Tag: Surgical Management

I thought another ‘update’ was due from me & my miscarriage journey as quite a few things have happened since my last post >> Miscarriage & Me // An Update, (posted on 14th September). I’m sharing my experience because:-

1) It’s been cathartic for me to write everything down and actually go over what’s happened, as some days are a bit of a blur – especially with all that hospital jargon.
2) The only way to learn is from others’ sharing their own experiences – I had absolutely no idea how common Miscarriage was/is. It’s only through sharing that I now know so much more and understand so much more. It’s also been of great support for me (and I’m told by others – which has overwhelmed me like you’d never know). By allowing people in and allowing them to also share in their journey has kept me going.
3) Charities such as Tommy’s rely on people sharing their own story, to aid their crucial research into Pregnancy Loss.

This could be lengthy as I get up to date – but as I say, typing it out helps me to move along and have a bit of a ‘brain dump’, as it were.

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19th September
Re-scan // Broomfield Early Pregnancy Unit
The re-scan was done in EPU this time. Despite bleeding lightly, pretty constantly, since 27th August, I was quite shocked to hear that my scan was looking no different to the scan I’d had two weeks previous (the 12 week scan).

As the empty sac still measured at just 7 weeks, and by dates, I was now 14 weeks, the midwives advised that we need to now take some further action as it looks like my body (ridiculously cruelly) still thinks it’s pregnant and that sac ain’t shiftin’.

We were then lead to that dreaded ‘Quiet Room’ once again; where Midwife, Amelia, came to discuss my options once again. There was absolutely no pressure, but she did remind me that as things weren’t ticking over naturally and had been stationary for longer than expected – therefore leaving me open to potential infection. Ugh.

We talked things through – I was then booked in for ‘Medical Management’ Part One for Friday 22nd September; followed by Part Two on Sunday 24th September.

(Here is some explanation on Medical Management of Miscarriage – including some of that lovely hospital jargon, simplified. Scroll on to continue with my ‘story’).

What is Medical Management of Miscarriage?

“You may choose to have medication to remove the tissue if you don’t want to wait. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out.

In most cases, you’ll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve. However, tablets that you swallow may be available if you prefer. A medication called Mifepristone is sometimes used first, followed 48 hours later by a medication called Misoprostol.

The effects of Misoprostol tablets usually begin within a few hours. You’ll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to three weeks.

In most units, you’ll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.

You should be advised to take a home pregnancy test three weeks after taking this medication. If the pregnancy test shows you’re still pregnant, you may need to have further tests to make sure you don’t have a molar pregnancy or an ectopic pregnancy.

You may be advised to contact your healthcare professional to discuss your options if bleeding hasn’t started within 24 hours of taking the medication.”

– Information taken from NHS Guidelines for Medical Management of Miscarriage // Treatment.

What happens?

Medical management involves a single visit to the hospital. During this time, you will have pessaries (tablets) inserted inside your vagina, or you may be given the tablets orally if you are having vaginal bleeding.  These work by making your womb contract and push out the pregnancy tissue.  You may need more than one treatment with pessaries or oral tablets before the miscarriage happens.  You may choose to stay in the hospital or go home following the administration of medication.  If you prefer you may take the tablets home and take them yourself at home.  Bleeding may continue for up to 3 weeks after treatment.

Does it hurt?

Once the miscarriage starts, most women have quite strong period-like pain and cramps and some find the process very painful, especially as the pregnancy tissue is expelled.  This is because the womb is contracting and pushing (imagine tightly clenching and then relaxing your fist a few times) rather like the contractions of labour.  You are also likely to have heavy bleeding and pass blood clots.  You may see the pregnancy sac and it may be larger than you expect.  You might see an intact fetus, which may look like a tiny baby, especially if you are miscarrying after 10 weeks.  You may take Paracetamol or Co-codamol for pain relief, but you should not take Aspirin or Ibuprofen as they may make the treatment less effective.

Some women react to the medication with nausea and/or diarrhoea.

Are there any risks?

The risk of infection after medical management is low, at around 1 in 100.  Signs of infection are a raised temperature and flu-like symptoms, a vaginal discharge that looks or smells offensive and/or abdominal pain that gets worse rather than better. Treatment is with antibiotics.  In some cases you may be advised to have an ERPC.  You will probably also be advised to use pads rather than tampons for the bleeding and not to have sexual intercourse until the bleeding has stopped.

