What to expect from an ERPC

I had my second scan at the public maternity hospital last Wednesday and there was again no heartbeat (no sh*t, sherlocks, this is my third scan in three weeks), so we were free to take intervention.

The mystery of the vanishing identical twin is never to be solved, as the material in the sac had begun to shrink and seep into the uterine lining, so things were even murkier than the week before.

I was given three options: allowing things to take their course naturally, medical management (taking Cytotec [Misoprostol] to start a bleed) or surgical management (evacuation of retained products of conception, ERPC = basically a D&C).

The first was not an option for me not only because I wanted to ask about cytogenetic testing of the embryo but also because: waiting even more weeks for things (maybe) to be resolved, really? I started this cycle on 5 January.

Genetic testing ruled out the second option too (I can’t imagine the horror of trying to retain and refrigerate the “products of conception” at home) and it also sounded a bit miserable: you take two lots of the drugs and then wait for a bleed at home that same day, with another adult there to keep an eye on you. Plus, only 80% of women miscarry completely within a week (I know I’d be delighted with these odds if they were the chances of a cycle being successful, but still) and there’s a 5% chance that you will need an emergency ERPC anyway. Either way, you need to go back 10-14 days later to make sure everything is gone. It sounded messy, painful, scary and inconclusive.

So I asked for the ERPC, and I got an appointment for 7 the next morning, Thursday. Brill.

Genetic testing was a little less straightforward, as the hospital’s policy is to do this only after three miscarriages. I explained that I was willing to pay for it myself and the doctor explained money wasn’t the issue but he would see what he could do. I made my case as best as I could, explaining that after three IUIs (one chemical pregnancy) and five IVF transfers of mostly great-looking five-day blasts into fine-looking linings (two miscarriages, two negative results and one chemical), knowing whether the embryo was viable or not would give us valuable information about maybe needing to ramp up the immunosuppression.

How an ERPC works
In case you’re wondering what to expect from an ERPC, I’m going to describe what happened below, as there were some small things I wish I’d known.

This will be very long and extremely boring for anyone not undergoing an ERPC, so feel free to whizz to the postscript.

Admission
I had to take two tablets of Cytotec (the medication used for option two) at 6 on the morning of the procedure (with a small sip of water, as you’re fasting from midnight) to “soften the cervix”. I could feel it take effect about 10 minutes later – there was a sudden, uncomfortable, horrible pressure in my abdomen followed by menstrual-like cramps on the way into the hospital.

I presented to Admissions at 6.50am, having been told to be there at 7. There were only two other parties waiting, one woman on her own who I wasn’t sure looked pregnant (like me) and one very pregnant-looking woman with her male partner.

We all waited quietly for someone to call us in. I was first in the queue and seen at 7.20. Reading the admissions list upside-down, I could see that, whereas one woman was down for an ERPC, I was down for an “ERPC/cytogenetic testing”, so I was pleased about that.

On the ward
I was up in the ward with my big green file 10 minutes later and seen pretty much immediately by a midwife, who brought me to a lovely bed in the corner, where the early-morning sun was streaming through the window. She was the first of many that day to say she was sorry I had had a miscarriage. She took my bloods, blood pressure and temperature and weighed me and asked me about my history. I went to the toilet and noticed these funny miniature cardboard cowboy hats on the shelf and wondered what they were for.

Around 7.45, I was waiting on the bed when I started to bleed. I was still dressed at this stage, so my first small piece of advice is to bring spare knickers, even though this is a day procedure. I asked my nurse, J, if the bleeding was okay and she said it was fine and gave me a sanitary pad, telling me to let them know if the flow became very heavy. Also, I should take care when going to the loo to catch anything that wasn’t urine in, you guessed it, one of the little cardboard cowboy hats, of which she gave me three, and to show it to her (ugh) in case it was some of the “retained products”. I changed into a hospital gown and hat but left my knickers on so I could wear the pad.

