Sensitive arrangements for pregnancy tissue after miscarriage and/or surgical treatment

If you give your permission, we will look at a small portion of the pregnancy tissue under the microscope, which is known as histology examination. We usually get the results of this within four weeks. Usually the results are normal, and we do not contact you. 

Abnormal results are rare and occur when the placenta develops abnormally. This is known as a ‘molar pregnancy’ or ‘gestational trophoblastic disease’. Although this is an uncommon cause for miscarriage it is important because if diagnosed, we need to arrange further tests of your pregnancy hormone levels to be sure that the pregnancy has completely resolved. We will contact you if examination suggests molar pregnancy. We will not contact you if it is normal (not molar). 

Please note, histology examination is different from a cytogenetics (chromosome) analysis, which is not usually recommended unless you have experienced three early pregnancy losses (see “what happens to the tissue if I have cytogenetic examination?” below). 

After examination, the small portion of the tissue that has been examined under the microscope may be kept indefinitely as part of your medical record. It will ultimately be disposed of with other clinical matter by incineration (heat treatment): this corresponds to option “A1” on the “Record of wishes” form, and is also what happens if you choose to “Opt Out” of further discussion. Sometimes, especially when the pregnancy loss is very early, or a miscarriage has already started, all of the tissue will be included in this histology testing (this happens in approximately one out of every four cases).  

Occasionally women would like the portion looked at under the microscope handled sensitively, and choose option “A2” on the “Record of wishes”. Tissue that has been looked at under the microscope cannot be released for four weeks, which may cause a delay to your further plans. Some people may choose to collect this small, tested portion of the sample separately at a later stage; others may choose to wait four weeks to collect everything together.

Incineration is the burning of tissue and is how most tissue samples in the hospital are handled: when pregnancy tissue is involved we ensure it is kept separate from other samples.

Cremation takes place at Islington Crematorium approximately every month.

The remains of the pregnancy would be placed in a small container and kept in the mortuary until taken to a local crematorium. A number of containers are then transported and cremated together in a shared coffin, and each is handled throughout the process with respect and dignity.  

There is no religious service. The ashes are scattered in the garden of remembrance, which you can visit if you wish. It is not possible to collect ashes. 

You don’t need to pay for these services.  

It is not possible for you to attend the cremation service. If you would like to know the date of the service, please contact the bereavement midwife (details at end). If you have a specific request, please discuss your options further with the chaplaincy (details at end) to see if this is possible.  

On occasion, there is no other tissue remaining after the histology examination. Unless you have chosen option ‘A2’, this would mean that no tissue would be left for cremation. We will not routinely contact you to tell you that no tissue was sent to the crematorium, but you are welcome to contact the bereavement midwife to confirm this.

If you are a person who would like to choose a service, burial, cremation or other remembrance, private arrangements may allow for this. To do this, you should contact a funeral director, your own religious leader or the hospital chaplaincy, who can advise you. Please be aware that the hospital would not pay for any costs of this which you would have to pay yourself. The costs vary considerably between funeral directors, and will depend on the arrangements and type of service you request.  

You will need to keep hold of a copy of your “Record of wishes” form to give to those arranging the service. The bereavement midwife will contact you when the pregnancy remains are ready to be collected from the mortuary. If you would like an update on when it will be ready to collect, you can contact them using the number or email address at the bottom of the page.  

Please note that we are only able to keep any pregnancy tissue for 3 months: we will try and contact you twice during this time, but if we do not hear from you then we will assume you have changed your mind and the remains will be cremated by the hospital, as described above, without further notice.

Yes, you may decide to bury the pregnancy yourself. Please be aware that there may be regulations about how and where you do this, and you may need to contact the land-owner and your local authority. Another alternative you may consider would be to bury the tissue in a pot with a plant or flowers.  

The bereavement midwife will contact you when the pregnancy remains are ready to be collected from the mortuary. If you would like an update on this timing you can contact them using the number or email address at the end. Please note that we are only able to keep the remains for 3 months: we will try and contact you twice during this time, but if we do not hear from you then we will assume you have changed your mind and the remains will be cremated by the hospital as described above without further notice.

