ERPC is an acronym that stands for “Evacuation of Retained Products of Conception”. It is an operation to remove any remaining products of conception in your uterus (womb) after a miscarriage or termination of pregnancy.

An ERPC must be carried out under anaesthesia condition when the patient is asleep and the operation might take between 5-10 minutes to complete. There is no need for cuts or stitch during the operation because it is done through the vagina. The cervix is stretched open and a long instrument is inserted to remove the remaining products of conception from the uterus (womb).

Prostaglandin tablets may be required for this procedure. Your GP inserts the tablets into the vagina which help the cervix to open prior to the procedure and hence, reducing the risk of your cervix being damaged during the procedure.

Risks of ERPC

ERPC is very safe, but every operation has its risks. The risk associated with ERPC is categorised as follows.

1. Complications of anaesthesia

 The anaesthetist should ensure he sees you prior to your operation to discuss the anaesthetic procedure with you. Some of the most common complications that may occur after anaesthetic include postoperative nausea, respiratory depression, vomiting, acute myocardial infection, delirium and fever.

2. General complications of any operation: general complications that may occur in any operation, as well as ERPC, include the following:

  • Pain: you may experience some pain after ERPC which is similar to normal menstrual pain. Pains should be controlled with simple painkillers such as aspirin.
  • Bleeding: You may experience some amount of bleeding from the vagina following your operation. The bleeding might be similar to that of a normal menstrual flow which should be settled after a few days. Severe bleeding might occur in some rare cases (usually 1 out of every 2000) in which blood transfusion or a further operation will be needed.
  • Infection: In some rare cases (usually 3 out of every 100), there is a small risk of getting an infection in your uterus (endometritis). This infection causes tummy pain and worsens bleeding a few days after the operation. Antibiotics can be taken to treat infections.

3. Specific complications of this operation:  some specific complications that may be associated with ERPC are as follows:

  • Puncturing the uterus (perforation): A uterus carrying a pregnancy is always very soft and it is possible to inadvertently make a hole in the uterine wall with the surgical instrument. This is an uncommon risk that happens in less than 5 in every 1000. When this happens, the surgeon may need to perform a laparoscopy to ensure there is no damage inside. If bleeding is serious or when there is bowel damaged, it will need a surgical operation and you may need to stay longer in the hospital.
  • An incomplete evacuation: It is not possible for the surgeon to see inside the uterus, and as a result of this not all the blood clots and placenta will be removed. The remaining uterine contents may just come away naturally in some cases.  Another ERPC may be carried out if bleeding continues or becomes very heavy.
  • Damage to the cervixthis riskis very rare, it happens to 1 out of every 10,000. It may occur when the cervix is stretched open.

Benefits of ERPC

An ERPC is a quick, simple and essentially safe procedure, which will reduce the amount of vaginal bleeding and allows the body to get back to normal quickly.

What to bring along when coming for ERPC

  • Sanitary towels
  • Dressing gown
  • Slippers
  • Something to occupy your time while you are waiting e.g. book or magazine.

What to expect after ERPC

 You are likely to experience some cramping a few days after your operation. Pains can be suppressed by regular analgesia such as paracetamol making you more comfortable.

It is normal if you experience some bleeding or discharge for a couple of weeks following the operation.  You should try as soon as possible not to use tampons and you must not resume sexual intercourse until the bleeding stops. You should contact an emergency clinic as soon as possible if bleeding becomes very heavy.

After the bleeding period, your next period should probably come in about 4 to 6 weeks after the operation. It might take a long time if you experience an irregular period. It will be needed you take a pregnancy test 3 weeks after the procedure especially when you were still having sex during this period.

The effects of the anaesthetic stay in your system for up to 48 hours after your operation. As a result of this, you must not drive or operate machinery during this time. If you must drive, then you must check the recommended guideline of your own insurance company regarding driving after a general anaesthetic. You will need assistance going home after the operation, you can go home by car accompanied by a responsible adult who must stay with you for at least 24 hours.