ERPC Leaflet
ERPC Leaflet
ERPC Leaflet
The guideline contains a full list of the sources of evidence we Patient Information Leaflet
have used. You can find it online at: www.rcog.org.uk/
resources/Public/pdf/green_top_25_management_epl.pdf.
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In some miscarriages the womb (uterus) empties itself completely Ward 11A South (All other times, including bank holidays) Tele-
“Complete Miscarriage”. In this type no further treatment is needed. phone no: 01438 286195; 01438 286193
In some cases, though, an ultrasound scan shows that the baby has died Jacqui Hylton, Bereavement Midwife—07770 280868
or not developed but has not been physically miscarried
“Missed Miscarriage”. The Miscarriage Association: 01924 200799 (Monday-Friday 09:00 –
16:00) www.miscarriageassociation.org.uk
Sometimes when a miscarriage occurs, not all the pregnancy tissue in the
womb comes away. Although the pregnancy is over, symptoms of pain and
heavy bleeding continue “Incomplete Miscarriage”. Early Pregnancy Association
www.miscarriageassociation.org.uk
In the case of a missed miscarriage or an incomplete miscarriage, the
pregnancy will fully miscarry in time, but the miscarriage may also be man- Womens Health
aged surgically or medically. You will usually be offered a choice, or the 52 Featherstone Street,
doctor might make a recommendation. London,
ECIY 8RT
Surgical Management: ERPC Tel no 020 7251 6333
This is an operation to remove the remains of your pregnancy and it is usu- E mail www.info@Womens Health London.org.uk
ally done under general anaesthetic (you are asleep).
When you leave hospital, a letter (known as a discharge letter) with details You may be advised to have surgery immediately if:
of your treatment will be sent to your general practitioner. You can ask for a
copy of this letter. You are bleeding heavily and continuously
The miscarriage is infected
Your next period will be in four to six weeks time. Ovulation occurs before Expectant or medical management are unsuccessful.
this, so you are fertile in the first month after a miscarriage. If you do not
want to become pregnant, you should use contraception. What does a surgical procedure involve?
You should be able to go back to work after a week or so. It can take longer The cervix (neck of the womb) is dilated (opened) gradually, and a narrow
than this to come to terms with your loss. suction tube is inserted into the womb to remove the remaining pregnancy
tissue.
When can we try for another baby? This procedure takes about 15 to 30 minutes. A sample of the tissue is usu-
ally sent to the pathology department to check that it is normal pregnancy
The best time to try again is when you and your partner feel physically and tissue. It is not usually tested for anything else unless you are having investi-
emotionally ready. gations after recurrent miscarriage.
Any ‘products of conception’ (POC) i.e. tissue or the foetus removed during
the operation, are sent to the histopathology labs to confirm the miscarriage
is complete.
No other investigations are usually carried out into the cause of the miscar-
riage at this time unless specifically discussed with you.
Following this you will be offered the option of having the POC cremated
within the hospital. Please discuss with the nursing staff if you have any
questions regarding this.
Does it hurt? What are the benefits of an ERPC?
The ERPC is usually carried out under a general anaesthetic. It is done For many women, the main benefit is that their miscarriage is “over and
vaginally and you will have no cuts or stitches. You may have some ab- done with” and they feel they can move on more easily. They may be
dominal cramps (like strong period pain) when you wake up and for a few shocked to find out that their baby has died and may not be able to tolerate
days afterwards. You are likely to have vaginal bleeding for up to two “carrying a dead baby” once they find out. With surgical management they
or even three weeks. know when the miscarriage will happen and can plan around that.
Bleeding may stop and start but should gradually tail off during that time. If Are there any disadvantages?
bleeding continues to be heavy or gets heavier than a period, it is best to
contact your GP or the early pregnancy unit/Gynaecology ward where you Some women are frightened of having an anaesthetic, surgery, a hospital
stay, or of something going wrong during the operation. Some prefer to let
were treated.
nature take its course and to be aware of the whole process. Some women
worry that the diagnosis might be wrong and refuse surgery in case there is
Are there any risks? a chance that scans might be wrong. Do not be afraid to see a doctor for
advice if you need to be sure before making a decision.
There is a small risk of infection or injury with any surgical operation and,
more rarely, a risk from having a general anaesthetic. When should I phone for help?
The risk of infection after ERPC is low (about 2 to 3 cases per 100). There You will be given a 24-hour telephone number for the early pregnancy unit/
is a very small risk (less than 1 in 200) of uterine perforation (making a Gynaecology ward to use if you:
small hole in the wall of the womb), and in rare cases, damage to the bow-
el or other internal organs. The risks of haemorrhage (extremely are worried about the amount of bleeding
heavy bleeding), or of scarring (adhesions) on the lining of the womb are are worried about the amount of pain you are in and the pain-
also very low (less than 1 in 200 cases). relieving drugs are not helping
Very occasionally, there is still pregnancy tissue remaining in the womb have a smelly vaginal discharge
and a second ERPC may be needed. get shivers or flu-like symptoms
are feeling faint
What if I get an infection? Will I know? have pain in your shoulders.
Signs of infection are a raised temperature and flu-like symptoms, a vagi-
nal discharge that looks or smells offensive and/or abdominal pain that
gets worse rather than better. Treatment is with antibiotics. In some cases,
you may need a second ERPC.