ERPC: a time for change
In a model of collaborative working and consultancy, the Association of Early Pregnancy Units 1 and the Miscarriage Association 2 have demonstrated widespread approval for changing a key part of the terminology of miscarriage. Results from two online surveys indicate a clear preference for the term Surgical Management of Miscarriage (SMM), to replace the commonly used Evacuation of Retained Products of Conception (ERPC).
Miscarriage can be a very distressing experience for women and their partners. The care and information that they receive from the healthcare team can have a significant impact on their emotional and physical wellbeing. The terminology of miscarriage has rightly received critical attention from both patients and professionals, resulting in recommendations from the RCOG 3 for the use of “miscarriage” rather than “spontaneous abortion”, “incomplete miscarriage” rather than “incomplete abortion”.
The recent publication by online organisation Mumsnet 4 of a charter for miscarriage care highlighted the need for more sensitive terminology. Their members’ survey confirmed strong anecdotal evidence that many women and their partners find the term Evacuation of Retained Products of Conception both upsetting and confusing, especially at an already difficult time.
It’s not a “retained product of conception”. For us, as soon as we see those two lines on the pregnancy test,that is OUR baby growing inside of me.
I had an ERPC last month and have never been able to call it that. I've always said'surgical management of my miscarriage'
What’s an ERPC? Is it the same as a D&C?
The Association of Early Pregnancy Units (AEPU) and the Miscarriage Association (MA) agreed to investigate use of an alternative term, which would be in plain English, medically accurate and acceptable to a wide range of patients.
The team ran two online surveys on SurveyMonkey, each asking a short and simple set of questions, and each widely publicised through professional and patient groups and media: RCOG, AEPU, Deaneries, MA., Mumsnet, Facebook and Twitter.
The first survey was completed by 955 people (52% patients, 42% health professionals, and 6% who had both a personal and a professional interest). While we showed a clear interest (75% overall) in changing the term ERPC, and a clear preferred alternative – Surgical Treatment of Miscarriage – it was flawed in that it did not include Surgical Management of Miscarriage in the three options being considered. The term Surgical Management of Miscarriage was mentioned by 46 respondents and this led to the second survey.
The second survey sought to sharpen the focus, offering a choice between just two options: Surgical Treatment and Surgical Management of Miscarriage. Overall, 80% of the 1,280 respondents (39% of whom were health professionals) preferred the term Surgical Management of Miscarriage.
There were only small differences between the groups: 85% of health professionals preferred this term, compared with 76% of people with a personal interest in miscarriage and 83% of those who had both a professional and a personal interest.
Benefits of the change
Adopting the term Surgical Management of Miscarriage (or the recommended abbreviation SMM), has other clear benefits to both patients and health professionals:
It fits with the other terminology used widely in the UK: Medical Management of Miscarriage and Conservative/Expectant Management of Miscarriage. (All three terms were also recommended in consensus guidelines developed in Australia in 2008 5.)
- It is clear, understandable and widely accepted by patients who have been through this experience
- Crucially, it removes the word “products”, which causes much distress
- The word “management” implies the breadth of the process, from obtaining consent through to management after the procedure. It also suggests collaboration with the patient, rather than the passive role implied by “treatment”.
Summary and recommendation
A collaborative process has produced a clear driver for change in miscarriage terminology. Patients and health professionals agree that the term Surgical Management of Miscarriage (SMM) should replace the term Evacuation of Retained Products of Conception (ERPC).
The AEPU and M.A. recommend that this new terminology be introduced as standard by all professionals groups involved in miscarriage care. This recommendation is formally supported by the Royal College of Obstetricians & Gynaecologists.