Overview

Losing a baby is traumatic, and it can be a difficult time to make decisions. If you have had an early miscarriage, or surgical management of an ectopic pregnancy, there might not be a recognisable fetus or baby. We call this ‘pregnancy remains’

This information explains the options you would have about what happens to the remains of your pregnancy.

We make sure that all babies, and the remains of pregnancies, are treated with care and respect. Our guidelines are in keeping with national guidance on sensitive disposal of pregnancy loss.

After a pregnancy loss

The remains of your pregnancy are routinely sent for histopathological examination if you:

• have surgical management of your miscarriage under local or general anaesthetic
• have surgical management of an ectopic pregnancy
• miscarry at home, and you bring the pregnancy remains to the early pregnancy and acute gynaecology unit (EPAGU) in a clean, dry pot
• miscarry during a hospital stay

This examination will confirm if it was:

• a molar pregnancy   
• the lining of the womb only (which changes when you are pregnant). In this case, you have already miscarried the pregnancy fully, or the pregnancy stopped developing too early.

Molar pregnancy

About 1 in 600 pregnancies in the UK develop into a molar pregnancy. This is where there is an abnormal growth of the cells that should become the placenta. Most molar pregnancies result in a miscarriage.

A molar pregnancy can cause problems even after a miscarriage as it might:

• take more time for your pregnancy hormone to return to its normal level, which will require longer follow-up than usual
• happen again in a future pregnancy

We might recommend that you do not try for another baby very soon after your pregnancy loss.

Why a histopathological examination is needed

A histopathology examination is when a pathologist (specialist in body tissues) examines samples under a microscope. We do this to confirm if you had a molar pregnancy.

The histopathological examination will not tell us why you miscarried, unless a molar pregnancy is found.

A doctor will review all the results, and the histopathology department will contact the EPAGU team if a molar pregnancy is found. You will not be sent a copy of your result unless a molar pregnancy is found. Most miscarriages are not caused by a molar pregnancy.

We recommend histopathological examination of all surgically-removed ectopic pregnancies (usually with the associated fallopian tube) to confirm the diagnosis. It is extremely rare for an ectopic pregnancy to also show molar features.

Genetic testing on pregnancy remains will only be offered if you have had 3 or more miscarriages. This is in line with national guidelines.

After the examination

After your pregnancy remains have been examined, the glass slides and the wax blocks that contain small amounts of the remains will be stored in our hospital archives as part of your hospital records.

In many cases, there is no tissue left after the examination. If there is any remaining tissue, this will be transferred to the mortuary and disposed of according to your wishes.

You should contact the EPAGU or the bereavement clinical nurse specialist (CNS) to find out the result of the examination.

Options after the examination

After you have read the information about your options of what to do with your pregnancy remains, we’ll ask you to sign a consent form confirming your choice. We understand that this is a difficult decision to make. Please talk to the nurse or doctor looking after you, or the bereavement CNS for more support.

If you have not made a decision, we will store any remains left after the examination for 4 weeks. After this time, if you have not told us what you would like us to do, the remains of your pregnancy will be disposed of as stated in our hospital guidelines.

If you want us to dispose of the remains of your pregnancy, these options are available.

Respectful incineration

The remains of your pregnancy will be incinerated. Only other pregnancy remains will be incinerated at the same time.

Communal cremation

The remains of your pregnancy will be placed in an individual, ecological coffin marked as ‘Baby of your name’. They will be communally cremated (with other pregnancy remains from our hospitals). These cremations happen every 3 months at Eltham Crematorium.

A hospital Chaplain will oversee the cremation and can conduct a short blessing with a Christian prayer. If you would prefer a different kind of blessing or no blessing at all, please let us know.

It is not possible for you to attend the communal cremation, but you can visit the crematorium garden if you would like to.

The hospital does not currently offer a burial service.

Private arrangements

If you’re making your own private arrangements, you can appoint a funeral director for burial or cremation, or make your own personal arrangements for burial. The funeral director will arrange for the remains to be collected from our mortuary. All other arrangements will be made between you and the funeral director, and they might charge you for a private funeral. Most funeral directors only charge a small fee, but it will depend on the type of service and arrangements you request.

If your private funeral arrangements do not take place within 12 weeks, we will try to contact you before we arrange a communal cremation.

Personal burial

Wherever you decide to bury the remains, you must check the local council guidelines (on their website) before making any plans or proceeding.

You can consider burying the remains in a garden, a planter with flowers, under a shrub or by a tree. Please consider that you might move house, or the land might be used for a different purpose in the future. Think about how you would feel if you could no longer get access to the site.

There are nationwide restrictions on what you are legally allowed to do, as well as any local laws.

• The burial must not cause a danger to other people.
• The burial must not interfere with the rights other people have on the land.
• The burial must not be any danger to water supplies.
• The burial container must be sealed, with no chance of any leakage.
• The remains must be buried at least 45cms (18 inches) under ground.
• Permission must be sought if you are not the owner of the land.

Please contact the bereavement CNS or EPAGU for the histopatholgy results within 2 weeks of the examination. You must have the results before you appoint a funeral director or make any personal arrangements.

Support and more information

Institute of Cemetery and Crematorium Management
Phone 020 8989 4661
www.iccm-uk.com

Human Tissue Authority
Phone 020 7269 1900
email: [email protected]

Miscarriage Association
Phone 019 2420 0795
Email [email protected]  
www.miscarriageassociation.org.uk

The Ectopic Pregnancy Trust
Phone 01895 238025
Email: [email protected]

Charing Cross Hospital - Gestational trophoblast disease service
Phone 020 3311 1409
Email [email protected]
www.hmole-chorio.org.uk/frequently-asked-questions/