Culling after miscarriage: Does it have to be?
Finally it had worked out: Susanne Stiegler (name changed) was pregnant! But in the 9th week, the 39-year-old suddenly started to bleed. Shocked, she called the clinic. She had to come immediately, she told her. The fear quickly becomes sad certainty: the embryo has died. After a brief examination at the clinic, you tell the doctor in a few words what's going to happen now: a scraping. But Susanne definitely does not want that. "I'd rather wait and see if it does not go by itself," she explains several times, even to the senior doctor who is being helped.
I would rather wait, if it does not go by itself.
But the doctors talk to her: If she does not get an immediate operation, she could get "madness infections" or even bleed to death. In addition, one must examine the tissue from her stomach, it could be malignant. Susanne gets it with the fear. In the end, she reluctantly agrees. In the weeks after she feels miserable, taken by surprise - and angry. She starts researching, scrounging through studies and books: was it really so urgently needed a curling, also called Curretage, necessary?
What she reads only stirs her indignation. Because in most cases, surgery after an early miscarriage is not absolutely necessary. The guideline of the prestigious British Royal Society recommends surgery only for severe bleeding, infection or unstable circulation. Or if a rare malformation of the placenta, a molar mole, has formed, which in very rare cases can degenerate into a tumor. All of these complications affect about ten percent of women who have 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 spontaneously complete the miscarriage. And their anger and anxiety grow, because a scraping can even have negative consequences for a later pregnancy. "I was literally cheated," she says.
The trained lawyer decides to sue. A first report, however, rejects their criticism: it has been treated according to German standards, writes the Medical Director of a Bavarian clinic; the judge tells her to withdraw the lawsuit. But she does not give up, researching further studies and evidence. Meanwhile, the court begins to rethink and has made a first settlement proposal, after which the plaintiff would receive a compensation.
Of course Susanne knows: Money does not relieve her pain. But she wants to use the process to help other women stay away from the nightmare: to mourn the loss of her child, to undergo an operation that was unnecessary and forced upon her.
What happens in a miscarriage
About every fifth physician-determined pregnancy ends early, usually in the first twelve weeks: Often it is a natural defense reaction, if an embryo is not "right" develops or dies. However, even in the case of a "natural" miscarriage, a doctor or a doctor must be consulted to rule out dangerous situations. In case of fever, severe pain, very heavy bleeding or an overall unstable state of health, medical intervention is necessary. Miscarriage does not reduce the chances of a successful pregnancy; This is already possible after the next menstrual period. It is often advisable to seek psychological help to process the loss. Ellen Grünberg of the German Midwives Association advises to look for a midwife who accompanies the time of parting. Which of the following methods is used can in most cases be decided by the women themselves.
Some people prefer that the sad process is as natural as possible and that they can gradually say goodbye to the pregnancy. For one thing, they can rely on nature: Studies from the US and Sweden show that in 80 percent of women who simply wait for a miscarriage, within three days, the body itself completely repels the tissue. For some, however, the process took several weeks. He succeeds rather when the bleeding has already begun, as in a "muted abortion", when the heart of the embryo does not beat, but the body of the woman has not responded to it yet.
risks: On average, one out of every ten women who opts for surgery has to undergo surgery and curettage. In addition, women who wait are bleeding on average two days longer and occasionally stronger than after a curettage, but that would usually be dangerous for them.
Medicines containing active ingredients such as prostaglandins are a safe alternative to surgery; they trigger contractions of the uterus or loosen the cervix of the cervix. And they make it two to three times more likely that the embryo will completely go off than just wait.
Side effects: Fatigue, nausea, diarrhea are common in prostaglandins.
Most commonly used in Germany, around 85 percent of AOK insured women who suffered a miscarriage during the first weeks of pregnancy were treated in this way in 2010. Some people consciously choose not to have to wait for bleeding to start on their own - that can take up to ten days. Often women are not offered the alternative "waiting" but also simply not.
The engagement: Most of the embryo and the remaining tissue is aspirated with a tube, but sometimes also scraped with a loop-shaped instrument. Gentler is the suction. Local anesthesia is possible, general anesthesia is more common. The procedure itself takes on average ten minutes, then the woman remains for observation in practice or clinic - at least two hours long.
risks: The complication rate is about two percent. It is the higher, the further the pregnancy has progressed and, above all, the less experienced the surgeon is. Consequences of the procedure can be infections, heavy bleeding and cracks in the cervix. Later, adhesions and scars can develop in the uterine wall - the so-called Asherman syndrome. The consequences range from painful menstrual periods to infertility. Dr. Andreas Nugent, a gynecologist at the day clinic Altona in Hamburg, estimates that every tenth woman is affected after a curettage. If a second intervention becomes necessary because the first one was unsuccessful, the risk doubles.