Teddy bear wtih a stethoscope

ERPOC – Evacuation of Retained Products of Conception

Overview

Evacuation of Retained Products of Conception (ERPOC) is a procedure used to manage miscarriage or retained pregnancy tissue after medical or surgical pregnancy loss, termination, or incomplete miscarriage. It is sometimes called surgical management of miscarriage or suction curettage.

The aim is to remove any remaining pregnancy tissue from the uterus to prevent bleeding, infection, or complications, and to support physical and emotional recovery.

When Is ERPOC Needed?

ERPOC may be recommended if:

  • You have had a miscarriage but bleeding or pain persists
  • There is evidence of retained tissue on ultrasound
  • Medical management has been unsuccessful or is unsuitable
  • You wish to manage miscarriage surgically for personal, emotional, or medical reasons
  • Bleeding is heavy or ongoing after an early pregnancy procedure

It may also be recommended after a missed miscarriage, anembryonic pregnancy, or incomplete miscarriage.

What Does the Procedure Involve?

ERPOC is usually performed under general anaesthesia as a short day-stay procedure.

  • A speculum is placed in the vagina to access the cervix
  • The cervix is gently dilated if necessary
  • Suction is used to remove retained tissue from the uterus
  • The procedure takes around 5 minutes
  • You’ll spend 1–2 hours in recovery before going home

Ultrasound is used during the procedure to confirm complete evacuation.

Recovery and Aftercare

Most people recover quickly from ERPOC, but you should plan a quiet day afterwards.

Common symptoms:

  • Light bleeding or spotting for up to 2 weeks
  • Mild cramping or discomfort
  • Fatigue or emotional ups and downs

What to avoid:

  • Tampons, intercourse, swimming, and baths for 1–2 weeks
  • Heavy lifting or vigorous activity for a few days

Menstruation usually returns within 4–6 weeks. You may ovulate before your next period, so contraception should be discussed if pregnancy is not desired.

Emotional Recovery

Miscarriage can be emotionally difficult, even when expected or chosen. Support is available, and it’s okay to feel grief, sadness, or relief — or a mix of all three.

We offer:

  • Time and space to talk in a safe, non-judgemental setting
  • Written resources and links to professional counselling if wanted
  • Shared care with your GP or psychologist where appropriate

Risks and Considerations

ERPOC is generally a safe procedure. Risks are rare but include:

  • Infection (1–2%)
  • Uterine perforation (less than 1%)
  • Excessive bleeding
  • Retained tissue requiring repeat procedure (less than 5%)
  • Intrauterine adhesions (rare with modern suction techniques)

We minimise these risks by using ultrasound guidance, antibiotics when indicated, and experienced surgical technique.

Alternatives

Depending on your clinical situation, alternatives may include:

  • Expectant management (waiting for natural completion)
  • Medical management with misoprostol or mifepristone
  • Hysteroscopy (if tissue is focal or recurrent retained tissue is suspected)

We will always discuss the best option for your individual needs and preferences.

FAQs

Is an ERPOC procedure painful?
The procedure itself is performed under a general anaesthetic, so you will be completely asleep and feel no pain. Afterwards, it’s common to experience some period-like cramping, which can be managed effectively with simple pain relief like ibuprofen and paracetamol.
How long does recovery take after an ERPOC?
Physical recovery is usually quick. Most people can return to light activities and work within a day or two. You can expect some light bleeding or spotting for 1-2 weeks. Emotional recovery is just as important and can take longer, so be gentle with yourself.
When will my period return to normal?
Your normal menstrual cycle will typically resume within 4 to 6 weeks after the procedure. It is possible to ovulate before your first period returns, so we can discuss contraception if you wish to avoid another pregnancy right away.
What are the alternatives to having an ERPOC?
Alternatives depend on your specific situation but can include "expectant management" (waiting for the tissue to pass naturally) or "medical management" (using medication to help the process). We will discuss all options to decide what is safest and most suitable for you.
What are the risks of the procedure?
ERPOC is a very safe and common procedure. The risks are low but can include infection, bleeding, or, very rarely, perforation of the uterus. Using ultrasound guidance and careful surgical technique significantly minimises these risks.

Trusted Resources

Why Choose Me?

As an experienced gynaecologist with expertise in early pregnancy care, I offer respectful, trauma-informed surgical management of miscarriage. I understand that no two experiences of loss are alike and will tailor your care to your clinical and emotional needs. My practice is gentle, evidence-based, and focused on helping you feel safe and supported during this difficult time.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.