry out this surgery unless we have your written consent.

During and after surgery

We will perform your surgery while you are under general anaesthetic (asleep).

We will perform it vaginally, with no incisions (cuts).

• The surgeon will gradually dilate or stretch the neck of your womb (cervix).
• They will insert a small suction tube into your uterus to remove the pregnancy tissue. This usually takes 10 to 15 minutes.

Immediately after 

Most women go home on the same day after surgery.

Before you go, it is important that you have drunk water and passed urine.

If your blood group is rhesus negative, we will give you an injection called Anti D before you leave. We use this to prevent Rh disease in Rh-negative women.

In the days after 

Many women experience some bleeding and mild cramps after surgery. This is usually similar to period-like bleeding, and it gradually reduces and settles over 1 to 2 weeks. It can take up to 3 weeks to settle, but this is rare.

Get in touch with Jasmine Unit if the bleeding has not settled after 3 weeks (see Contacts below).

We recommend you follow this guidance:

• Do not use vaginal tampons, have intercourse, or go swimming until the bleeding has settled. This is to avoid risk of infection.
• Arrange to take a pregnancy test 3 weeks after the surgery. If this tests positive, get in touch with Jasmine Unit so we can arrange a scan to check the surgery was fully successful.

Risks and side effects

Bleeding

You can expect mild vaginal bleeding after the procedure, and this can take up to 3 weeks to settle.

Heavy bleeding can happen at the time of the procedure, soon afterwards, or up to 2 weeks afterwards. It may mean you need a blood transfusion. This is uncommon (it happens to 1 to 2 women per 1000).

• If you have heavy bleeding and you feel faint and unwell, go to your nearest Emergency Department (A&E).
• If you feel well, but are concerned that bleeding is heavy, talk to your GP or call the Jasmine Unit (see Contacts below).

Infection

4 out of 100 women who have the procedure experience pelvic infection. Symptoms include lower abdominal pain, smelly discharge or fever.

• Contact your GP as soon as you experience any of these symptoms. They can treat it with antibiotics.

Incomplete evacuation (pregnancy tissue not completely removed during the procedure)

4 out of 100 women who have the procedure will experience this. Symptoms include heavy bleeding with clots, and severe cramps.

• Talk to your GP or contact the Jasmine Unit (see Contacts below) if:
  • You experience heavy bleeding and severe cramps at any time after the procedure
  • The bleeding goes on for longer than 3 weeks.

You may need a repeat surgical procedure.

Perforation of the womb (development of a small hole)

Up to 1 in 1000 women who have the procedure will experience this. We will tell you if this has happened before we discharge you home.

It does not affect your fertility long-term and will not affect your ability to become pregnant and have a normal birth in the future.

If your womb is perforated during surgery, we may need to pass a laparoscope (a type of telescope) through a cut below your belly button. This will allow us to complete the procedure safely and to check there is no other damage.

Cervical tear

A significant tear to the neck of the womb is rare. We will tell you if this has happened before we discharge you home.

If it happens, we will repair the tear immediately.

Intrauterine adhesions (scar tissue inside the uterus)

Intrauterine adhesions are experienced by up to 19 out of 100 women who have the procedure.

In most of the cases, the adhesions are mild or moderate.

3 in 100 women experience severe adhesions. These can cause light periods or no bleeding, and problems with conception.

Contact Jasmine Unit (see Contacts below) if you do not have a period within 10 weeks after the procedure and are sure you are not pregnant again

Testing after more than one miscarriage

If this was the third in a row (or more) miscarriage that you experienced, we will send a sample of your removed pregnancy tissue for a routine test.

This is so we can rule out placental tissue abnormalities (called molar pregnancy) which can cause miscarriage. This test does not check for other possible causes of the miscarriage.

We will only get in touch with you if your tissue shows abnormalities. If you do not hear from us, you can be reassured that we found no abnormality.

Trying for another baby

Trying for a baby is a personal decision for you.

We advise you to wait until you have had at least one period before you start trying to conceive again. This gives your body time to recover.

For most women, their periods return 4 to 6 weeks after surgery. However, it is possible to become pregnant before your first period. For this reason, we recommend you use a temporary method of contraception, such as condoms.

Emotional and physical support

Experiencing a miscarriage will affect you (and your partner) physically and emotionally. You may experience mental health concerns like anger, guilt, frustration and despair, and feelings of loss and extreme sadness.

You are not alone, and support is available. You can ask for help from your GP, who may refer you to a specialist if needed.  See also More information, below. 

More information

These specialist organisations offer support:

Miscarriage Association 

The Mariposa Trust