Having a miscarriage is one of the most heartbreaking things anyone can go through, and if it’s something you’ve just experienced – we are so sorry for your loss 💔
As well as the emotional sadness you’ll no doubt be feeling, 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.
If you’ve had a miscarriage, your doctor may advise you that you need to have some surgery to remove any excess tissues from the womb. That’s when ERPC and D&C might come up.
We know these terms are very medical, impersonal and practical: we also know they’re not talked about too much.
So, here, we’re going to tell you what they are, what they involve and, most importantly – hear from women who have gone through it so you might 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.
We’ll look at:
ERPC means Evacuation of Residual Products – not a very nice term, we know, just super-medical 😔 It’s an operation where anything left in the womb after a miscarriage (or termination, or sometimes, even after birth) is removed via suction and generally takes about 10 minutes under anaesthesia.
It’s more usual that you will have ERPC rather than D&C if you were in the early stages of pregnancy (before 10 to 12 weeks).
D&C (dilation and curettage) does the same thing as ERPC but instead of using suction, it involves gentle scraping of the lining of the uterus.
What happens at an ERPC or D&C?
Going to hospital is never the most fun experience – we get that 😔 Hopefully you’ll have someone you love and trust with you (one of our forum mums mentions that you’ll need someone to take you home as you won’t be able to drive / or get home safely in other ways on your own because of the anaesthetic).
Before the procedure you’ll be given a surgical robe to wear rather than any of your own clothes for hygiene reasons. You’ll be taken to the operating room – usually on a trolley, which can seem very odd when you don’t feel ill – and then be given your anaesthetic by injection.
You might also be given a drug to relax you and stop you producing too much saliva prior to the anaesthetic. The injection of anaesthetic takes near-immediate effect and you will lose consciousness until you are in the recovery room.
Once the anaesthetic has taken effect, your legs will be put up in stirrups so that the gynaecologist can best access the vagina. The gynaecologist first dilates (opens) the cervix with special instruments and then inserts either a curette, a metal instrument with a loop at one end, a little like a spoon, to gently scrape the womb lining.
Or, with an evacuation of retained products (ERPC) a fine, hollow tube is inserted into the uterus and the pregnancy tissue is cleared with suction.
The whole procedure is very quick and you’ll be coming round from the anaesthetic within 20 minutes to half an hour.
After you come round from the anaesthetic you’ll usually be kept in the recovery room for a while where they’ll monitor your vital signs until you’re properly awake.
D&C: One mum’s experience
One of the mums on our forum, xFran82x, decided to share her experience of D&C to help others who were facing it. Here’s what she says:
“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.
“After a while this gave me cramps which became painful and asked for some paracetamol (the other ladies didn’t seem to be in pain it may just have been that I was 11 weeks).
About 4pm they took me to theatre and you are knocked 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.
“You will need your OH to stay with you and you can’t drive yourself home. You need to fast from the night before until after the op. My bleeding is just tailing off now [10 days after this post was written].”
What are the risks of D&C or ERPC?
The risks of either D&C or ERPC are very small, our GP Dr Philippa Kaye tells us. First off, there are the risks of having a general anaesthetic in the first place – but you’ll be assessed by an anaesthetist before your operation, and they discuss any issues with you then.
The there are the risks related to the ERPC procedure itself. As Philippa tells us: “The risks related to the ERPC procedure are pain, bleeding and infection.
“The risk of an infection in the uterus after the op is about 3 in every 100 women 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.
“Although of course we discuss risks – in general an ERPC is a quick and safe procedure which reduces vaginal bleeding.”
Philippa also notes that very rarely after a D&C specifically (not ERPC) scar tissue can form which may affect fertility. If you are concerned or not sure which procedure you are having or being offered please speak to your doctor.
How long does it take to recover from D&C/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 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 two 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).
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 D&C, 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. Though you should 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
How much time should you take off work after a D&C or ERPC?
Physically, at least, you’ll need at least one day off work afterwards to recover, perhaps a couple, but if the reason for a D&C or ERPC was miscarriage then you are likely to need more time – 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 and they will be able to sign you off work for the time you need.
Mum KazzieM on our forum says: “I was 7-8wks when I lost my 1st pregnancy…the harder recovery was the mental/emotional one, it will be on your mind & you will find yourself worrying and comparing whilst TTC & pregnant.
“Just remember that every pregnancy truly is different & that whilst this one sadly wasn’t meant to be the time will come. Keep the faith & know you have friends support here [on the MadeForMums forum] when needed.”
We totally agree with what KazzieM says here: even if you’re physical recovery is fast, chances are if you’ve had a D&C or ERPC it’s because you’ve had a great loss – and you need time to heal from this, so please do try and put yourself first for a while❤️
Dr Philippa Kaye is a London GP who has written several books on pregnancy and childcare including The First Five Years. See www.drphilippakaye.com and follow her on twitter @drphilippakaye