Having an Evacuation Procedure (ERPOC) for a Miscarriage
What is ERPOC?
ERPOC is a surgical procedure that is sometimes done for miscarriages. During the procedure cervix (neck of the womb) is dilated and the contents of the uterus is curetted out using either a sharp instrument or suction curettage with a vacuum like instrument. It is sometimes known as a D&C.
Is it always necessary to undergo a ERPOC after a miscarriage?
If the miscarriage occurs during the first trimester, about half about the women will not require any D&C at all as the product of conception (POC) will pass out spontaneously. However, miscarriages more than 10 weeks, the POC tends to not be expelled completely requiring a D&C.
After a miscarriage, there are a few options:
- Expectant management: Wait for spontaneous miscarriage to occur naturally i.e on its own.
- D&C: a planned D&C procedure once the diagnosis is confirmed
- Medical termination: You will given some medication either to be taken orally or inserted vaginally to start or complete the miscarriage process.
- You need to discuss with your doctor regarding what option will be best for you.
What anaesthetic will be given for me for the ERPOC?
Majority of the time, you will be given a general anaesthetic for the procedure. You will not feel any pain during the procedure. You could discuss with your anaesthetic doctor regarding other types of anaesthesia.
What are the complications associated with ERPOC?
Most of the time, the procedure will occur without any complications. However, there is a risk of possible complications as listed below:
- Risk associated with the general anaesthesia e.g adverse effect from the anaesthetic drug or breathing problem.
- Laceration or injury to the cervix
- Incomplete evacuation of the uterus that may require a second ERPOC to be done.
- Infection of the uterus
- Perforation of the uterus and injury to the bowel
- Scarring of the cervix or uterus
- Bleeding
Is it dangerous to have repeated ERPOC?
You should only have a ERPOC when it is necessary to do so. ERPOC is not recommended to be done repeated especially for unwanted pregnancies due to failed contraception as it is associated with the above mentioned complications. In patients with repeated ERPOC, there is an increased risk of scarring of the uterus. This could lead to difficulty in conceiving in future and an increased risk of placenta accreta in the next pregnancy.
What should I expect after a ERPOC procedure?
Most of the time you will be able to leave the hospital a few hours after the procedure. You may need to stay longer if there were complications or you have some medical condition. In addition, you may experience mild abdominal cramping and vaginal bleeding which should gradually reduce in amount. Return to normal activities could be done after a few days following the procedure. Please contact your doctor if you have excessive vaginal bleeding, abdominal pain, fever, foul smelling vaginal discharge.
