Surgical Management of Miscarriage under Local Anaesthetic – Manual Vacuum Aspiration

Surgical Management of Miscarriage under Local Anaesthetic – Manual Vaccum Aspiration

We are really sorry that your pregnancy has ended in a miscarriage. To help you
through this difficult time we will spend time with you to talk about your treatment
options and you will receive information leaflets to read in your own time.
This patient information leaflet aims to inform you about manual vacuum aspiration. It
explains the risks, benefits and/or alternatives and what to expect when you attend
hospital. It is hoped this will help answer your questions.

What is Manual Vacuum Aspiration (MVA)?
An MVA is a way of surgically treating a miscarriage under local anaesthetic by
emptying the uterus (womb) to leave it healthy. A speculum (plastic tube used for
vaginal examinations) is inserted into the vagina so that the cervix (neck of the womb)
can be clearly seen. Local anaesthetic is injected into the cervix to numb the area. A
narrow tube (straw) is inserted into the cervix to empty the uterus by aspiration (gentle
suction). A vacuum will be created to remove the pregnancy tissue. You will be awake
during the procedure, and it will take 15 – 20 minutes.

What are the benefits/advantages of MVA over surgical treatment with a general
anaesthetic (GA)?

• MVA is 98% effective
• It is associated with less blood loss
• It is associated with less pain
• It avoids the risks and side effects of a GA
• There is a reduced risk of perforating the uterus (putting a hole in the uterus)
• Shorter length of stay in hospital
• Shorter time to wait for the procedure than waiting for a procedure with GA

What are the risks of an MVA?

• There is a small risk that all the pregnancy tissue will not be removed,
  therefore requiring a repeat the procedure
• There is a small risk of bleeding
• There is a minimal risk of infection, which can be treated with antibiotics
• There is a very rare risk of perforating the uterus
• You may feel faint/sick during or after the procedure but this usually passes
  very quickly

Who will perform the procedure?
A Gynaecologist who has been trained in the procedure, supported by a team of
experienced nurses.

Is there any special preparation?
You will be given pain relief and anti-sickness medication prior to the procedure and
are advised to have previously eaten. We may also give a medication called
Misoprostol to soften the cervix, to make the procedure more comfortable for you.

What will happen during the procedure?
A member of the nursing team will support you and stay with you throughout the
procedure. There will be several other clinicians in the room to carry out the MVA and
assist.

We will check your medical history, ask about any allergies and if you take any
medications.

We will put an identity wristband on you and check your observations: blood pressure,
pulse, temperature.

You will be asked to remove your lower clothing and a sheet will be given to you to
protect your dignity and you will be asked to lie on the examination couch.

When you are ready, treatment will begin. Some discomfort may be expected but pain
relief can be given, including Entonox (‘gas and air’) if required.

How long does MVA take?
The MVA takes around 15 -20 minutes but you will stay after the procedure for
approximately an hour to make sure you are well recovered and that you have had
something to drink/eat and emptied your bladder.

When can I go home?
As soon as you feel well enough. We will make sure you are comfortable, re-check
your blood pressure and provide tea and biscuits. We would like someone to drive you
home and ensure you are well for the following 24 hours. You will be able to walk
around straight away.

What happens to the pregnancy tissue?
One of our clinicians will talk through the options of what happens with your pregnancy
tissue. You will need to make your wishes known on a consent form, so that we can
ensure your wishes are acted on.

Will there be any follow up?
You do not need to be seen in a clinic setting for follow up after an MVA however, we
would ask you to do a pregnancy test at home, 3 weeks following the MVA and call the
Early Pregnancy Assessment Unit if this remains positive.

You can also call the Emergency Gynaecology Assessment Unit if you have any
concerns, ongoing symptoms or need advice.

Contact information
Emergency Gynaecology Assessment Unit: 01905 761489
Early Pregnancy Assessment Unit: 01905 761489

Things to look out for after discharge

• Heavy vaginal bleeding with clots that is not slowing down
• Pain which is severe and not controlled with simple pain relief
• A smelly vaginal discharge
• Feeling unwell, hot and feverish

Further help and support
For free and confidential counselling support:
The Cedar Tree: 01905 616166, [email protected]
The Miscarriage Association: 01924 200799, www.miscarriageassociation.org.uk

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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