Women’s health: abortion after miscarriage: is it necessary??

Cervical curettage after miscarriage: Is it necessary?

It finally worked out: Susanne Stiegler (name changed) was pregnant! But in the 9. In her 39th week, the 39-year-old suddenly began to bleed. Shocked, she called the clinic. She had to come immediately, she was told. Fear quickly turns into sad certainty: the embryo has died. After a short examination at the clinic, the doctor tells her in brief what will happen now: a curettage. But Susanne does not want that under any circumstances. "I’d rather wait to see if it doesn’t go on its own", she explains several times, also to the senior physician who is called in.

I would rather wait and see if it doesn’t go by itself.

But the doctors talk her down: If she doesn’t have the operation immediately, she could get "crazy infections or even bleed to death. In addition, the tissue from her abdomen must be examined, as it could be malignant. Susanne gets it with the fear. In the end, she reluctantly agrees. In the weeks that followed, she felt miserable, blindsided – and angry. She begins to research, to look through studies and books: Was a curettage really so urgently necessary??

What she reads only fuels her indignation. Because in most cases, an operation after an early miscarriage is not even mandatory. The guidelines of the prestigious British Royal Society recommend surgery only in cases of severe bleeding, infection or unstable circulation. Or if a rare malformation of the placenta has formed, a bladder mole, which in very rare cases can degenerate into a tumor. All these complications affect about ten percent of women who suffer an early miscarriage – but not Susanne. She realizes that in other countries, such as France, it is more common to simply wait and see if the body can complete the miscarriage on its own. And her anger and worry grow, because a scraping can even have negative consequences for a subsequent pregnancy. "I was really deceived", she says.

The trained lawyer decides to sue. A first expert opinion, however, rejects her criticism: she was treated according to German standards, writes the medical director of a Bavarian clinic; the judge suggests that she withdraw the lawsuit. But she does not give up, researches further studies and evidence. In the meantime, the court also begins to rethink and has made an initial settlement proposal, according to which the plaintiff would receive compensation for pain and suffering.

Of course Susanne knows: money does not ease her pain. But she wants the process to help spare other women the nightmare of having to mourn the loss of their child and endure an operation that was unnecessary and forced on her.

What happens in a miscarriage

About one in five pregnancies diagnosed by a doctor ends prematurely, usually in the first twelve weeks: this is often a natural defensive reaction when an embryo does not develop "properly" develops or dies. However, even in the case of a "natural" miscarriage a medical professional should be consulted to rule out dangerous situations. In the case of fever, severe pain, very heavy bleeding or an overall unstable state of health, medical intervention is necessary. A miscarriage does not reduce the chances of a successful pregnancy, which is possible after the next menstrual period. It is often advisable to seek psychological help to come to terms with the loss. Ellen Grunberg of the German Midwives Association advises finding a midwife to accompany her through the time of farewell. In most cases, women can decide for themselves which of the following methods will be used.

1. Wait and see

Some people prefer the sad process to take place as naturally as possible, so that they can gradually say goodbye to the pregnancy. You can certainly rely on nature for the time being: Studies from the USA and Sweden show that in 80 percent of women who simply wait after the onset of a miscarriage, the body itself completely rejects the tissue within three days. For some, however, the process took several weeks. It is more likely to succeed if bleeding has already started than in the case of a "restrained miscarriage", When the embryo’s heart stops beating, but the woman’s body has not yet reacted to it.

Risks: On average, one in ten women who decide not to have the procedure end up needing surgery, i.e. curettage. In addition, women who wait bleed on average two days longer and occasionally more heavily than after a curettage, but without this usually being dangerous for them.

2. Medication

Drugs with active ingredients such as prostaglandins are a safe alternative to surgery; they trigger contractions of the uterus or loosen the cervix Cervix. And they make it two to three times more likely that the embryo will come off completely than if you just wait it out.

Side effects: Fatigue, nausea, diarrhea occur frequently with drugs from the group of prostaglandins.

3. Scrape

Most commonly used in Germany: about 85 percent of AOK-insured women who suffered a miscarriage in the first weeks of pregnancy were treated this way in 2010. Some people make a conscious decision not to wait for bleeding to start on its own – this can take up to ten days. Women are often given the alternative "wait and see" but also simply not offered.

The procedure: In most cases, the embryo and the remaining tissue are aspirated with a tube, but sometimes a loop-shaped instrument is used to scrape out the embryo. Suction is considered gentler. Local anesthesia is possible, more common is general anesthesia. The procedure itself takes an average of ten minutes, after which the woman remains in the practice or clinic for observation – for at least two hours.

Risks: The complication rate is about two percent. It is higher the more advanced the pregnancy and especially the more inexperienced the surgeon is. Consequences of the procedure can be infections, heavy bleeding and tears in the cervix. Later, adhesions and scars can form in the uterine wall – known as Asherman’s syndrome. The consequences range from painful periods to infertility. Dr. Andreas Nugent, a gynecologist at the Altona Day Clinic in Hamburg, estimates that one in ten women is affected after a curettage procedure. If a second procedure is necessary because the first one was unsuccessful, the risk doubles.

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