Retained products of conception (RPOC) and your treatment options

Expectant (natural) management is when you do not want to take any action and would prefer ‘to let nature to take its course’.

You will be advised to perform a urine pregnancy test  after3 weeks. If this remains positive contact Gynae-SDEC. It may be that we need to discuss further management with you, for example medication or surgery as the RPOCs are not coming away naturally.

Expectant management is successful in 50 in every 100 cases. You will not know when to expect to pass the pregnancy tissue.

The risks of choosing expectant management are: 

• 1 to 3 people out of 100 procedures will develop an infection
• 2 people out of 100 procedures will haemorrhage (have heavy vaginal bleeding), which may need surgery to control.

If you would prefer or need medical intervention a medication called Misoprostol is used. Misoprostol is used ‘off label’, this means its use in the management of miscarriage is not what the medication was originally intended for, however, has since been found to be a successful medication for medical management. 

You will be given a one off dose of 4 tablets to take orally. 

This option gives you more control over when you pass the retained products of conception than expectant management as we know that bleeding and cramping normally starts 2 to 4 hours after taking the Misoprostol.

You can usually go home once you’ve taken the medication. In some cases, where you have certain medical conditions or have had a previous caesarean section, you may need to take this medication in hospital and stay to allow us to monitor you for any complications. We will talk to you about this at your appointment. 

3 weeks after taking this medication you will need to perform a urine pregnancy test. If this test is positive please contact Gynae-SDEC for review.

Medical management works in 85 out of every 100 cases.

You will need to attend the Gynae-SDEC  for routine bloods and vaginal swabs before taking this medication, the Nurses will complete some paperwork with you including consent for the procedure.

The risks of choosing expectant management are:

• 1 to 4 people in 100 procedures will develop an infection. You will be offered vaginal swabs before the procedure to minimise your risk of infection
• 2 out of 100 people will haemorrhage (have heavy vaginal bleeding), which may need surgery to control. After the treatment, you may bleed for up to 3 weeks. If the bleeding is heavy, you should contact Gynae-SDEC or the Gynaecology ward (B11) for advice.

Surgical management is an operation to remove the pregnancy. A fine tube is passed through the neck of your cervix (entrance to your womb) into your uterus (womb) and suction is used to remove the pregnancy. This is carried out under general anaesthetic (which means you will be asleep).  As this is a planned procedure, you will be told in advance when this will happen.

On the day of the procedure you may be given tablets to swallow or inserted vaginally before the operation, to soften your cervix. The procedure usually takes 10 to 15 minutes and you will need to recover on the ward. You can usually go home later on the same day. 

Pain is usually managed with paracetamol or ibuprofen if you can have this and vaginal bleeding may last for 2 to 3 weeks, gradually becoming lighter. Surgical management works in 95 out of every 100 procedures.

A day or two before the procedure you will attend Gynae-SDEC for some routine tests before your operation and to get all of the information for you to decide if you consent to having the procedure.

There are risks with having a general anaesthetic, including: 

• 16 to 18 people out of every 100 will develop scar tissue in their uterus
• 1 to 3 in 100 people will develop an infection after the procedure. We offer to take vaginal swabs before this procedure to help us reduce this risk
• 1 in 10,000 have an allergic reaction to general anaesthetic
• 5 in 10,000 will have a major haemorrhage (large amounts of bleeding)
• 5 in 10,000 procedures will result in a perforation in the uterus
• less than 1 in every 30,000 procedures will result in having to have a hysterectomy due to uncontrollable bleeding or severe damage to your uterus
• less than 1 in 100,000 procedures result in death 

You may be offered this procedure to remove the pregnancy remains through your cervix under local anaesthetic (you are awake but numbed in the area). Pain relief is also available. The procedure is performed by a doctor and will take around 10 to 15 minutes, but you will be in the clinic for 2 to 3 hours for observations and care before and after the procedure. The staff on the unit will be with you to support you during this procedure. Separate, more detailed information is available for this procedure.