Evacuation of Retained Products of Conception (ERPC)

ERPC

ERPC is performed to remove tissue related to pregnancy (also known as products of conception) from the womb. This may be done for a number of reasons. The procedure involves gently opening the neck of the womb (cervix) by stretching it. Any pregnancy tissue within the womb is then removed using suction The procedure takes about 10 to 15 minutes but you will in hospital for a few hours.

Before your operation

A doctor or nurse practitioner will ask you some questions in order to record your medical history. You will also have routine blood samples taken (full blood count and blood group) and your admission to the ward will be arranged.

You will be advised to have nothing to eat (including sweets and chewing gum) for 6 hours before your procedure. You can have sips of water, which you may have up until you go to theatre.

You will be given information about your procedure and you will be able to ask any questions that you may have.

You will then be asked to sign a consent form.

The procedure is often done under general anaesthetic (GA), which means you are asleep for the procedure. If this is the case, you will be seen by the anaesthetist before your procedure. The anaesthetist is responsible for giving you a general anaesthetic. There is a small risk associated with any general anaesthetic.

You will be seen by the surgeon (and anaesthetist if you are having a GA) prior to the procedure and can ask any questions.

If having a GA, you will be walked to theatre, or taken on a trolley. The anaesthetist will put a small needle into the back of your hand or arm to inject the general anaesthetic. If you have any further questions, please ask a member of staff.

What are the benefits of ERPC?

The benefits of having an ERPC are that it removes the any tissue relating to pregnancy, allowing you to recover quickly, usually with minimal bleeding afterwards. Return to work and normal life is usually possible within a few days.

What are the risks?

When you are asked to sign the consent form, the person obtaining consent will explain the procedure and inform you of any risks. There are a few risks associated with having an ERPC:

• There may be some blood loss during this procedure
• On rare occasions (1 to 3 in every 1000 cases) this loss is heavy enough that a blood transfusion may be needed, or a course of iron tablets will be prescribed, which needs to be completed.
• In 4 in every 100 cases, the womb (uterus) there may be a small amount of pregnancy tissue that remains, often your bleeding after will manage this. However, if you have bleeding that continues for more than 2 weeks after the procedure, or it becomes heavy then you should arrange a review. Further intervention may need to be considered.
• There is a 1 in 1000 chance that the uterus can be perforated at the time of the procedure. This means a small hole is unintentionally made in the womb wall and is usually recognised by the surgeon at the time. In rare circumstances damage can also occur to the bowel, bladder or a blood vessel. Further surgery may be needed and this may require a longer stay in hospital, but it should not have any long-term effects. Further surgery may involve having a laparoscopy or mini-laparotomy. Laparoscopy is the insertion of laparoscope (camera) through a small incision into the abdomen. Laparotomy is an incision into the abdomen.
• In 4 out of every 100 cases there is a risk of developing an infection after the procedure. Occasionally you may be given antibiotics at the time of the operation. It is advisable not to use tampons after the procedure (you can use these again with your next period) and not to have sexual intercourse until the bleeding has settled. If you notice that your discharge is offensive smelling or you feel hot and flushed, you should see your GP as soon as possible. The GP may take some vaginal swab tests and give you a course of antibiotics. It is important to have any infection treated, as untreated pelvic infection may lead to further complications.
• Following surgery there is a very small risk of developing a pulmonary embolism (bloods clot in the lungs) or a deep vein thrombosis (blood clot in the leg). Should you have any chest pain, shortness of breath or any leg pain or swelling then please gain urgent medical advice.

After your operation

If you have had a GA, you will wake up in the recovery room next to the theatre. You will have an oxygen mask on your face. Your blood pressure will be taken regularly. When you have recovered from the anaesthetic you will be taken back to the ward. At first, you will feel drowsy and may need to sleep. If you have any discomfort, please let your nurse know and you will be given pain relief.

If your blood group is rhesus negative you will be given an injection of Anti-D Immunoglobulin.

Discharge from hospital

Usually, you can go home a couple of hours after the procedure providing that you are comfortable, your blood pressure is normal, there is no heavy bleeding and you have passed urine.

If you are going home on the same day as the procedure , a responsible person must accompany you home and stay with you for 24 hours. You must not drive for 24 hours after a general anaesthetic.

You may have some light bleeding for 7 to 14 days. If it continues, or you have pain, an unpleasant discharge or you are feverish, you should contact your GP.

You may also have some slight abdominal discomfort for a day or two after your surgery. Over the counter pain relief and be used to help this.

We advise you to take a urinary pregnancy test 3 weeks after your procedure to check that it is negative.

We also advise you not to have unprotected sexual intercourse until your pregnancy test is negative.

Return to work

Usually, you will be able to return to your normal activities a few days after your procedure.

However, this varies from person to person and some women feel the need to take more time both for physical and emotional reasons.

Contact information

A hospital clinic appointment is not routinely arranged. If you have any questions or problems, please contact your GP.

Gloucestershire Domestic Support Service (GDASS)

This is a county-wide service offering a variety of support programmes for women and men over 16 years old who are experiencing domestic abuse.

Tel: 01452 726 570

Monday to Friday, 9:00am to 5:00pm

Domestic Violence Helpline

Tel: 0808 2000 247 (24 hours)

Email: support@gdass.org.uk

Website: www.gdass.org.uk