There is a small risk of haemorrhage; a recent study reported that 1 in 100 women had bleeding severe enough to need a blood transfusion.  If you have very heavy bleeding or severe pain and/or feel unwell, or if you just find it hard to manage, you may ring your Early Pregnancy Unit for advice, 111 or 999 if necessary.

Medical management is effective in approximately 80 to 90% of cases.  Where it is not, women may be advised to have surgical management – an ERPC.

What are the benefits of medical management?

The main benefit is in avoiding an operation and general anaesthetic.  Some women prefer to be fully aware of the process of miscarriage and may want to see the pregnancy tissue and perhaps the foetus.  Some women feel this helps them say goodbye.

Some women see medical management as a more natural process rather than having an operation, but more manageable than waiting for nature to take its course.  It may be helpful to know that if the treatment doesn’t work, you may be able to opt for ERPC.

Disadvantages?

Some women find the process painful and frightening, though good information about what to expect can help.  Some women are anxious as to how they might cope with the pain and bleeding, especially if they are not in hospital at the time.  Some fear seeing the fetus.  Bleeding can continue for up to three weeks after the treatment and women may have to have several follow-up scans to monitor progress.  This can be upsetting.  Some women will end up having an ERPC as well as medical treatment.

– Information taken from NHS Guidelines for Medical Management of Miscarriage // Obstetrics & Gynaecology Department

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I was given the usual consent forms ahead of being  handed the Mifepristone along with anti-sickness tablets. I then had an hour to rest and had the typical stat’s taken before/after. All was fine and I was sent home. I had no pain, no nausea and more importantly, no bleeding in the 48 hours ahead of Part Two.

Although I was willing for SOMETHING to happen, nothing did. We went for lunch with my parents (who had visited for the weekend); and we even had a child-free trip to the CINEMA! (FINALLY saw Dunkirk, which is just the most incredible slice of cinema I’ve seen, ever, I think). The distractions didn’t offer up anything.

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So we went back to the hospital bright and early on Sunday morning. I was mega nervous. I had a nervous tummy, sweaty palms and little-to-no conversation in me.

Sunday 24th September
Gosfield Ward – Early Pregnancy Unit – Broomfield Hospital
The ward was pretty silent when we arrived at just before 10am. Eerily so. No sooner had we arrived before I was changing into a hospital gown and laid on the bed in my private room. I was given more information about the procedure and had my stats taken. After the birth of Eli, I was admitted to hospital for a week  to treat  near-death early-caught-Sepsis. The experience left me with ‘White Coat Syndrome‘ – of which I have to explain to EVERY caregiver who has the joy of taking my blood pressure – “White coat hypertension, more commonly known as white coat syndrome, is a phenomenon in which patients exhibit a blood pressure level above the normal range, in a clinical setting, though they don’t exhibit it in other settings. It is believed that the phenomenon is due to anxiety that those afflicted experience during a clinic visit”. I have to say, I do feel for these poor individuals – I’m not the easiest patient to deal with!

By 11am I had ordered my lunch (from a pretty extensive and surprisingly appetising hospital menu!) and was awaiting the doctor to come with my medication to kick-start the ‘induction’, so to speak. I weirdly felt quite relaxed… I think it felt like there was finally light at the end of the tunnel. Maybe I was riding on nerves and adrenaline/anticipation.

The pessaries were inserted (all 4). Yes it was uncomfortable – and slightly painful – but it takes just a few minutes. So its completely bearable. I would then have to lay flat for an hour – hour & half.  Within 10 minutes the bleeding started. It suddenly became very, very heavy. We called for a Nurse (Lucy), who got me up out of bed and took me into my  private en-suite.

I was then given the ‘pan’ of which I would need to collect all tissue – which would then be taken for assessment. I’m sure all will agree that dignity is something very foreign when enduring anything child-baring related. This wonderful Midwife sorted me out at my most vulnerable – in the most caring and gentle way. She made no fuss and made me feel at ease; whilst giving me a ‘wet wipe’ bath to remove the blood stains from my legs and back. Sorry if this is a totally grim read – but I want to be honest. There’s no shame in any of this – and sadly, it’s just the way it is. This is the process. I won’t go into the whole NHS funding/Nurses wages thing – but my god, these wonderful, wonderful humans – they deserve the world. The things they must see, on a daily basis. I can’t even comprehend. What incredibly skilled and insanely caring people. Unbelievable. #SAVETHENHS

I spent my time back and forth from the bed to the en-suite for the next hour, when we managed to get the bleeding under some control and I could rest on the bed with maternity pads/bed pads. My lunch arrived – and I was ravenous. James went to the Hospital M&S to grab himself some lunch and for a bit of a breather too, I imagine. It’s all pretty gruesome and definitely something he’s coped with exceptionally well considering he was once very squeamish (he may well be squeamish still, not sure how you can’t be looking at what we went through this weekend – but he did a bloody marvellous job of comforting and supporting me throughout).  The Chilli I ate for my lunch was beautiful – really hit the spot and cheered my mood right up – as did the Harry Styles album I had streaming.