An anaesthetist came and asked me once again about my history and told me to ready myself for being asked the same questions many times during the day. She asked if I had any crowns, caps or dentures and checked my teeth and tongue; I noticed she scored me 1 and 2, no idea what for.

A doctor came and explained how the procedure would work. I was to be put under a general anaesthetic and they would gently remove the pregnancy tissue after dilating the womb. She explained about possible side effects (mainly bleeding and maybe nausea, with a 1% chance of a punctured uterus, which usually just sorts itself out anyway, and a 2% chance of uterine infection). She also said I should double-check that they were going to perform genetic testing when I went to theatre.

I’m not sure but I think it was probably the doctor who explained that the pregnancy tissue they removed would be quite small and asked me to confirm that I was happy for them to discard it on my behalf.

The nurse came to take me to theatre and I went to the toilet on the way. Catching the blood in the cowboy hat and discarding the urine was a little bit weird but not as weird as showing the results (blood with a few small clots) to Nurse J, who said it was fine and to bin it. I hadn’t brought slippers, which seemed like overkill for a short shuffle to the theatre, but had socks on and a dressing gown with pockets, which was just as well, as I needed somewhere to put my (slightly bloody) knickers before I went in for the op.

The procedure
In an ante-room, another anaesthetist went through the same questions again and one of the doctors who was to perform the procedure introduced herself. There were lots of people in surgical gowns wandering around the various theatres saying friendly hellos.

On the way into mine, I discarded my pad, sheepishly stowed my underwear and gave them my dressing-gown and glasses (you need to bring a contact lens case and solution if you wear lenses – and no piercings, makeup or nail varnish allowed).

Having had two egg collections, I was less scared about the anaesthetic than I would have been otherwise. I think there were about five people in the room, including a male anaesthetist (the only man I came across the whole day apart from visitors/partners), the doctor performing the procedure and three others lurking in the background. The doctor explained what they were about to do and said it was a very gentle procedure. They put my oxygen mask on, which always makes me a little panicky, and inserted a needle in my left hand. The doctor said to imagine I was somewhere that made me feel very comfortable, like my own bed, and talked me through them giving me a painkiller through the needle, followed by the anaesthetic. I stared at the light and waited for the room to lurch, as it does before egg collection, and I was out.

Patient information leaflet on the ERPC here:

Patient information leaflet on RPC

Recovery
I think the ERPC happened at around 8.50 and I came to in the recovery room at around 9.40 hooked up to an IV, with a blood pressure monitor on my arm and an oxygen monitor on my finger and minus my hat. They gave me back my glasses the minute they noticed I was awake, which was thoughtful, and moved me back to the ward at around 10. I had a somewhat bloody disposable sheet under me, which Nurse J took away, and a pad between my legs.

Tea and toast arrived at 10.45 and tasted like the best thing ever. I had only the mildest of mild cramps and no nausea whatsoever.

I don’t think I can even remember the many different people who came and went while I was recovering. C, the support midwife, came at around 11.10 to make sure I was emotionally okay. She gave me her card and said I was to call at any time with worries or questions or just to talk. I could also ring her in a couple of weeks about the results of the genetic testing, in case I or my doctor hadn’t heard back. The original midwife checked my obs and the doctor who performed the procedure called by to say everything had gone quickly and as expected.

At around 12.20, Nurse J asked me about my blood group. As I’m Rhesus negative, I had to then get an Anti-D shot in case I make antibodies against Rhesus positive blood that could damage a future Rhesus positive baby’s blood cells. I wonder was I supposed to get this after my miscarriage last year? Must ask someone at the clinic about this.

At around 12.30, a hospital chaplain visited and tentatively asked if I’d be interested in the remembrance ceremony they are having in October. I said I didn’t think I would need that and was doing fine but thanked her. I had said on my registration form that I was of no religion but I guess the ceremony is non-denominational and it was nice that she called by.

I’d say I could have been out of the hospital by about 1pm but the doctor who needed to sign me off was delayed and I was eventually discharged at around 2pm. My lovely mother had come to pick me up (you must be escorted home and can’t drive for 24 hours) and brought some Always maxi with her (you can’t use tampons in case of infection). I haven’t used sanitary pads since I was about 15. Small piece of advice number two is to make sure you have some super-sized pads at home.

