Do you need a curettage after a miscarriage?

Diagnosis of a miscarriage: it is a nightmare for affected parents, but sad routine for many doctors. Her explanations about the further medical procedure after the miscarriage are correspondingly sober. In many cases, an appointment to have the uterus removed is almost standard. But this is not always necessary, especially in early pregnancy.

What happens during an abortion after a miscarriage?

A miscarriage curettage is a brief surgical procedure that removes the remains of the embryo and placenta from your uterus. This is to avoid infections and prolonged bleeding. The procedure is usually performed on an outpatient basis and under general anesthesia. The doctor first dilates your cervix in order to reach the uterus and scrape out the remaining pregnancy residues. For the scraping itself, he uses a spoon-like instrument that can be sharp or blunt. When using a sharp curette, the procedure is called abrasion. If a blunt spoon is used, it is called a curettage. With a suction curettage, the scraping is carried out using an electric suction device. Examination of the removed tissue may be able to determine the cause of the miscarriage. However, since such an examination is very time-consuming, this usually only happens if you have already suffered several miscarriages. For more information on the causes of a miscarriage, you can also read our article “Miscarriage: When Pregnancy Ends Early, ” learns.

After the excision rest and protection

After a curettage, you should definitely take it easy and not work or engage in any other physical activity. Light bleeding over the next few days is normal and nothing to worry about. However, if the bleeding gets heavier and you get fever and pain, see your doctor immediately. In very rare cases, the wall of the uterus can be injured during a scraping. Even if such injuries usually heal without complications, you should have the healing process checked.

Excavation not always necessary

Whether a scraping after a miscarriage is medically necessary depends primarily on the stage of your pregnancy and the type of miscarriage. Especially after a miscarriage in the first six to eight weeks of pregnancy, there is a good chance that the fetus will be expelled completely on its own with heavy bleeding within a few weeks. It is also often the case that a woman who has a miscarriage does not know anything about her pregnancy in the first few weeks and confuses the bleeding described, which is also referred to as a “natural miscarriage”, with her menstrual bleeding.

However, if the pregnancy has already been established, many doctors recommend a scraping after a miscarriage in order to avoid complications and end the pregnancy as quickly as possible. The conscious decision for or against a curettage is very individual: Some women want to say goodbye to their pregnancy and their unborn child in peace and therefore prefer a “natural miscarriage”. This step is important for them to process and cope with their grief. Other women, on the other hand, cannot bear the thought of continuing their pregnancy until the onset of bleeding and want to undergo a curettage as soon as possible.

When is a scraping inevitable?

Even if a scraping can be avoided by waiting for a “natural miscarriage”, it is not always avoidable. If the following circumstances exist or occur, a curettage is necessary:

When is an excavation necessary?

• After a miscarriage in the eighth to twelfth week, remnants of the placenta often remain in the uterus, even after a “natural miscarriage” . These should be removed in any case, as they can prevent you from getting pregnant again.
• After a “natural miscarriage”, your doctor will check the levels of the pregnancy hormone human chorionic gonadotropin (hCG) , which is responsible for maintaining the pregnancy. If the value does not drop significantly even after a “natural miscarriage”, a scraping is unavoidable.
• A so-called hydatidiform mole must also be excavated. One speaks of a hydatid mole when the egg has been fertilized but no embryo has developed. You can find out more about the different forms of miscarriage in our article “ Abortion: forms and differences of a miscarriage ”.
• If the bleeding after a “natural miscarriage” lasts longer than a week and is associated with severe pain, a curettage is often unavoidable.
• If after the twelfth week of pregnancy no heart activity can be detected in your unborn child, it is often necessary to induce labor with labour-inducing drugs and complete it with a curettage.

What else can happen after a curettage and miscarriage?

If you have the blood group characteristic “Rhesus negative”, but your partner has “Rhesus positive”, you will receive a so-called anti-D immunoglobulin injection after a miscarriage. This rhesus prophylaxis is intended to prevent complications arising from a rhesus incompatibility between mother and child with regard to a renewed pregnancy. If necessary, the injection is also administered in the case of a normal first pregnancy or immediately after the birth. You can find out more about this in our article “ Rhesus intolerance: causes and consequences ”.

Midwifery assistance during or after a miscarriage

You can also seek the help of a midwife during or after a miscarriage. The costs for the so-called midwife help are covered by the health insurance companies. A midwife may be able to help you decide whether you want to wait for a “natural miscarriage” or have an abortion. In addition, a midwife can offer you psychological support in the form of talks and bereavement counseling in addition to observing the regression processes after the miscarriage. This is particularly important after such a severe blow of fate as a miscarriage. You can find more helpful information on coping with grief and the importance of processing it in our article “ Bereavement After a Miscarriage ”.

A scraping after a miscarriage is therefore not absolutely necessary. If you have the opportunity and it helps you to process your grief, you can also wait until your pregnancy ends naturally. Physically, nothing stands in the way of a new pregnancy. It is usually possible to get pregnant again four to eight weeks after a miscarriage. It is important that you have processed the grief over the painful loss before getting pregnant again and that you also pay attention to contraception. Take the time you need to gain new courage and look positively into the future.