Gynaecology - Manual vaccum aspiration

What is Manual Vacuum Aspiration (MVA)?

MVA is a procedure to remove pregnancy tissue from the womb using a hand-held suction device.

It is done in an outpatient clinic under a local anaesthetic whilst you are awake.

It can be used as a treatment for miscarriage or retained products of conception (where some pregnancy tissue is left inside the womb after a miscarriage or delivery).

Is MVA a new procedure?

MVA has been performed for over 30 years worldwide.

It has been shown to be a safe and successful procedure which is well accepted by patients.

It offers an alternative option to women who want surgical treatment of miscarriage without needing to have a general anaesthetic (being put to sleep).

Success rate of treatment is equal in both.

When is MVA not suitable?

MVA is not recommended in the following situations:
●    If the pregnancy has progressed beyond 9 weeks due to the increased risk of bleeding and higher chance of the procedure failing
●    If you are allergic to local anaesthetic agents
●    If there is evidence of pelvic infection
●    If you have any anatomical abnormalities which may make it difficult to gain access inside the womb
●    If you have any bleeding disorders or significant anaemia
●    If your body mass index (BMI) is over 40
 
The doctor or specialist nurse will explain the procedure to you and ask you to sign a consent form. You will be given a date, time and place for your appointment. You will need baseline observations, blood tests and vaginal swabs performing prior to the procedure.

You will also be given a prescription for some medication to take 2 hours before your appointment – Misoprostol tablets and an anti-sickness tablet. You will need to collect this from the hospital pharmacy in advance.

You will also be advised to take painkillers such as paracetamol and ibuprofen or codeine approximately 1 hour before the procedure. Please ensure you let the doctors know about drug allergy.

Women who are less than 25 years of age or have had a previous sexually transmitted infection (STI) are at a higher risk of infection and will therefore be offered a single dose of an oral antibiotic.

What is Misoprostol?

Misoprostol tablets allow the cervix to soften. This makes the procedure safer as it is easier to insert the plastic suction tube through the cervix into the womb.

Are there any side effects with Misoprostol?

Misoprostol can cause nausea or vomiting and therefore your prescription will include an anti-sickness tablet. Other possible side effects include diarrhoea, abdominal pain, headache, hot flushes and an unpleasant taste in the mouth.
 
A speculum is inserted into the vagina to visualise the cervix (neck of the womb). This is similar to during a smear test. Local anaesthetic is injected to numb the cervix and a narrow plastic tube is passed into the womb. The cavity is then emptied using gentle suction. You may feel some discomfort similar to a crampy period pain. You can request that the procedure is stopped at any time.
With your consent, the contents of the suction tube is then sent to the laboratory and examined under a microscope to ensure that there is pregnancy tissue is present.

How long will MVA take?

The procedure itself takes approximately 15 minutes.
You will be monitored for up to 1 hour afterwards then you may go home once you feel well enough to do so. We recommend that someone escorts you home.

What happens after the MVA?

At home you may experience some crampy abdominal pain which is normally controlled with simple painkillers.

You can also expect some vaginal bleeding which normally settles within 7 days but can continue for up to 14 days. To reduce the risk of infection we recommend you use sanitary towels instead of tampons and do not have sexual intercourse until the bleeding has settled.

You can contact the Gynaecology Assessment Unit (GAU) or your GP if you are worried about worsening pain or heavy bleeding. These symptoms sometimes indicate an infection which may need treatment with antibiotics.
 
You may return to work after 48 hours or when you feel able to.

If your blood group is Rhesus negative, you will need an Anti-D injection.

You will be offered contact details for a counselling service and given a follow-up appointment for the Telephone Miscarriage Support Clinic to provide further advice and bereavement support.

With your consent, a discharge letter will be sent to your GP summarising the treatment you have had so that they are kept informed regarding your care.

What are the options if I do not want MVA?

●    Conservative management – waiting for the pregnancy to pass naturally
●    Medical management – using medication to encourage the pregnancy to pass
●    Surgical management – a surgical procedure to empty the womb performed under general anaesthetic

These will be discussed with you in more detail by a doctor or specialist nurse.
 
All procedures carry a small risk of complications. Complications with MVA are similar to those that can be encountered with surgical treatment under general anaesthetic (GA). The risks of having a GA are obviously not applicable with MVA. Other risks may include:
●    Infection – up to 40 in 1000 women (common)
●    Heavy bleeding requiring blood transfusion – 0 to 3 in 1000 cases (uncommon)
●    Perforation (a tear in the womb) – 1 in 1000 (uncommon)
●    Injury to the cervix – less than 1 in 1000 (uncommon)
●    Retained pregnancy tissue – up to 40 in 1000 women (common)
●    Need for repeat procedure – 3 to 18 in 1000 (uncommon)
●    An operation to repair any damage – this may be either keyhole or open surgery done under GA
●    Scar tissue forming inside the womb – 160-180 in 1000 (common) – this can also occur following expectant or medical management and the significance remains uncertain
 
There is no time limit on how long you must wait before trying for a baby again but the following advice is generally recommended:
●    That you wait until you have had at least one period as it allows time for your body to recover from the miscarriage and it makes calculating the dates of the next pregnancy more accurate
●    You and your partner should avoid smoking, drinking alcohol or taking recreational drugs
●    Aim to achieve a healthy weight and eat a balanced diet prior to falling pregnant
●    Ideally take folic acid for 3 months before trying to become pregnant and continue until you are 12 weeks pregnant

What shall I do if I have a problem or concerns?

●    Contact your GP or ring GAU (0161 627 8855) if you notice any of the following symptoms – fever, dizziness, offensive vaginal discharge, prolonged heavy bleeding or severe abdominal pain
●    In the event of an emergency – go to your nearest A&E or call 999
 
The Miscarriage Association – www.miscarriageassociation.org.uk

Babyloss - http://www.babyloss.com

NHS Choices – www.nhs.uk

Patient Advice and Liaison Service (PALS) - To make comments or raise concerns about the Trust’s services. A member of staff will be able to direct you to the PALS office.