The afternoon was again spent back and forth from the bed to the en-suite (I couldn’t just stay in the en-suite, I wanted to be on the bed and cosy) with Nurses coming and going – checking my progress – checking the tissues I’d expelled and the bleeding – but not overstaying, which gave us some well needed privacy that I really valued.

By 3pm I was in need of painkillers. The cramps were getting really painful – not unbearable, but I didn’t want them to get to a point where I was in need of severe pain management. So the Midwife (Pankaja) nipped the pain in the bud with 2 paracetamol and liquid morphine.

Not long after, I was given the menu for tea – even though I’d anticipated I’d be home by now. So I reluctantly I ordered Chicken Tikka & Rice and a Rice Pudding. Yep three meals with RICE, in one day –  YOLO.  I’ve got to praise this hospital food – seriously! It was super tasty, a great portion size, hot and not in the slightest bit sloppy, soggy or plasticky – which is what I’d encountered previously. My body definitely appreciated the good food too.

By 5pm, I was given a pretty painful internal. Which even the painkillers couldn’t fend off. A huge light was brought in on wheels along with the paraphernalia you’d normally see when having a Smear Test…and/or having your waters broken. The doctors agreed that the bleeding would continue and were satisfied with my progress thus far – my Cervix was open – so that was a good position to be in. Though, they were not convinced that the sac had passed and began discussing the repeat procedure of the pessaries – which would mean an overnight stay. While the staff debated my situation, Eli arrived with my parents. They were going home that evening. Thankfully the bleeding was nigh on stopping and the pain had eased. So he just saw his Mama in her “really pretty” hospital gown – and my god, I was so happy to see him and we had the BEST cuddles. His affection made me forget about it all – made me zone out – for just a few moments. (He also said I looked pretty in my hospital ‘dress’. There’s a first!)

By 7pm, the Registrar had decided against an overnight stay and repeat procedure – I’d had too much medication for one day. Therefore, I’d be discharged with a letter, antibiotics and a repeat scan for 2nd October. So I have until the 2nd to finish expelling whatever is left.

I was discharged at around 8:30. I was shattered and it was a surreal journey home – it felt like 4am or something. I then slept. Slept and slept and slept. Never have I ever slept so much. I even SLEPT THROUGH on Sunday night, something I’ve not managed since well before Eli arrived. So that was weird too.

Since then – and up until today, Wednesday 27th – I’ve had little/no bleeding once again. Though I’ve had the odd cramp, back pain and baaaaaaad head. So once again, I’m in limbo. Has it all expelled? Is it over? Is it stuck?! Has the sac come away? Has my cervix closed up again?! Am I anaemic with all this blood loss? Is that why I’m so damn tired? Guess I’ll just have to wait it out until 2nd October when I get scanned again. (I’m also eating allll the kale, cavolo nero and spinach I can muster to get my iron on the up, incase!). If there are still some bits of tissue remaining/the sac still clinging on, then it will be off to surgery for me – for the dreaded Surgical Management (ERPC or ERPoC, which stands for Evacuation of Retained Products of Conception. You might hear it called it a D & C too) which is under anaesthetic.

 

One thing I would say is though – Men/Partners do tend to get ‘ignored’ slightly during processes like this. I know I’m going through it harder – physically – but mentally, we’ve both lost out. We both desperately wanted that baby and we’ve both had the pregnancy loss. Both had the miscarriage.

Throughout the 30+ hours of labour with Eli, James was offered a cup of tea just ONCE. I was offered dozens of cups, despite being nil by mouth. The same happened again during this process – I was offered loads of tea/coffee. James wasn’t ever offered either – it was Sunday and the coffee shops closed early. So I really felt for him – he was going through it too – and yes, tea generally does solve a lot of things! If nothing else, it warms you up from the inside and gives you something to zone off with, even for just a few minutes. So perhaps it could be worth taking a flask of tea in – or whatever beverages/snacks you both need – should you be reading this ahead of venturing through this procedure too.

So there we are, thats where I’m up to now.

As before – it’s good to talk about things. So please do keep getting in touch and sharing your experiences. It’s the only way we’ll learn.

All my love,
C
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