In some cases, miscarriage can be waited out or managed with medication. But in other cases, a woman’s provider will determine that surgical intervention is a better option. Surgical treatment can be a good option for women who have an incomplete miscarriage, who have an infection, who are experiencing heavy bleeding, or who have medical conditions that make nonsurgical treatment unsafe. There are two different surgical options to treat pregnancy loss: vacuum aspiration and dilation and curettage.
Vacuum or suction aspiration
This procedure is quick, simple, and cost-effective because of the minimal amount of equipment it requires. It’s also a little more convenient because it can be done in an outpatient setting like a healthcare provider’s office.
- How it’s done: The provider inserts a speculum into the vagina to keep it open during the procedure. He or she will numb the cervix with local anesthesia and insert a small plastic tube called a cannula into the cervix. At the other end of the cannula is a device that applies gentle suction pressure through the tube. This moves the nonviable pregnancy tissue out of the uterus and through the tube.
- When it’s done: Vacuum aspiration can only be used in the first twelve weeks of pregnancy, so it’s a good option for early pregnancy loss but it’s not an option for women who experience loss past the first trimester.
- Recovery: This procedure isn’t invasive, so vacuum aspiration doesn’t require any physical recovery time.
Dilation and curettage (D&C)
This minor surgical procedure requires more equipment than a vacuum aspiration. Because it’s a more complex procedure, it needs to be done in an operation room or a surgical center. It’s common to confuse a D&C with a D&E (dilation and evacuation), but they’re not the same thing. A D&E is done later in pregnancy – in the second trimester – and involves more surgical equipment.
- How it’s done: Instead of local anesthesia, women may take pain medication or go under general anesthesia for this procedure. To perform a D&C, the provider will insert a speculum into the vagina, clean the vagina and cervix, and then dilate the cervix. He or she will then use an instrument called a curette to remove nonviable pregnancy tissue from the uterus.
- When it’s done: Most commonly in the first trimester.
- Recovery: Because this is an invasive procedure, it tends to require more recovery than vacuum aspiration. Women usually stay for an hour after the procedure, and they need someone else to drive them home. After about 24 hours they are usually feeling back to normal, but women are advised to not put anything into their vaginas for two to three weeks.
Both vacuum aspiration and dilation and curettage carry a very low risk of infection or injury. Any rare complications that may occur can be treated with antibiotics or a repeat procedure. Women who have a miscarriage in the first trimester likely won’t need to go back to their provider for any tests once it’s complete, but women who experience repeat miscarriages or who miscarry in their second trimester may need to go back to their provider and undergo tests to determine what could be causing the loss.
- “Early Pregnancy Loss.” ACOG. FAQ 090 from the American College of Obstetricians and Gynecologists, Aug 2015. Web.
- “Treatment after miscarriage.” MarchofDimes. March of Dimes Foundation, 2017. Web.
- “Dilation and Curettage.” ACOG. FAQ 062 from the American College of Obstetricians and Gynecologists, Feb 2016. Web.