SMM, EPRC or D and C after miscarriage: everything you need to know
SMM, EPRC or D and C after miscarriage: everything you need to know
If you're miscarrying or have already miscarried, you might be told you need a surgical procedure called SMM, ERPC or a D&C. We explain what that all means (including what all those initials are about), what to expect – and what it was like for other women who've been through it
We know that having a miscarriage is one of the most heartbreaking things anyone can go through. And if this is something you’re experiencing or have just experienced, we can’t tell you how sorry we are for for your loss.
As well as the emotional whirlwind you’ll no doubt be reeling under, you’ll probably have a hundred questions swirling in your head about what happens next, too: what the subsequent stages are, any procedures you need and how your body will recover.
“You’ll be given various options if you’re having a miscarriage,” explains expert GP Dr Philippa Kaye. “These include waiting for bleeding to start, being given medication to start or speed up this process, or – in some cases – a small surgical procedure. That’s when the terms SMM, ERPC or D&C might come up.”
If you’ve already had a miscarriage (“completed a miscarriage” to use the medical jargon), there is also a possibility that there is still some tissue left in your uterus (womb). And, if that’s the case, your doctor will probably start talking about SMM, ERPC or D&C, too.
We know these abbreviations are very medical and impersonal (and it’s pretty hard to guess what they actually stand for). We also know that the procedure they’re describing is really not talked about all that much.
So we’re going to tell you what the initials mean, what the procedure involves and, most importantly, hear from women who have gone through it so you can get an idea of what to expect.
Please also know that our forum is a really good place to chat to others who are experiencing the same thing, or just to hear from other people who know something of the situation you’re in.
What do SMM, ERPC and D&C mean?
All 3 abbreviations stand for medical terms that pretty much mean the same thing: a small, 10-minute surgical procedure to remove material from your uterus (womb).
SMM stands for Surgical Management of Miscarriage, and is the preferred term used by doctors these days for a procedure during which a small suction tube is inserted into your womb through your vagina, and then used to remove the remains of your pregnancy. It can be done under general anaesthetic but some hospitals will also offer it under local anaesthetic – in which case it may be called (yes, more initials!) MVA, which stands for Manual Vacuum Aspiration.
ERPC means Evacuation of Retained Products of Conception – and has, thankfully, been “retired” as a term by many hospitals because many women (understandably) find it so cold and heartless. It describes exactly the same procedure as SMM.
D&C stands for Dilation & Curettage. It’s a slightly different procedure – normally performed on (non-pregnant) women with period problems – that involves scraping the lining of the womb. Many people refer to SMM/ERPC as “a D&C”, which is why it’s often thought of as something to do with miscarriage.
What will the SMM/ERPC procedure be like?
If you’re having general anaesthetic, you’ll have to fast for a set period before the procedure. When you get to hospital, you’ll be given a surgical robe to wear (for hygiene reasons) and then taken to the operating room – usually on a trolley – before being given your anaesthetic by injection.
You will lose consciousness until you wake up in the recovery room.
Once the anaesthetic is working, your legs will be put up in stirrups, so that the gynaecologist can best access your vagina. The gynaecologist first dilates (opens) your cervix with special instruments, and then inserts a fine, hollow tube into your uterus and clears the pregnancy tissue with suction.
The whole procedure is very quick and you’ll be coming round from the anaesthetic within 20 minutes to half an hour.
You’ll usually be kept in the recovery room for a while where they’ll monitor your vital signs until you’re properly awake.
I went into hospital at 9am and got a bed around 10am. I changed into a hospital gown and a nurse came and took my details and explained what was going to happen and took my blood pressure. After a while, the doctor came to fill in some forms and take blood. After another while, the doctor came and gave me a pessary which softens the neck of the womb. This gave me cramps which became painful and asked for some paracetamol (the other ladies having the same procedure didn't seem to be in pain, though). About 4pm, they took me to theatre and knocked me out. I woke up around 5.10pm and had cramps which they gave me pain relief for. I was taken up to the ward and the nurse helped me change into my nightie and they gave us some tea and toast. I got home at around 8.30pm. My bleeding is just tailing off now, 10 days later.
If you’re having local anaesthetic, you’ll be given some pain killers and a tablet will be inserted vaginally to help soften the neck of your womb.
Then the local anaesthetic will be injected into the your cervix, before the gynaecologist dilates (opens) your cervix with special instruments, inserts a fine, hollow tube into your uterus and clears the pregnancy tissue with suction. It’ll take about 10 minutes.
What happens to the pregnancy tissue that’s removed?
The pregnancy tissue that’s taken out will be sent off for testing (to confirm your miscarriage is complete) but should then be disposed of respectfully, and in a way that you have discussed with hospital staff before the procedure.
What are the risks of SMM/ERPC?
The risks are very small, Dr Philippa tells us.
If you’re having a general anaesthetic, there are the risks associated with any general anaesthetic but you’ll be assessed by an anaesthetist before your operation, and they discuss any issues with you then.
Then there are the risks related to the procedure itself, which are, says Dr Philippa: “pain, bleeding and infection”.
“The risk of an infection in the uterus after the op is about 3 in every 100 women,” she says, “and is generally treated with antibiotics.
“There is a small risk of puncturing the womb during the procedure and of damage to the cervix but both of these events are very uncommon.
“In general, this is a quick and safe procedure which reduces vaginal bleeding.”
How long does it take to recover from SMM/ERPC?
Physical recovery after a D&C is very fast (though, of course, we know the emotional side of a miscarriage can take much, much longer).
Because of the general anaesthetic (if you’ve had it), you’ll need to stay in hospital under observation for a few hours after the procedure, but you may be allowed to go after as little as 2 hours.
You’ll be given some toast and a drink on the ward and will need to pass urine before being allowed home (you won’t be able to drive). If you can, do bring someone you love and trust to support you. You also won’t be able to drive home safely on your own because it can take time for the full effects of the anaesthetic to wear off.
You’ll then need to be watched by a family member or friend for 24 hours after the operation as a precautionary measure, and you shouldn’t drive for 48 hours.
You also shouldn’t use tampons or have sexual intercourse until you have fully recovered (for about a week), and you should avoid heavy lifting for a few days.
You might experience cramps, like period pain, for half an hour to an hour after the procedure, and some women have cramps for the rest of the day. Your usual pain relief medication, such as paracetamol or ibruprofen should take care of this.
You will probably also have light bleeding or spotting. You should, however, seek medical help right away if you experience any of the following:
abdominal pain (more than period-like cramps) or painful cramps that persist beyond a couple of days and aren’t helped by painkillers
heavy or increased vaginal bleeding or clots in the blood
a discharge from your vagina with an unpleasant odour
Will I need to take time off work afterwards?
Physically, at least, you’ll need at least one day off work afterwards to recover, perhaps a couple, but, given that you’ve had a miscarriage, then you are likely to need more time to start to recover emotionally, so do be kind to yourself, and let yourself take the time you need to heal mentally. We cannot stress this enough.
Speak to your GP if you need to; they will be able to sign you off work for the time you need.
As KazzieM on our forum says: “I was 7-8wks when I lost my 1st pregnancy and the harder recovery was the mental/emotional one. It will be on your mind a lot.
“Just remember that every pregnancy truly is different and that whilst this one sadly wasn’t meant to be, the time will come. Keep the faith and know you have support here [on the MadeForMums forum] when needed.”
Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on pregnancy, child health, diabetes in childhood and adolescence. She is a mum of 3.