Manual Vacuum Aspiration (MVA)

Information for patients

NHS Lanarkshire Maternity Department

PIL.MANVAC.19523.W

We are sorry to confirm your early pregnancy loss today.

When a miscarriage is confirmed there are various treatment options available.

Conservative approach: no medical treatment or intervention; we wait for a period of up to three weeks for the miscarriage process to be completed naturally.
Medical management: tablets are used to induce contractions (cramps) in the womb to complete the process of miscarriage.
Surgical management: miscarriage is completed using a surgical procedure.

Your doctor has discussed these treatments with you and advised a surgical process is the best option for you. This leaflet provides information to support the discussion you have had with the doctor and will help you decide if you want to proceed with the surgical procedure.

Manual Vacuum Aspiration (MVA) is a surgical approach where the pregnancy tissue is gently removed from the womb under a local anaesthetic (numbing of the neck of the womb (cervix)) and you will be awake during the procedure.

There is minimal disruption to your daily activity. The success rate is as high as 96% to 98%.

What are the advantages of MVA?

You avoid exposure to a general anaesthetic.
You can eat and drink normally; there’s no need to fast.
Quicker recovery following the procedure.
Early return to normal activity.

Why am I offered this procedure?

Not all women are eligible for this procedure.
As you fulfil the eligibility criteria you are offered this choice.

What happens next if I choose MVA?

If you decide to undergo MVA we will arrange an appointment for you to attend a hospital clinic appointment.

You will need to provide a blood sample so that we can check your blood count and confirm your blood group. You will need to sign a consent form agreeing to the procedure.

If you have any queries regarding this procedure before coming for your appointment, please contact the Early Pregnancy Assessment Service in your area.

Contact telephone numbers (during office hours):
EPAS Wishaw: 01698 366217
EPAS Monklands: 01236 763298
EPAS Hairmyres: 01355 584501

What happens on the day of the procedure?

You should have your usual breakfast on the day of the procedure and attend the Early Pregnancy Assessment Service in Ward 21 at Wishaw General Hospital for 8am.

You may bring your partner, a family member or a friend with you.

We will discuss the results of your blood test and go over your consent form with you.

We will also discuss sensitive disposal with you and obtain your consent.

The healthcare staff supporting you will be able to answer any questions you may have.

Preparation for the procedure

We will record your vital signs (temperature, pulse rate, blood pressure)., A Misoprostol 400 microgram tablet will be administered vaginally two to three hours before the procedure. This is to soften the neck of the womb. You will also have a Metronidazole 1 gm tablet administered rectally. You will then be able to rest until one hour before the procedure when you will be asked to take the following tablets by mouth:

Azithromycin 1 gm
Ibuprofen 800 mg and Co-codamol 8/500 x 2 tablets
(Co-codamol would be given if you cannot take Ibuprofen)

How is the procedure done?

The procedure takes place in a clinical treatment room. You will need to change into a hospital gown. You will be asked to lie on the couch with your feet on footrests. A speculum is placed in the vagina which is similar to the technique used to perform a cervical smear. Once the cervix is visualised a local anaesthetic gel (numbing gel) is instilled into your cervix. A local anaesthetic injection (similar to the injection used for dental procedure) is injected into the cervix to make it numb. You may feel a stinging sensation, light headedness and palpitations (heart beating fast) for a few seconds; this is perfectly normal and will ease off very quickly. Then the neck of the womb (cervix) will be gently stretched (dilated) and a narrow plastic tube attached to a syringe will be placed inside the womb to gently remove the pregnancy tissue from the womb. Some women may experience a period type of cramp which soon passes away. If you need more pain relief, gas and air can be offered to you. The procedure itself takes about 10 to 15 minutes. The tissue that is removed is sent to the laboratory to check that it is normal pregnancy tissue. No other test would be carried out.

How will I feel after the procedure?

You may experience some period type of cramps and mild vaginal bleeding. The bleeding will gradually become lighter. You will be given painkillers to take home.

What happens after the procedure?

We will observe your vital signs (temperature, pulse rate, blood pressure) at regular intervals for up to an hour. If you belong to rhesus negative blood group, then you will be offered an anti-D injection.

You will be offered refreshments and you can expect to leave hospital around one hour after the procedure if deemed fit by the healthcare team. If you needed to use gas and air during the procedure you should have someone to accompany you to go home. You should avoid driving for 24 hours.

What to expect when I go home?

You can have period type of cramps for a few days which you should be able to control with simple analgesics (paracetamol/Ibuprofen/Co-Codamol). You may experience bleeding like a period and it should gradually stop within the next three – seven days.

We recommend you use sanitary towels until the bleeding stops – not tampons.

We also recommend you avoid sexual intercourse until bleeding stops.

You should use contraception if you are not planning for a pregnancy as you may ovulate (release an egg) before your
next period.

Things to look out for

Contact your GP or the Early Pregnancy Assessment Service (EPAS) if:

you have tummy cramps that do not ease off when using simple painkillers; or they seem to be getting worse
you have any signs of infection such as feeling hot and shivery, experiencing a smelly vaginal discharge and or heavy vaginal bleeding which is much more than a period

Does MVA hurt?

If you have had a cervical smear in the past and did not experience much pain, then you will be able to tolerate the MVA procedure.
One of our EPAS staff will be with you throughout the procedure to provide support.

What are the risks of the MVA Procedure?

Like any surgical procedure there is a small risk of infection or injury. These risks are no higher when compared to the procedure performed under a general anaesthetic.

If you have any queries please contact:
EPAS Wishaw: 01698 366217 (Monday to Friday during 9am-5pm)
Maternity Triage Wishaw: 01698 366120 (out of office hours and during weekend)