Manual Vacuum Aspiration (MVA) Termination of Pregnancy | Hull University Teaching Hospitals NHS Trust

This leaflet has been produced to give you general information about your treatment / procedure / condition (delete as appropriate). Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is it?

An MVA is available for up to 10 plus 6 weeks gestation at this service. If you choose and are found suitable for this method, it will involve a day-case admission after your initial consultation in Hull Women and Children’s Gynaecology Outpatient Department (GOPD).

An MVA is a way of removing a pregnancy from the womb using gentle suction under local anaesthetic, i.e. while you are awake. This is an alternative to having a general anaesthetic in theatre. This is a day treatment, and you should be well enough to go home after the procedure.

What are the benefits?

The pregnancy tissue is removed quickly and in a planned way. Some people may feel they do not want a general anaesthetic and may prefer to be alert and aware of what is happening and a bit more in control. There is also a quicker recovery time with this procedure.

What are the disadvantages?

Some women are worried about pain, bleeding or anxiety of the procedure happening. Your concerns should have been discussed during your initial consultation.

As with any treatment, there are risks with this procedure, although it is generally very safe. Risks include the following:

There is a risk that not all the pregnancy tissue will be removed and sometimes we will have to do the procedure again.
There is a small risk of infection with this procedure. If you develop an infection and have symptoms such as foul-smelling vaginal discharge, abdominal pains and fevers, you must seek urgent advice.
There is a small risk that you will bleed. There is an even smaller risk that you will bleed heavily and need a blood transfusion (1:1000).
There is a risk of perforating the uterus (making a hole in the womb). This is rare.
Towards the end, or after the procedure, you may feel lightheaded or faint. If this happens, it usually passes quite quickly.

You must take your antibiotics (Azithromycin) the night before your procedure

The procedure will take place in the Gynaecology Outpatient Department (GOPD), in Hull Women and Children’s Hospital. It is advisable to wear comfortable clothing that day and have analgesia at home such as paracetamol. You will need to purchase some sanitary pads for home. We can offer you drinks and a biscuit whilst waiting in the department but if you wish to bring your own food or drink in you can.

You can bring someone with you to your appointment; however, they will need to wait in the waiting area. You will not be able to drive yourself home after the procedure so will need to arrange with someone to collect you when you have been discharged. You might want to bring a magazine or book with you.

Two hours before your procedure you will have some medication called Misoprostol to soften your cervix, this medication is dissolved in the mouth between the cheek and lip or inserted vaginally. One hour before your procedure you will take a tablet called Diclofenac for pain relief, this is a NSAID (Non-Steroidal Anti-Inflammatory Drug) like Ibuprofen; you may have been asked to avoid this medication is you have asthma. Do not take any ibuprofen at home the same day as your procedure. You will self-administer these medications at home or in the GOPD as pre-arranged on the day of your initial consultation.

You will be taken into the procedure room. We will ask you to lie down on the couch with your legs in stirrups (lithotomy boots). The doctor will insert a tube-shaped tool (a speculum) into your vagina. This will stay in place while the procedure takes place. A local anaesthetic (numbing injection) will be injected into your cervix. The cervix is then dilated (stretched) gradually. A narrow suction tube is then inserted into the womb to remove the pregnancy tissue. The radio will be on in the clinic room, but you may hear some sounds of the suction. You will have had a discussion and signed a form about disposal of the pregnancy tissue in your initial consultation, if you change your mind about this or want to find out more information, please inform a member of staff.

The staff in the room will be there to support you throughout your procedure. They will offer you inhaled pain relief if you need it called Entonox or Penthrox; you may have heard of these self-administered medications as ‘gas and air’. The procedure takes about 10-20 minutes. You will be expected to wait for approximately one hour after the procedure to make sure you are well enough to go home.

If you are having Long-acting Reversible Contraception (LARC) fitted i.e. IUD/IUS (a coil), that will also be done at that time. If you are having a contraceptive implant (Nexplanon) or Depo Provera contraceptive injection that will be fitted/administered straight after the procedure. These methods will be effective straight away. If you have declined LARC we may give you a prescription for a different method of contraception as discussed at your initial consultation, you will need to get this from the Hull Royal Infirmary Main building pharmacy on the ground floor.

Does the procedure hurt?

You may feel a stinging feeling while the local anaesthetic is being injected into the cervix, but then the cervix should be numb, and you may feel some pressure but no pain. As the pregnancy tissue is being removed, most women experience period like cramps, but you will have pain relief to help with this. The pain does not usually last long. If it is too painful for you, the doctor will stop and will offer you alternative treatment options. You could have some light bleeding after the procedure. If it becomes heavy (heavier than a period), you must go to your local emergency department. Sometimes women feel faint during the procedure. We have some recliner chairs in our recovery area to rest after your procedure and we will make sure that you are well before you call someone to collect you and take you home.

What happens afterwards?

You must be accompanied home by a responsible adult who is aware of the treatment you have had.
You are advised not to travel long distances, especially by air straight after your surgery, However, if you do decide to travel, we strongly recommend you inform your travel insurance company that you are undergoing a procedure.
Following your operation, it is advisable that you do not undertake any strenuous activity i.e., lifting, carrying heavy loads and exercise such as sports activities until your bleeding has settled.
You are advised to have a bath/shower daily whilst you are bleeding (you do not need to add anything to the bath water). If having a shower, it is important that you do not apply the jet of water directly to the vagina (douching) as this may increase the risk of infection.
You are advised to avoid sexual intercourse whilst you are bleeding as this may increase the risk of infection, however using condoms may help to reduce this risk. You need to be aware that you can get pregnant before your next period if adequate contraception is not used.
Your next period should occur 4 to 6 weeks following the operation; however, this can be affected by the method of conception you are using. The bleeding on this period may be heavier than you are normally used to.
Blood loss following the operation can be expected up to 7 days. The amount can vary, and it is not unusual for it to stop and start. This is not a period. With this bleeding we advise you to use sanitary towels. Avoid tampons for the days when you are bleeding heavier.
You may experience ‘period type’ pains (cramping) as an individual this can be anywhere from 24 hours up to 1 week. You can use Paracetamol/Ibuprofen for pain relief as directed on the patient information leaflet in the packet. Do not exceed the stated dose in 24 hours.
It is not usually necessary for any further appointments, but you will be advised on discharge regarding any follow up arrangements.
It is important that you do not drink alcohol, take illegal substances or drugs, which have not been prescribed for you by a doctor, operate machinery (including power tools, boiling kettles, fires etc.) or make any important decisions for 24 hours after having a general anaesthetic.

Support

You can bring an adult with you for support; however, they will need to sit in the waiting area.

If you are under 18 years of age a female adult of your choice can stay with you throughout your treatment, and you need an adult (aged 18 or over) to take you home when it is finished. If this is difficult for you, please tell the clinic at the earliest opportunity so that your treatment can be provided safely. Please discuss this with your nurse.

If you are under the age of 16 a female support person can stay with you, right up until you go into theatre.

Contact Information

If you require any further advice on your procedure, you can contact:

Emergency Gynaecology Unit

Monday to Friday from 08:00 am to 17:30 pm on tel: 01482 607829

Saturday to Sunday from 08:00 am to 15:30 pm on tel: 01482 608767

Ward 30 (Cedar Ward) 24 hours a day on tel: 01482 604387 or 01482 602739

If you require any further advice on your procedure, you can contact

Pregnancy Advisory Service (PAS)

Monday to Friday from 08:30 am to 18:00 pm on tel: 01482 607829