"Retained products and infection after D&C / ERPC"

About: Alexandra Hospital / Gynaecology

(as the patient),

I recently had a D&C (ERPC) at the Alexandra Hospital in Redditch after a missed miscarriage, and I was unfortunate to be one of the (apparently) 3% for whom it is not complete - I. e. they did not manage to remove all of the 'retained products of conception'. As a result, two days after the procedure I began to have severe contraction type pains and, the following day, began feeling 'fluey'. My GP diagnosed infection and tried to arrange a scan, but the gynae-team wanted me back in hospital.

I was re-admitted onto ward 9 where I then spent 5 days (4 nights) while the infection was treated by IV antibiotics. Obviously this prolonged the miscarriage and was unpleasant for me and for my family left at home.

I found the nursing staff and health care assistants on Ward 9 to be caring and helpful. They seem to be happy in their jobs and get along well. Some of them are very cheery and jokey indeed - I am thinking particularly of Becky the HCA whose laughter and chatter could be heard all over the ward when she was there - initially when I was reeling from the shock and trauma of my situation I didn't really welcome this but as the week went on I think it was helpful to prevent it from becoming a thoroughly depressing.

Some of the nurses e. g. Julia from New Zealand were particularly compassionate and seemed to understand how I was feeling, which was good.

I have two suggestions for improvement which I would like to be passed to the doctors and those in charge of their management.

1. The D&C / Evacuation procedure itself. It was explained to me that this is a 'blind' procedure and that is why so much was left behind. Why, then, can it not be carried out with a scan at the same time, or a quick scan be carried out afterwards while the patient is still under anaesthesia, to check it is complete? I asked this to several doctors and was told that it would be better but it is for 'resource' reasons - surely even if only a small percentage of these end up with retained products and hospital admission as I did, this would be more costly than making a scanner available.

2. Consistency of approach. Each time I saw a doctor in hospital, it seemed to be following a shift change, and each doctor gave me a different plan of action. The first said they could not carry out a second D&C as the risk was far too high on an infected womb. The next said they WOULD do it as the risk of leaving it was higher, so I should be 'nil by mouth' the next day. I followed this, but was then told the following day they would not do the procedure that day, but would first try the 'tablets' and then do the D&C if not effective, so I was to be 'nil by mouth' again the next day. That doctor told me they would definitely not send me home with 'infected matter' in me, as that would be the highest risk option. The next day after being 'nil by mouth' again, I was told that the consultant had now advised not to do the procedure, but to stay in hospital on IV antibiotics until it had passed naturally. The following day, this had not happened, but I was discharged, which seemed to be what one of the doctors had said would definitely not happen! I am to return after 10 days for further scan and a decision to be taken then as to what to do.

At no stage did I speak to the consultant although I asked to do so once. I think what should happen is the consultant decides what happens, and then there is a meeting of the doctors so that everyone knows the plan of action. I realised the situation may change as a result of scans etc but surely there should be a plan of action for what should happen in the event of certain things happening.

I understand that, as one doctor told me, medicine is not black and white, and there will be differences in opinion, but surely someone should decide and everyone follow this.

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Response from Worcestershire Acute Hospitals NHS Trust

Thank you for your kind comments about our nurses on ward 9.

I appreciate your concerns, and I thank you for your suggestions for improvements, these will be passed on to the department concerned for their attention. Thanks for taking the time to give us your valuable feedback.