Evacuation of Retained Products of Conception (ERPC)

What is an ERPC?

Evacuation of retained products of conception is the medical term for removing any parts of your pregnancy that remain in your womb after a pregnancy has ended. This may include a small fetus, the pregnancy sac, placenta or blood clots.

Will I need an ERPC?

Medical staff often offer surgical management if they are sure that your womb is not empty and/or you are bleeding heavily or having other symptoms such as irregular bleeding or pain. However, if there is very little tissue or blood clots in your womb, they may advise that you wait until you pass the contents of your womb naturally -  letting nature take its course.

Some people find a surgical procedure can help them by giving some closure especially if it has taken a long time to confirm that the end of the pregnancy is still not completed. Others will prefer to let nature take its course or to use medical treatment.

What will happen before my surgical procedure?

A doctor /nurse will ask you about your medical history and make sure that you are fit for a general anaesthetic. The procedure will be explained to you and you will be able to ask any questions you may have. If you are then happy to proceed, a consent form will need to be signed as well as a document expressing your wishes with regard to the sensitive disposal of the remaining pregnancy tissue.

You may be given a small tablet to be placed into the vagina approximately 2 hours before your procedure. In certain cases this is helpful to soften the cervix (neck of womb) and make the operation easier. After the tablet has been inserted you may experience some period like cramps and increased bleeding. Please do not be alarmed if this occurs. If you are worried please seek the advice of the staff at the Elizabeth Suite office*or the staff looking after you in Day Treatment Centre.

What do I need to do before my surgical procedure?

Before the operation you should remove any make-up nail varnish or false nails. If you have false nails and you do not want to remove them all, you may remove just one on each hand.

If you have had heavy bleeding between the time of your scan and the date of the operation, and you feel that the operation may no longer be needed, please contact the Elizabeth Suite office* or let the doctor know as it may be advisable to repeat the scan prior to your procedure to assess if the operation is still appropriate.

What can I eat and drink before my surgical procedure?

If your operation is in the Morning: 7:30 AM:

• Eat normally until midnight before the procedure.
• After midnight you must remain Nil by Mouth. This means no food, but you may drink water only up to 2 hours before you attend your check in time.

If your operation is in the Afternoon: 12:00 PM:

• Eat a light breakfast before 6:00 am
• After 6:00 am you must remain Nil by Mouth, This means no food, but you may drink water only up to 2 hours before you attend your check in time.

Where should I go for my surgical procedure?

On the day of your surgery please attend the Treatment Centre reception - (Ground Floor beside escalator/ Lift Bank B)

What will happen during an ERPC?

You will be taken to theatre and given a general anaesthetic to ensure you are asleep during the procedure. Once you are asleep, your legs will be placed in leg rests and the area around your vagina cleaned with a sterile solution. A speculum will be placed in the vagina to allow the doctor to see the cervix (neck of the womb). The cervix is then gently stretched to allow an instrument to be inserted so that the tissue products can be removed; this is often performed with a suction tube which is more effective at emptying the womb. This takes around 10 minutes and you will have no cuts, scars or stitches.

Are there any complications?

As with any surgical procedure, there are   small risks involved.

Frequent risks:

• Bleeding that lasts for up to 2 weeks (Very common).  
• Heavy bleeding is uncommon (Uncommon 1–3/1000 women).
• Need for repeat procedure if all pregnancy remains are not removed (Common 40/1000 women).
• Pelvic infection (Common 40/1000 women), all women will be offered 7 days of antibiotics after the operation.
• Development of intrauterine adhesions (Common 190/1000 women).

Serious risks:

• Perforation of the womb (Uncommon 1/1000 women).
• Significant tear of the neck of the womb (Rare <0.1/1000 women).

Extra procedures which may become necessary during or after the procedure:

• Blood transfusion (Uncommon 0–3 in 1000 women).
• Laparoscopy (keyhole surgery) or laparotomy (open surgery) to repair complications from a uterine perforation.

What happens following my surgical procedure?

When you return to the recovery room you will still feel sleepy, but physically well, although you may experience some abdominal cramping.

If you have had your procedure at the Treatment Centre Theatre during the day, you are likely to be allowed home the same day. Following a discharge assessment, you should be ready to go home by 1pm after a morning case or 5pm after an afternoon case. Please arrange for an adult to take you straight home in a car or taxi. As you would have had general anaesthetic, you will need someone to stay with you for 24 hours after the procedure.  If, however, you go to the Main theatres as an Emergency or if any complication had arisen, you are likely to have to have an overnight stay for monitoring purposes.

Once you are discharged, you may have abdominal cramps for up to 48 hours after the procedure but you can relieve this with simple pain killers. You may continue to bleed for up to two weeks, on and off after the procedure. The bleeding should not be heavier than a period and is best to use sanitary towels rather than tampons to avoid infection For the same reason please avoid having unprotected intercourse until the bleeding has stopped. If the bleeding is heavier than a period and you experience clots of blood; If bleeding or vaginal discharge smells offensive: If you develop a raised temperature and have flu-like symptoms, you should contact the Elizabeth Suite office*, your General Practitioner (GP) or attend the Accident and Emergency Department if you feel very unwell.

What can I do after my surgical procedure?

• It can take up to 24 hours for the anaesthetic to completely wear off. Please make allowances for this in your activities following the operation.
• If you drive you should always contact your insurance company before you start driving again after an anaesthetic.
• You may feel you need to take some time off work. The length of this is very individual and depends on your physical and emotional state. If you need a certificate you can obtain one from your GP but this is only normally required if you have more than 7 days off.
• You will need to perform a home Urine Pregnancy Test 2 weeks after your procedure to ensure your pregnancy hormones are negative within your body. If the result comes back as positive it is possible that some pregnancy tissue has been left behind, please contact the Elizabeth Suite* as you may need to be assessed further.

The next pregnancy

You can expect your period any time up to eight weeks after your surgical procedure. It may be heavier and last longer than normal. If you have not had your period by this time, you should seek advice from the Elizabeth Suite* or your GP.

You can ovulate (produce an egg) at any time after your surgical procedure and so you may become pregnant before you have a period. If you have intercourse you may conceive, so it is worth reviewing contraception as soon as possible if you want to wait before trying again.

Most doctors advise that you wait until you have at least one period before trying to conceive again. This allows time for you and your partner to recover emotionally and physically and will also help with accurate dating of the next pregnancy. 

Contact details: 

Elizabeth Suite nurses phone line is open between:

0203 315 5073 (admin queries only 9-12pm & 2-4pm Mon-Fri).

0203 315 5070 (clinical queries only 12-2pm Mon-Fri).