One unforeseen consequence
The procedure was on Thursday and today, Tuesday, I’m still bleeding sporadically in what feels like a pretty average period. I find it hard to tell if the volume of blood is normal, as I generally use tampons. I’ve had only mild menstrual cramps on and off and it’s been pretty easy. They advised me to take Paracetamol or Neurofen as required but there has been no need.

In the interests of full disclosure and because I was slightly concerned about this and you might be too, the only real abdominal pain I have had has been caused by constipation, I think. Yep.

I don’t get constipated, except maybe once before, I think due at that time to the Crinone progesterone suppository. On Friday morning, I got out of bed feeling great but about 15 minutes later I was doubled over with pain. It didn’t feel like menstrual cramps and I wondered if it was an infection. I crawled back to bed with a hot-water bottle and was fine about 15-30 minutes later. I can’t remember if I had moved my bowels on Thursday after the ERPC (sorry) but nothing happened on Friday in that department until about 9pm, and it was a bit of an effort. I was just drifting off to sleep at around midnight that night when I woke up to a searing, knife-like pain somewhere rectum-way and had to clench my fists to ride it out. I didn’t get back to sleep until around 5.30 with sporadic pain all night. I was mentally packing my bag for a trip back to hospital but had an inkling it was bowel-related because I had had to “strain” a few hours earlier. Every time there was any semblance of gas or movement in my innards, I was in pain.

I managed about four hours’ sleep in the early hours and was okay when I got up at about 9.30 on Saturday morning. I haven’t been “blocked up” since but things are definitely a bit painful and not quite right in the old bowels, though I don’t think it’s an infection. I think the Cytotec/painkiller/anaesthetic and a lack of fluids are probably to blame.

So, my third small piece of advice is to drink plenty of water, get the prunes/Aloe Vera juice/Milk of Magnesia/senna pods as applicable in and make sure you’re getting enough fibre. And don’t drink alcohol if you can help it: I had two bottles of Miller on Wednesday night before the ERPC, just BECAUSE I CAN now that I’m not pregnant, which was really stupid, as I couldn’t drink any water the next morning, and one bottle on Friday night, which was equally foolish. Beer and coffee are some of my only pleasures these days but try to avoid them around the ERPC if you can.

Headaches
I’ve had severe headaches on and off for the last couple of days, even on waking, and a pain behind my eyes.  A quick Google has told me I’m not alone in experiencing this; it can last a week or two; and it could be falling hormone levels that are to blame. As with the constipation, no one mentioned this in the hospital as a possible after-effect. My final piece of advice is to be prepared for headaches, especially as they have made working in front of a computer quite difficult for me.

But, all in all, the ERPC was a pretty straightforward operation that would have been virtually painless if not for the above.

Postscript
An email arrived today from my ex (who dumped me for someone else a year or so after we bought a place together) telling me casually that he and his new wife (not the one he dumped me for – that was short-lived before he asked me to take him back, ‘twas merely a five-year itch) are having a baby in August. I haven’t cried once during this entire doomed cycle but this brought me very, very, very close.

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4 Responses to What to expect from an ERPC

  1. Katie says:

    Hiya – tracked this page down after mooching around on your YouTube channel. I wanted to say a sincere Thankyou for the ‘all too well’ song that was posted. I have had two cornual ectopic pregnancies (no cause identified) in the last few years – nothing and I mean nothing has spoken to my heart like those lyrics (did you adapt/write them yourself?). I feel myself beginning to heal. My last treatment for EP was is late August 2014 – baby was due April 5th. I cannot Thankyou enough – simply beautiful. Do you have a FB page? x

  2. That news from your ex was just awful timing. Hope you’re okay. I hope you also feel physically better soon. I think anaesthetic plus fasting and meds, as you found, can cause constipation I found that after egg collection.

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