This provides information for women who have chosen to have surgical management under general anaesthetic following a diagnosis of a miscarriage.
It is also relevant for women who choose to have surgical management of pregnancy tissue or placenta that has remained inside the uterus (womb) after a termination of pregnancy, or after birth.
The purpose of this is to:
- Describe what surgical management of miscarriage under general anaesthetic is
- Inform you how to prepare for surgery
- Inform you what to expect before, during and after surgery
- Explain the risks of surgery
For more information about why miscarriage happens, and the other options for treatment of a miscarriage, please see our other page entitled “Early Miscarriage”.
- Your surgery has been booked for:
- You should attend the Surgical Admissions Unit/Day Surgery Unit at:
- You should stop eating and drinking at:
- You can drink unflavoured, non-fizzy water until:
Surgical Management of Miscarriage (SMM) is a procedure to remove pregnancy tissue from the womb. Alternatively, it can be referred to as an ERPC (Evacuation of Retained Products of Conception), MVA (Manual Vacuum Aspiration) or a D&C (Dilation and Curettage). These terms all refer to the same procedure.
General anaesthetic (GA) is used to make sure you are asleep and do not feel anything during the procedure.
You can discuss the alternative options with the team, and read our information on miscarriage.
Your alternative options may include expectant management (watching and waiting), medical management (using medication), or surgical management under local anaesthetic – although we may suggest SMM under GA if you are at higher risk of heavy bleeding (for example if your pregnancy is more advanced), or if other options are unlikely to be successful.
Consent
You will be seen by a doctor who will talk you through the operation, explain its risks and benefits, and ask you if you have any questions. They will then invite you to sign a consent form if you wish to proceed.
If you are unsure about any aspect of the procedure, please ask to speak with a member of the team again.
Blood tests
You will need to have some blood tests to check your full blood count (to check if you are anaemic) and to confirm your blood group before the procedure. This will happen a few days before your procedure and will usually take place in the phlebotomy (blood test) department.
Pre-assessment
You will be asked to complete a pre-assessment questionnaire, asking you about any current or past medical problems, via the MyCare App.
If you have a significant medical condition that needs to be assessed before you have an anaesthetic, or if you do not speak English (and are unable to answer our pre-assessment questionnaire), you will be contacted with a pre-assessment appointment once you have left the Early Pregnancy Unit. This appointment is often carried out over the phone, but may take place in the Pre-assessment Department.
Preparation prior to the procedure
You should remove all piercings and jewellery before coming to hospital. Ideally at least one fingernail should not have dark or acrylic nail varnish on it.
Before an operation under general anaesthetic, it is important that you stop eating and drinking so that your stomach is empty. The time you should stop eating and drinking will depend on the admission time you have been given.
The morning of the procedure
You should wear comfortable clothes, and bring any regular medication with you (including inhalers). If you wear glasses, you should bring them and ensure than they are labelled. We also recommend bringing something to read, a mobile phone charger, and some sanitary towels. Do not bring valuables into hospital with you.
You will be advised to go to either the Surgical Admissions Unit (on the first floor of the main hospital), or the Day Surgery Unit (on the second floor). You may not be able to be accompanied by a partner or friend after this point: please check your admission letter for up-to-date information, and ask in advance if you have concerns.
You will be seen by the doctor who will be giving you your anaesthetic (anaesthetist) and the doctor who will be performing your surgery (gynaecologist). They will be able to answer any questions you may have, and confirm that you wish to proceed. If you have had any heavy bleeding since your last scan then the gynaecologist may want to do an ultrasound scan to check that the procedure is still required.
You may have to wait for some time before your operation.
When it is almost time for the procedure, you will be asked to change into a hospital gown, and you will be given a pair of disposable knickers to wear, and some stockings. You will be given a large bag to place all your belongings in to.
Once it is time for the procedure, you will be taken to the operating theatre where you will have a cannula (thin plastic tube) inserted into a vein in your arm or hand. This is so that you can be given the anaesthetic and any other medications needed during the procedure. You will then have medications to make you drowsy, be given a mask over your face to breath, and be put under an anaesthetic so you sleep.