Sometimes when we look at the tissue under the microscope, we cannot see any pregnancy tissue. This may be the case if there is only blood clot, or cells of the lining of the womb (endometrium). In some cases this will have implications for your care (for example, we may need to check that the pregnancy tissue has passed or been removed completely), and for this reason we may be in touch with you. 

If there is no pregnancy tissue then we are unable to offer cremation of the tissue, as the crematorium is unable to accept non-pregnancy tissue. We therefore incinerate the non-pregnancy tissue, unless you have opted for private arrangements, in which case we will contact you to re-discuss your options.

It is common and normal not to want to think about what happens to the pregnancy tissue after pregnancy loss or termination.  

As explained at the start of this leaflet, if this is the case for you, then we will fill in our “Opt Out” form, indicating that you have been offered further information but have declined detailed discussions. 

In this situation, the tissue will be examined histologically, and then stored and incinerated after 3 months because we recognise that your feelings may change over time. If you change your mind and would like to discuss your options further, you can call the bereavement team. It will not be possible to change your mind if more than 3 months have passed since the loss.

It is common and normal not to feel ready to make a decision. You may wish to have time to think, or to discuss with your partner,  family or your religious leader. You can indicate this in option B4 on the “Record of wishes” form.  

We ask you to call the bereavement midwife within 3 months to confirm your decision. If you have not contacted us within 3 months then the remains will be cremated by the hospital as described above. We will not contact you before going ahead with this.

In this case, it will often pass on the toilet, and it often happens that the tissue is flushed away. Alternatively, you may decide to bury the pregnancy tissue yourself.  

You may prefer to bring the pregnancy remains to the hospital for incineration or cremation, in which case you should contact the early pregnancy unit nurses (see contact details at the end) to arrange this. Please bring it in a container that you do not need us to return to you (such as a clean, empty plastic container with a lid). If you bring it in to us, we will be able to offer examination under a microscope, and offer you any of the options for handling described above. If we are able to plan for this in advance, we will be able to provide you with a labelled container to bring in.

Cytogenetic (also known as chromosome, or karyotype) examination is usually only recommended and paid for by the NHS if you have had three early pregnancy losses. If you have cytogenetic examination, the small amount of tissue that is transported to the laboratory outside the hospital is handled by incineration. If you would like instead for the tissue being returned to you, please raise this with your doctor at the time that cytogenetic examination is requested, or contact TDL laboratories within 48 hours of the request (contact details at the end). You will need to either collect this tissue from the laboratory in London yourself, or ask them to post it to you.

Once each year, on the first Sunday in May, the hospital arranges a memorial service for families who have suffered pregnancy loss. Please email our bereavement midwife for details of this if you would like to attend. 

The charity Saying Goodbye also organise remembrance services across the UK.  

Some couples feel an official government issued certificate of pregnancy loss would be beneficial to them. You can apply for this via the government website: https://www.gov.uk/request-baby-loss-certificate

• The Early Pregnancy Unit can be contacted on 0203 447 6515 (please leave a message, which will be picked up during working hours Monday-Friday 9am-5pm), or via email on uclh.epunurses@nhs.net 
• The Bereavement midwife can be contacted in working hours on 07539 215484, or by email on uclh.bereavementmidwife@nhs.net 
• You may wish to speak to the chaplaincy team. They can be contacted on 0203 447 3007. You can ask to speak specifically to the chaplain of your faith.  
• TDL Laboratories, who carry out any cytogenetics testing, can be contacted on 0207 307 7409, or by email at CytoGenetics@tdlpathology.com 
• You cannot contact the histopathology laboratory directly.

Miscarriage Association

Telephone: 01924 200799

The Ectopic Pregnancy Trust

Telephone: 01895 238025

Saying Goodbye (The Mariposa Trust)

Antenatal Results and Choices