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

If you give your permission, we will look at a small amount under the microscope. We usually get the results of this within two weeks. Usually the results are normal, and we do not contact you.

Abnormal results are rare and occur when the placenta develops abnormally and grows quickly. This is known as a molar pregnancy, and is an uncommon cause for miscarriage. It is important to detect a molar pregnancy because follow-up is required to ensure it completely resolves. We will contact you if examination suggests molar pregnancy.

Please note, histopathology examination is different from a cytogenetics analysis, which is not usually recommended unless you have experienced three early pregnancy losses (see below).

The small sample that is looked at under the microscope may be kept indefinitely as part of your medical records, or may be disposed of with other clinical matter by incineration (heat treatment). Occasionally women would like this small sample handled of in other ways. However, tissue that has been looked at under the microscope cannot be released for four weeks. Some people may choose to collect this small, tested part of the sample separately; others may choose to wait four weeks to collect everything together.

For some people, it is important for their chosen option to happen as quickly as possible, often for religious reasons. If this is the case, please discuss this with your healthcare professional or the bereavement midwife, and we will try to help.

1. Cremation arranged by the hospital

Cremation takes place at Islington Crematorium approximately once every two months.

The remains of your pregnancy will be placed in a small container. It will be looked after in the mortuary and is then taken to a local crematorium along with other pregnancy losses, each in their own container within a coffin. Although a number of containers are transported and cremated together, each one is handled throughout the process with respect and dignity.

There is no religious service, but a member of staff from the hospital spends a short while at the crematorium in silence. The ashes are then scattered in the garden of remembrance in the St Pancras cemetery, which you are unfortunately unable to join. However, the garden is open to visitors every day of the year. 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 (see contact details at end).

2. Private burial

Private arrangements may allow you to have the type of service or burial that you prefer. To do this, you should contact a funeral director, your own religious leader or the hospital chaplaincy, who can advise on how to do this. Please be aware that you would have to pay the costs. The costs vary considerably between funeral directors, with some offering much of their service for free, but will depend on the arrangements and type of service you request.

You will need to keep hold of a copy of your sensitive handling form (SH 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 below.

3. Burial at home

Alternatively, 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. You might choose instead 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 when it will be ready to collect, you can contact them using the number below.

It is common not to feel ready to make a decision, so please do not worry. You may wish to have time to think, or to discuss with your family or your religious leader.

We ask you to call the bereavement midwife within one month to confirm your decision. If you have not contacted us within three 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.

You may prefer for the hospital to handle the pregnancy remains, in which case you should contact the early pregnancy unit nurses (see contact details below) to arrange to bring it in to us in a container that you are happy for us to keep (such as a clean, empty food container with a lid). If you bring it in to us, we will be able to offer examination under a microscope. If you 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 or cremation. 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 end).

Once each year (usually in May), the hospital arranges a memorial service, to which all families who have suffered pregnancy loss are invited. Please email our bereavement midwife for details of this.

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

Some couples feel an official government issued certificate would be beneficial to them. At the time of writing, the government had announced that this will be available in the near future. They will be able to be back-dated. For up-to-date information ask your healthcare professionals, or ask the support organisations listed below.

• 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)

• 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 do cytogenetics testing, can be contacted on 0207 307 7409, or by email at CytoGenetics@tdlpathology.com

• Miscarriage Association Telephone: 01924 200799
• The Ectopic Pregnancy Trust Telephone: 01895 238025
• Saying Goodbye (The Mariposa Trust)
• Antenatal Results and Choices