ERPOC procedure

Evacuation of retained product of conception (ERPOC) – Dilatation & Curettage (D&C) @ Suction & Curettage (S&C)

Pre-operative

1. History, physical examination and transabdominal ultrasound –> confirm diagnosis of incomplete miscarriage/ missed miscarriage.
2. Obtain informed consent for procedure and also blood transfusion consent
3. Keep nil by mouth for at least 6 hours (procedure under GA)
4. Set up branula, intravenous line and run fluid
5. Take FBC and GXM
6. Inform OT and Anaesthetist

Operative procedure

1. Patient under GA
2. Positioned in lithotomy position
3.  Perineum area cleaned and draped
4. Bladder catheterized
5. Vaginal examination done – vulva and vagina normal, os closed, position of uterus –> anteverted/retroverted
6. Sim’s speculum inserted for visualization of cervix
7. Anterior lip of cervix grasped with Volsellum forcep
8. Cervical os dilated with Hegar dilator until size ___ (eg: size 9)
9. Uterine sound inserted and cervicouterine length measured ___ (eg: 10cm).
10. Suction done with Karman curette size 8 until gritty sensation felt/ Curette used ± sponge forcep to remove any remaining POC
11. Check for any active bleeding from external os, lip of cervix and from internal os.
    1. If present active bleeding, compress with gauze –> if still bleed, suture
    2. Fill in form for POC sent for HPE
    3. Swabs and instrument counts

Intra-operative findings

1. Vulva, vagina NAD
2. Os admit tip of finger
3. Cervix healthy
4. Uterus anteverted and ___weeks size (eg:12 weeks size)
5. Uterine sound measured ___ (eg: 10cm)
6. POC volume was ___cc (eg:30cc)
7. Total blood loss was minimal

Post-operative plan

1. Monitor vital signs ½ hourly, then once stable, 4 hourly.
2. Monitor pad chart, inform if excessive bleeding
3. Encourage orally and ambulation
4. Off IVD once tolerating orally
5. Allow Discharge cm if well
6. TCA at Daycare 2/12 to review HPE

By: Suganthini Salvanayagam