Evacuation of Retained Products of Conception (ERPC)
You may be required to undergo this procedure if you have been diagnosed to have incomplete miscarriage or a missed miscarriage. Retained products of conception can often be removed through the cervix using an instrument called suction curette (narrow plastic tube). This is a special type of suction tube used to remove products of conception (Pregnancy tissue). It uses negative pressure (suction effect) to gently remove pregnancy tissue. The cervix (neck of the womb) may require dilatation (gentle opening of the cervix) before the suction tube is passed through the cervix into the womb. Because it goes through the cervix, it is not necessary to make an incision. The procedure is done in an operating room setting. The procedure is performed most times under general anaesthesia. You will have a drip in your arm, which will allow you to have fluids until you are able to drink normally.
What Kind of examination will your Doctor be performing before the operation? You may have a pelvic examination to determine the rough estimate of the length of pregnancy. During this examination a swab sample may be taken from the vagina to check for a bug called Chlamydia. If this test is positive, you and your partner will require antibiotics treatment. An ultrasound scan may also be performed in the hospital or clinic to help make diagnosis of miscarriage.
The pre-operative Assessment Before your surgery you will be assessed by a member of the nursing staff or doctor, who will ask questions about your previous medical history and will arrange for some tests i.e. blood test (the blood test will include your Rhesus blood group. If you are Rhesus negative, an injection is given after the operation to prevent antibodies forming. Such antibodies can produce blood-cell damage in subsequent newborn children (causing jaundice and anaemia).
What to do before coming to Hospital You will come into hospital the day of your operation. You are required to starve to reduce the complication of anaesthesia.
What happens after the operation? After the operation we will take you to the recovery room. Once you are awake and breathing on your own we will take you back to your ward.
Will I be Pain free? Pain levels vary from person to person but there are different methods of pain relief that we can use so that you remain comfortable. Nurses can also give injections of strong pain relief and when you start eating you will be able to take tablets.
How long will I be in hospital? You will usually be able to go home within 24 hours but it could be later if you are found to be unwell to go home.
Is there anything I need to do when I go home or expect to experience after miscarriage? When you go home we advise you to just do gentle movement to start with and to avoid strenuous effort for the first few days. After this time you can build up to your normal levels of activity but it may not take time for you to regain your previous levels of fitness. During the first few weeks you may notice a bloodstained discharge from the vagina. For the first few days after the operation, you will probably experience some bleeding from your vagina and might experience some cramping pains low in your abdomen. You can use a sanitary towel to protect your clothes from the bleeding, and the pain can usually be relieved by your usual pain-killers. Sometimes, there is very little bleeding or no bleeding at all. Please don’t use tampons for this bleeding because they might introduce infection to your womb.
I am worried I might have an infection after a miscarriage All surgical procedures carry a small risk of infection. If you develop the following symptoms after ERPC, you might have an infection in your womb: A raised body temperature (greater than 37°C); Smelly vaginal discharge; Pain or discomfort in your lower abdomen that is getting worse rather than better;
How can I reduce the risk of infection after ERPC? Bleeding from your vagina that is increasing rather than getting better or that has lasted past 14 days after the ERPC. To reduce the risk of infection, after a miscarriage don’t use tampons during the subsequent bleeding – you can use them again for your next proper period. It is also not a good idea to have long, soaking baths, as the bath water will get into your vagina – shower if possible.
What should I do if I have an infection after a miscarriage? If you have any of the symptoms of an infection (listed above), don’t panic. Contact your general practitioner (GP) who can offer you some advice and treatment. If this is not possible, you can come back to the hospital.
I am worried I will get pregnant again after my miscarriage Many women are worried that if their method of contraception has worked. It would be advisable you make an appointment to attend the family planning clinic or see your GP.
How will I feel emotionally after a miscarriage? In the first few days after a miscarriage, your feelings can be quite mixed up. This is partly the result of what can seem a stressful experience and partly due to hormonal changes. Having someone to support you through this time can be very helpful, whether it be from your partner, family or friends. If you find that you continue to feel distressed after this time, and talking to those close to you doesn’t seem to make much difference, then contact your general Practitioner. You may resume sexual intercourse after the bleeding or any infection has settled and you have sorted out your contraception if you are not planning for a pregnancy.
Are there any risks associated with this surgery? Risks include:
Heavy bleeding during or following surgery
Damage to the bladder or bowel during surgery
Urinary tract infection
Deep Vein Thrombosis (Blood clot in the veins)
Failure to achieve desired results i.e. failed evacuation of retained products of pregnancy
Very small risk of laparoscopy (Key hole surgery)
Rarely, risk of abdominal operation or hysterectomy
What are the benefits of this surgery? The benefits of this surgery are to remove the products of pregnancy and prevent severe bleeding.
When will I be able to drive? You are allowed to drive if you are able to perform an emergency stop but will need to check details of your cover with your insurance company.