Surgical Management

Surgical management, typically a Dilation and Curettage (D&C) procedure, is done as a day procedure with the actual operation taking approximately 15 minutes. This option provides the quickest physical resolution and is sometimes recommended based on specific medical circumstances.

This will involve admission to a day hospital. If you are going through the private system, you may be required to go to a maternity suite for your admission, which may be emotionally triggering, so it would be beneficial to have someone with you for support.

The Procedure

Before the Procedure

You may be given Mifepristone followed by Misoprostol (orally or vaginally), normally 2 hours before your operation, allowing time for your cervix to soften prior to surgery. You will be advised not to eat or drink for a specific period before the procedure due to the general anesthetic.

During the Procedure

You will have a general anesthetic and be asleep for the operation. During surgery, your vagina will be held open with a speculum (the same as used in a pap smear), and your cervix will be gently opened to allow access to the uterus. A gentle suction device (like a plastic straw) followed by a small scoop-shaped instrument will be used to remove blood, clots, and the lining of the endometrium will be cleaned away.

Recovery

After the procedure, you will be taken to a recovery room where you will be monitored as you wake up from the anesthetic. Most women can go home on the same day as the procedure, usually within 3-4 hours. It's advisable to have someone drive you home and stay with you for the next 24 hours. You should plan to rest for the remainder of the day and possibly the next day, depending on how you feel and your doctor's advice.

What to Expect After Surgical Management

Physical Recovery

Following a D&C, you may experience mild to moderate cramping for a day or two, which can usually be managed with over-the-counter pain relievers like Paracetamol or Ibuprofen. Light vaginal bleeding or spotting is normal and may continue for a few days to a week. This bleeding should be lighter than a normal period. You may also experience some fatigue, mild nausea, or light-headedness as the anesthetic wears off.

Your healthcare provider will give you specific post-operative instructions, but generally, you should avoid strenuous activity, heavy lifting, and sexual intercourse for about two weeks to allow your body to heal. You should use pads rather than tampons for any bleeding. Most women can return to light activities the day after the procedure and gradually resume normal activities over the next few days, listening to your body's signals.

Hormonal Changes

The hormonal aspects of recovery are similar to those described for the other management options. Your pregnancy hormones will decrease over time, leading to the reduction of pregnancy symptoms.

As your hormone levels decrease (at a rate that varies from woman to woman), you may experience headaches, emotional changes including feelings of sadness, mood swings, and tiredness. Breast tenderness will diminish, and some women may experience milk production, which can be managed by minimizing breast stimulation, avoiding expressing milk, wearing a firm-fitting bra, and using cold packs for relief.

Emotional Considerations

The emotional impact can be significant, and it's important to allow yourself time to grieve and seek support as needed. While surgical management offers the quickest physical resolution, the emotional healing process follows its own timeline. Be gentle with yourself and recognise that feelings of sadness, grief, or loss are natural responses to pregnancy loss.

Requesting Your Baby's Remains After D&C

If you would like to have your baby's remains returned to you after the D&C procedure, it's important to discuss this with your healthcare provider before the procedure takes place. This request needs to be made in advance, as special arrangements must be made for the collection and handling of the remains.

Your healthcare provider can explain the process and any requirements that may apply in your situation. Some families find that having the remains allows them to create meaningful rituals or memorials, while others may prefer the hospital to handle the remains respectfully. There is no right or wrong choice—only what feels right for you and your family.

If you're considering this option, discuss it with your partner or support person beforehand, as it can be an emotionally significant decision. Your healthcare team is there to support you and answer any questions you may have about this process.

When Should I Seek Further Medical Assistance?

If bleeding becomes heavy (soaking through a pad in an hour), if you develop a fever, if you experience severe pain not relieved by medication, or if you notice an unusual vaginal discharge, you should contact your healthcare provider immediately as these could be signs of complications such as infection or incomplete removal of tissue.

Other warning signs to watch for include feeling faint or dizzy, experiencing intensifying pain that isn't relieved by pain medication, or if your breasts become painful, red, inflamed, or feel hot to the touch, which could indicate an infection.

If you are concerned about your health, please seek advice from your healthcare professional.