ERPC, medical management or wait?

I had my follow up scan yesterday and it turns out that my continuing pregnancy symptoms aren’t all in my mind. The empty pregnancy sac has grown. My body has still to realise that this pregnancy isn’t viable.

Following the scan I met with the doctor and thankfully was able to see a registrar rather than the usual newly qualified doctors. The registrar was pretty helpful and whilst having quite a forthright bedside manner (not much sympathy to be had from her) she was able to discuss the options with me, answer my concerns in a seemingly knowledgable way and help me make a decision as to how to proceed.

As you are no doubt aware from your previous miscarriage experiences, the three main options are (I) ERPC (now called surgical management); (II) medical management; and (III) natural miscarriage (or wait and see). The reg’s preference seemed to be ERPC, they offer it at my local hospital, could do it on Monday and would be able to collect the ‘products’ for testing – although I did question whether there was much to test seeing as how I have an empty sac and no foetal pole but she said they would still test(?)

My concern with the ERPC is that it will be third in a year. After my second my periods didn’t come back as they were before. I bled monthly but only for a few days and they were light. I was initially told this would be hormonal but my period returned straight away after my first ERPC so I wondered why the second would be different and when I questioned further I was told it could be a sign of mild scaring. I have also been told by another doctor that repeat ERPCs can cause damage to the cervix which is also something I’d like to avoid. This is a little frustrating as I’ve previously found ERPC to be a quick, simple and relatively painless way to end a miscarriage and if I felt like the risks were tiny I’d definitely do it again but so far I haven’t managed to find a doctor who has told me that the risk is negligible when talking about having so many in a short space of time. In fact the reg yesterday told me that if i had another she would recommend having a coil fitted for six months to prevent adhesions forming. So that’s option 1.

Option 2. Medical management. My local hospital don’t do this but can make referrals. The reg says that the concern with this is the difficulty in collecting the products. She suggested that if I did choose this option that I say in hospital while the miscarriage happens even though hospital protocol is to send people home. Apparently they will make an exception now I’ve reached the magical ‘three in a row’.

Option 3. Wait…. This does seem like a good option but the concern is that they don’t let you wait forever and despite the fact the the embryo didn’t develop at all, I’m now almost 9 weeks into the pregnancy. My previous pregnancies showed no sign of ending either despite the first one stopping growing at about 8 weeks, I didn’t have the ERPC until 14 weeks. I’m just not sure if I can wait another month or more only to end up needing medical intervention anyway. I’m tired of feeling sick and having other pregnancy symptoms knowing its just my stupid body not realising what’s going on! I also really don’t want to risk having a miscarriage whilst visiting family over Christmas.

So on Monday I’ve got an appointment at another hospital for more scans and to discuss the possibility of a medical management. To be honest I’m quite scared. I’ve read some horror stories about medical management but I’ve also read bad things about uterine scaring causing infertility, further miscarriages and pregnancy problems. I just wish I wasn’t in this position and more than anything I wish it wasn’t so damn close to Christmas when I supposed to be a parties, carol concerts and Christmas lunches. The timing just sucks!

Sorry for the length of this post; I just wanted to get all of my thoughts down. My question for you is, have you been in this situation? What did you choose and how did you feel after? Also do you know how important it is to collect the products for testing if all there is is an empty sac??

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14 thoughts on “ERPC, medical management or wait?

  1. Oh hun, I’m so sorry you’re going through this. It’s bad enough to be suffering the loss but to be forced to decide which route to take is so hard. We always second guess our decisions and think of the what-if scenarios. Your concerns are all valid and I don’t have the answers but I think you need to sit with them all for a bit and go with what feels the most comfortable. I’ve never chosen medical management. I was told my my RPL specialist not to do it because of the emotional trauma it can cause and because it can be painful and drawn out. He was worried all my losses would be relived in one go. Naturally miscarrying a MMC is hard too, the constant waiting and wondering when things will kick in was torturous. Plus you just want to get on with your life. ERPC was to me the most healing. I had waited weeks to have it done so there wasn’t much besides the sac left so I was shocked they were even able to test it. But knowing the results was somewhat reassuring. In our case we found out it was a fluke abnormality, nothing to do with age or quality or RPL. In that sense it gave me some closure, some relief, some hope. I would probably choose that route again. But I do hear your concerns about scar tissue and cervical damage when having multiple ERPCs. It’s never straightforward is it. I hope the answer becomes clear to you, here to support you whatever your choice. Sending love xxx

