Manual Vacuum Aspiration (MVA)

What is Manual Vacuum Aspiration (MVA)?

MVA is a suction procedure that is used to remove the pregnancy tissue from the womb while you are awake. This information leaflet explains what to expect when you come to hospital for your procedure.

What happens before the procedure?

Please note that you must not eat for 4 hours before your appointment time but can drink plain water up to 2 hours before your appointment time.

• You will be admitted to hospital on the day of your procedure. You will meet the doctor performing your operation and they will answer any questions you may have.
• 1 – 2 hours before the operation, you will be given some prostaglandin tablets which you put into your vagina. A nurse can do this for you if you prefer. The tablets are used to soften the neck of the womb.
• Before the procedure you will be given some painkillers.
• Immediately before the procedure you will be asked to empty your bladder.
• The nurse caring for you will take you into an examination room.
• You will be taken into the procedure room by the nurse who will stay with you to reassure and support you.

What happens during the procedure?

• In the examination room, you will be asked to sit on an examination bed (similar to a dentist chair) which will be reclined for your procedure. You will be awake for the procedure.
• The doctor will gently insert a small speculum (an instrument used to examine the womb) into your vagina to see the neck of the womb (as if you were having a smear test).
• Your cervix is numbed with local anaesthetic, and an injection of local anaesthetic will then be given into your cervix. This rarely causes pain but if it does, tell the nurse.
• Following the injection, the neck of your womb is dilated (stretched). This sometimes causes a little discomfort.
• Entonox (gas and air) is available for you to use during the procedure if you need it.
• Using a small tube which is passed into your womb, the pregnancy tissue is removed by gentle suction. This part of the procedure takes around 10-15 minutes. Although the whole procedure from start to finish may take up to 30 minutes.

If at any time you feel that you are unable to continue with the procedure let the Nurse/Doctor know.

How will I feel after the procedure?

• You may have light bleeding and period-like cramps which will wear off gradually. Pain relief is available if you need it.
• You will be able to rest in the unit to make sure you are well.  Within 1 – 2 hours of finishing the procedure, you may feel ready to go home.
• You will be given an antibiotic suppository (Flagyl/Metronidazole) before you leave the department to reduce the risk of infection.
• If your blood group is Rhesus negative, you will be given an injection of Anti-D before you go home. The nurses will discuss this with you at the time.

Please do not drink alcohol for 48hrs after the procedure.

If you have opted to have an injection for contraception after the procedure, this will be given prior to your discharge.

How successful is MVA?

97 women in every 100 would have the remains of pregnancy tissue removed.¹

Are there any risks or possible complications with MVA?

MVA is a very safe procedure. However, there are risks you need to consider before you agree to the procedure. These include:

• Heavy bleeding at the time of the operation. This is rare but can happen to 1 woman in every 1,000.²
• Post-operative infection. The risk of infection is reduced by the antibiotic suppository but if you have any signs of infection afterwards, you must contact us (see below), or your GP.
• Incomplete evacuation of the uterus. This means some pregnancy tissue may have been left behind, and further tests or treatment will be needed.
• Uterine perforation (making a hole in the uterus). This is rare but it can happen to less than 1 woman in every 1,000.¹ If this happens you may need an operation.

How will I feel when I go home?

You may have some:

• Vaginal bleeding. This can last up to 14 days but should gradually stop, like a period.
• Period-type cramp pain for 24 – 48 hours. Taking Paracetamol can help. You should always follow the instructions provided in the leaflet supplied with your tablets.

How can I help myself?

• You should use sanitary pads, not tampons, during this bleed.
• You are advised to avoid sexual intercourse for about 2 weeks to minimise the risk of infection to your womb.
• You may bath and shower as you wish.
• Your next period will be due anytime during the next 3 – 8 weeks and may be heavier or lighter than usual.
• We recommend you do a home pregnancy test in 3 weeks following procedure, by which time it should be negative. If this test is still positive, then please contact us on the numbers you have been given for follow up.

What are the signs of infection after the procedure?

Very occasionally, women may develop an infection after the procedure. You need to contact us urgently if:

• Your pain becomes severe.
• Your bleeding is very heavy, for example, soaking sanitary pads.
• Your vaginal loss becomes smelly.
• You feel feverish or generally unwell.

If you experience any of these symptoms you must ring for urgent advice.

Contact Numbers

You will be given specific Emergency contact numbers before you leave the department you originally attended.

Nurses are available Monday to Friday between 8am and 4pm.

Surgical Decisions Unit Reception
Outside of the hours of Monday to Friday between 8am and 4pm, you can contact the Surgical Decisions Unit who will be able to advise you, or if needed, assess you in the hospital:

Telephone: 01642 624566/ 01642 382830

References

1. Milingos D. Mrthur M. Smith N. Ashok P. Manual vacuum aspiration: a safe alternative for the surgical management of early pregnancy loss. BJOG 2009; 116:1268-1271.
2. Ectopic pregnancy and miscarriage: diagnosis and initial management. National Institute for Health and Care Excellence (NICE) Guideline NG126.https://www.nice.org.uk/guidance/ng126

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

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Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1273
Date for Review: 08/09/2024