The procedure
During the operation, your legs and tummy will be covered with sterile drapes. The doctor will use a speculum to view the cervix (the neck of your womb). They will then use instruments called dilators to gently stretch the cervix so that they can pass the thin plastic suction tube into the womb and remove the pregnancy tissue. A member of the team will often scan your tummy at the same time to help perform the procedure and to try and make sure that all the pregnancy tissue is removed.
Sometimes we perform the ultrasound by inserting a probe into your bottom (rectum, i.e. a ‘transrectal’ scan). This may allow more detailed views of your womb while doing the procedure. Sometimes we will give you medication (misoprostol) into your bottom to help the womb to contract, and to reduce bleeding.
You may notice some ultrasound gel, or some unabsorbed tablet, if you open your bowels soon after the procedure.
The whole procedure usually takes about 20 minutes to complete.
Recovery
Once the procedure is finished you will be taken to the recovery unit where the team will wake you up from your anaesthetic.
You may feel a little groggy, nauseous or have pelvic cramps after the procedure: this is normal. Your nurse can give you medication to help with this.
The SMM procedure is usually a ‘day case’. This means that you do not need to stay overnight in the hospital and will be able to go home the same day. You will need to eat and drink something, pass urine, and feel steady on your feet before you leave.
You must have a responsible adult (over the age of 18) to take you home after your procedure. You will also need somebody over the age of 18 to stay at home with you for 24 hours after your operation, who should be aware that you have had a procedure.
All treatments and procedures have risks, and we will talk to you about the risks of this procedure when we ask for your written consent. Overall the risk of serious complications is low.
Heavy bleeding
Sometimes, during the procedure, you may bleed very heavily. Very rarely, you will need a blood transfusion (donated blood given through the cannula in your arm).
Occasionally you will bleed heavily when you are at home. This can be a sign that some pregnancy tissue is left inside, and you should contact the early pregnancy unit if you are concerned, or attend A&E in an emergency.
Infection
Any procedure has a risk of infection, and the risk of infection for this procedure is low.
If you develop signs of infection (fever, chills, worsening tummy pain, or discharge with a strong, unpleasant smell), you should contact the early pregnancy unit or attend A&E. If infection occurs, you will need antibiotics, and you may require admission to hospital.
Injury to the womb (perforation)
There is a risk of the instrument we use for the operation going too far and causing a small hole in the muscle of the womb, called a perforation. The risk is small: it happens in less than 1 in every 200 operations. Often, this hole will heal without any need for further surgery, but you might need to stay in hospital overnight for monitoring, and to have antibiotics.
Occasionally, we are worried that you may be bleeding inside the tummy, or that there may be injury to other organs, and a laparoscopy (keyhole surgery) or laparotomy (surgery through a bigger cut on your tummy) may be required.
Intrauterine adhesions
Generally the lining of the womb heals very well after surgery. Adhesions is the term for scar tissue that can form within the womb. Although mild scarring is commonly seen after miscarriage (including miscarriage managed without surgery), it rarely has any implications for the future. Severe adhesions are uncommon, but may result in difficulty getting pregnant in the future. We do not fully understand what causes some women to develop severe adhesions, and others not to.
Severe adhesions may present with absent or very light periods. If you have not had a period within six weeks of your surgery, or your period is very light, we may suggest a repeat scan or camera test(hysteroscopy) to look inside the womb and check for these.
Unsuccessful treatment
Sometimes, in spite of our best efforts to remove all the pregnancy tissue, a small amount of tissue will remain. A common sign of this could be your bleeding being particularly heavy, or continued bleeding beyond two weeks after the procedure. The risk of this is approximately one in twenty. Often this tissue will pass by itself, but sometimes you will need an additional surgical procedure to treat it.
Thrombosis
After any operation there is a small risk of blood clots forming in the veins in your legs and pelvis (DVT). The clots can travel to the lungs (PE) which can be serious.
You can reduce the risk of clots being as mobile as you can as early as you can after your operation, and doing leg exercises when you are resting. You will also be given anti-thrombotic stockings (TEDS) to wear during your operation. If you are considered very high risk, you may be advised to have a course of blood-thinning injections.
You will have a blood test prior to your procedure that will show your blood group and your Rhesus status.
If you are Rhesus negative (eg. O negative) then you will require an Anti D injection during or after your procedure, in order to prevent you from developing antibodies which could cause problems in future pregnancies. We will provide you with more information about this should you need it.
