Is curettage always needed after a miscarriage?
What retained tissue after a miscarriage means, how it is identified, when a further procedure is needed and what to watch for during recovery.
Pregnancy loss is a delicate time, physically and emotionally. One of the questions asked most often is: do I have to have a curettage after a miscarriage?
Below is what happens to the inside of the womb after a miscarriage, when a clearing procedure is needed, and what matters during recovery.
What the procedure is
When a miscarriage occurs, ideally all the tissue of the pregnancy is expelled from the body through the contractions of the womb and the bleeding — a complete miscarriage. Sometimes, though, part of the pregnancy tissue remains inside the womb. This is called an incomplete miscarriage, and clearing the retained tissue with a small procedure under ultrasound guidance is known as a revision curettage.
How retained tissue is identified
Whether tissue remains inside the womb after a miscarriage — retained products of conception — can only be diagnosed with certainty by gynaecological ultrasound performed by a specialist. Some warning signs from the body can point to it:
- Prolonged, heavy bleeding. Bleeding after a miscarriage that lasts longer than expected or becomes heavier.
- Persistent cramping and pain. The womb continues to contract in order to expel what remains, and severe pelvic pain can follow.
- Foul-smelling discharge and fever. Retained tissue can become infected over time.
When the procedure is needed
Not every miscarriage requires curettage. If ultrasound shows that the womb has cleared completely, the patient is simply monitored. Guidelines indicate a revision curettage in the following situations:
- Bleeding that cannot be stopped. Retained tissue prevents the muscle of the womb from contracting fully and stopping the bleeding. Where bleeding is heavy, intervention is a medical requirement.
- Risk of infection and sepsis. Retained pregnancy tissue is a significant risk factor for serious pelvic infection and for sepsis. Where there are red-flag findings — a temperature of 38 °C or above, shivering, a heart rate above 130 beats per minute, or a general deterioration — the source of infection must be cleared quickly.
- Waiting has not worked. Sometimes, under medical supervision, a period of waiting is allowed for the tissue to pass on its own, with or without medication. If it does not, surgical clearance follows.
How it is done, and what follows
Revision curettage is usually a short, comfortable procedure known as vacuum aspiration, in which the inside of the womb is cleared gently using fine plastic cannulas.
Rules for recovery:
- Preventing infection. Taking the antibiotics your doctor prescribes regularly matters a great deal. To keep the risk of infection as low as possible, use sanitary pads rather than tampons for as long as bleeding continues, and avoid pools, the sea and baths.
- Pelvic rest. To allow the tissue inside the womb to heal completely, avoid sex for the period your doctor advises — generally 1-2 weeks.
- The follow-up appointment. Have your follow-up ultrasound on the date arranged, to confirm that the womb has recovered properly.