    • Thank you. I really want to try to get some answers this time so will try to make sure that we are able to collect the products for testing. Thanks for the advice x

  2. I was in the same boat as you. My body wasn’t recognizing the miscarriage.

    With the first one, I took a pill to start the miscarriage. This was the worst decision I had ever made. I spent several days lying on the floor with contraction like cramps, severe bleeding, vomiting, etc. A few days after, I stopped bleeding. However, almost a week later, I started gushing, to the point where I was concerned about blood loss. Therefore, for the second and third, I did the operation. I felt the recovery was physically and emotionally better. I also had testing done, and I feel like those results helped us in our journey. For two of them, we did just have an empty sac. They could even tell us the gender, which I really wished they didn’t…

    Hope this helps. Thinking of you ❤

    • I’m so sorry, friend. I can relate. I had a similar scenario with my last miscarriage. We waited. Nothing. Did the pils – lots of bleeding, but didn’t miscarry. Finally had a D&C. It is so hard to try to figure this out. Ugh. I truly feel for you. Will be thinking of you and saying prayer. Hugs.

      • Thank you. My fear is that we’d go through all of this, take the pills, have a horrid and painful experience and then still need the op afterwards. I guess I’d at least know that I had tried but I don’t know if that would make me feel better. Thank you for the advice.

    • I did a similar thing as well for one loss but it was a suppository. Never again. It was the worse pain of my life. Coupled with the emotional pain I could never imagine facing it again. The worst was that after a month they were still seeing “debris” on the scan (yes, they refereed to the remaining bits of my baby as “debris”. A least a hospital stay might mean some pain meds..that might make it bearable.

      • Im sorry you had such a horrid experience. I think it’s the pain i fear the most. And the risk that it might not work. Thank you for the advice.

    • Your medical management experience sounds horrid. I think that is my biggest fear, that it would hurt like hell, last for days and I’d still need the operation afterwards. Thank you for the advice.

  3. I’m sorry you’re going through this 😦 I know I couldn’t wait to have it naturally–I’ve used medical management but not D&C, but at this point I think the D&C would be less traumatic as long as I trusted the doctor performing the procedure (not to cause scarring). That’s my perspective. Hugs. XO

  4. It’s such a tough decision. I was told that the risk of scarring would be really small, but there could be lots of reasons why the risk would be different in your case. I was also told that by 10 weeks or so, the bleeding from a natural miscarriage could actually be really dangerous, and so my doctor discouraged me from handling it naturally in the cases where my sac was close to 10 week size. From an emotional standpoint, D and C definitely seemed like the easier route. I couldn’t stand the idea of waiting and waiting, all the while feeling awful. By the time the surgery was over and I felt physically better I was already feeling a lot better emotionally just knowing that it was all over and I could move on.

    I’m so so sorry you’re having to make these decisions and deal with this again. I wish this had been your baby, it’s so unfair.

    • Thank you, i completely relate to your comment about what to know it’s done so I can move on. I really want to try to get some answers this time so will try to pick an option which will make sure that we are able to collect the products for testing. Thanks for the advice.

  5. I’ve been thinking about how to respond to your post all day.. I have nothing to say that will make you feel any better but I did want you to know that I’ve read your post and I’ve been thinking about you all day. I wish I could somehow vanish all of your pain and make everything better, but I know I can’t. You have such hard decisions to make right now and because I’ve been there too.. my heart just breaks for you. Life just stinks sometimes. This is one of those times. I’m so sorry you have to go through all of this and make such hard decisions on top of that.

    • Thank you for commenting. It means loads to know that I’ve got support. I am overwhelmed by how many people take time out of their day to offer advice and support to someone they’ve never met. Truly humbling!

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