Pregnancy tissue that is removed during a surgical procedure is handled sensitively, and in accordance with your wishes. We recommend histology examination (where the tissue is examined under a microscope) to exclude a molar pregnancy (a rare cause of miscarriage, which requires further follow-up). We do not write to you with these results unless they are abnormal. For some women with recurrent miscarriage, cytogenetic testing is recommended, and this will be discussed further with you.
After testing, many women then choose for the hospital to handle the pregnancy tissue by communal cremation. Other women prefer to take the pregnancy home with them. We will discuss your options with you, and ask you to sign a form about your choices.
You can also discuss your options with the bereavement midwife on 07539 215 484.
You can shower or take baths when you get home, but it’s a good idea to have someone nearby in case you feel dizzy. You may experience some pelvic cramps for a few days after your procedure. You can take over-the-counter painkillers (e.g. paracetamol and/or ibuprofen) for this.
During the first 24 hours after a general anaesthetic you may feel more sleepy than usual and your judgement may be impaired. If you drink any alcohol, this might affect you more than normal. You should have an adult with you during this time and you should not drive or make any important decisions.
After the procedure, we expect you to bleed relatively heavily for one to two days, possibly with some clots. Lighter bleeding may continue for up to two weeks. If your vaginal bleeding becomes very heavy (filling more than one large sanitary pad every hour for two consecutive hours) or your pain is unmanageable at home, or you become unwell with signs of infection, you should attend A&E.
During the first two weeks following a miscarriage, or until your bleeding has stopped, you should avoid having sex, swimming, or using tampons to reduce the risk of infection.
Follow-up is not usually needed, but if your bleeding continues for longer than two weeks, or you have other concerns you should contact the Early Pregnancy Unit for advice.
When you return to work depends on you and how you feel. It is advisable to rest for a day following your operation. Although you may physically feel back to normal within a day or two, many women find they need longer emotionally.
You can ask your doctor for a sick note on the day of the procedure. If you need longer than two weeks, you should see your GP.
You will usually get your next period 4-6 weeks after surgical management of miscarriage. If you feel physically and emotionally ready, you can start trying for a pregnancy after this period. It is possible and safe to get pregnant even before this first period, but our advice is generally to use contraception in this time. This is so, when you do get pregnant, you will know how far along you are (which helps us know what to expect on scan), and also to make sure you are healthy for a new pregnancy.
For women who have had a previous miscarriage managed at UCLH, we offer a reassurance scan via our walk-in clinic at 7 weeks’ of pregnancy.
It is common to experience profound sadness and grief after a miscarriage. Some women and their partners find that these feelings persist for a long time. Other people experience anxiety, depression, and post-traumatic stress after a miscarriage. If you are struggling emotionally, it is important that you discuss this with your healthcare professional in hospital and your GP.
You may find some of the support organisations listed at the end helpful. You may also need more formal support or treatment, for which your GP can help or refer you.
You can also self-refer to your local counselling service, via “NHS Talking Therapies”.
You may find the following organisations helpful:
The following website may be helpful for information about general anaesthetic:
If you have questions or concerns about the care you received, you can contact PALS:
PALS
The Patient Advice and Liaison service (PALS) is a service which offers general support, information and assistance to patients, relatives and visitors.
Telephone: 020 3447 9975 Email: PALS
Address: PALS, Ground Floor Atrium, University College Hospital, 235 Euston Road, London, NW1 2BU
Early Pregnancy Unit
Direct line: 020 344 76515 (please leave a voicemail) Email: uclh.
Opening Times:
Monday- Friday 09:00 – 12:30 and 14:00 – 15:00
Saturday and Sunday 09:00-12:30 (A&E referrals only)
If you are running late or need to cancel the procedure on the day, you can call the department that is expecting you:
- Surgical Admissions Unit: 0203 447 3184
- Day Surgery Unit: 0203 447 0205
The Early Pregnancy Unit is located in the lower ground floor of the Elizabeth Garrett Anderson Wing. Follow signs to “Clinic 3”.
The Surgical Admissions Unit (Level 1) and the Day Surgery Unit (Level 2) are both in the main hospital.
Page last updated: 20 May 2024
Review due: 01 May 2025