ERPC — surgical management of miscarriage

Summary

ERPC (evacuation of retained products of conception) is a short, gentle operation to empty the womb after a miscarriage, or when some pregnancy tissue remains in the womb after a miscarriage or birth. We know this operation comes at a hard time; the procedure itself is brief and safe, and the team will care for you with privacy and kindness throughout.

• Done under a short general anaesthetic using gentle suction — usually 10–15 minutes.
• Home the same day in most cases.
• Alternatives — waiting for nature to take its course, or tablets — are real options in many situations and are always discussed.
• Physical recovery is quick: bleeding like a period for up to two weeks, then settling.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

After a miscarriage — or occasionally after a birth or termination — tissue can remain in the womb. If it stays, it can cause continued bleeding or infection. ERPC (sometimes called surgical management of miscarriage, or SMM) removes this tissue through the vagina and cervix with gentle suction. There are no cuts anywhere.

The tissue removed is handled respectfully, and is usually sent for laboratory examination; the team will discuss this with you beforehand. If you have questions about what happens to the tissue, please ask — you are entitled to a clear answer.

Why it is performed

• Missed or incomplete miscarriage — when scans show the pregnancy has ended but tissue remains
• Heavy or continuing bleeding after miscarriage or birth caused by retained tissue
• Infection risk — retained tissue that has become, or is likely to become, infected
• Your choice — some women simply prefer a single definitive procedure to days or weeks of waiting

Benefits

• Definitive and quick — the womb is emptied in one short procedure, with success rates above 95%.
• Less bleeding and fewer days of it than waiting or tablets, on average.
• A planned time — for many women, knowing when it will be over matters.

Alternatives

• Expectant management — waiting for the womb to empty naturally; succeeds for many women within 1–2 weeks, avoids anaesthetic, but bleeding can be heavier and timing unpredictable.
• Medical management — tablets (misoprostol) that help the womb empty; succeeds in the majority, usually within days.
• All three are safe choices in most situations. The right one depends on your scan findings, bleeding, and — importantly — your own preference.

Preparing for surgery

You will have had an ultrasound scan confirming the situation. Blood tests check your blood group (anti-D is given if your group is rhesus negative) and blood count. Tell the team about all medicines you take.

• Fasting: typically no food from 6 hours before, water up to 2 hours before.
• Support: bring someone with you if you can, and arrange for them to take you home. You are welcome to ask for privacy at any point.

The day of surgery

You are admitted on the day. The team confirms your identity and the plan, and you meet the anaesthetist and the surgeon. You will be asked to sign the consent form, which records the procedure, its benefits and its risks as they apply to you. You can still change your mind — including choosing a different management option — at this point.

During the operation

Under a short general anaesthetic, with your legs supported, the cervix is gently widened if needed and the womb emptied with a soft suction tube. A medicine to help the womb contract is often given at the same time, which reduces bleeding. The procedure usually takes 10–15 minutes.

After the operation

• Cramps like period pain for a day or two; simple painkillers are enough.
• Bleeding like a period, gradually settling over up to two weeks.
• Going home the same day once you are comfortable and have passed urine.

Recovery at home

• Rest for a day or two; most women feel physically ready for normal activity within a few days.
• Use pads rather than tampons until bleeding stops; avoid sex until bleeding settles.
• Your next period usually comes in 4–6 weeks. Fertility returns quickly — contraception is needed straight away if you do not wish to conceive.
• Trying again: when you feel ready, there is usually no medical need to wait more than one cycle — ask what applies to you.
• Grief is normal. A miscarriage is a bereavement for many families. Take the time you need, and tell us if you would like to talk to someone — support is available.

Risks and complications

ERPC is a very safe procedure. Figures below are averages from published UK guidance.

Expected, temporary effects

• Cramping and period-like bleeding for up to two weeks

Complications

• Retained tissue needing a repeat procedure (uncommon, around 1–2 in 100).
• Infection of the womb — treated with antibiotics (uncommon).
• Heavy bleeding needing further treatment or rarely transfusion (uncommon).
• Perforation — a small hole in the womb wall; usually heals on its own, occasionally needs a laparoscopy (rare).
• Scarring inside the womb (Asherman syndrome) affecting future periods or fertility (rare).
• Anaesthetic risks — serious complications of a short anaesthetic are rare.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal pain not controlled by your painkillers
• An offensive-smelling vaginal discharge
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing you should feel you understand why this procedure is recommended for you, what the realistic alternatives are, and which risks matter most in your case. Print this checklist and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE guideline NG126. Available from: https://www.nice.org.uk/guidance/ng126 [last checked 12 August 2026].
2. Royal College of Obstetricians and Gynaecologists. Miscarriage — patient information. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ [last checked 12 August 2026].
3. National Health Service (UK). Miscarriage — what happens. Available from: https://www.nhs.uk/conditions/miscarriage/what-happens/ [last checked 12 August 2026].