Surgical Management of Miscarriage Under Local Anaesthetic (MVA)

Please note, this page is printable by selecting the normal print options on your computer.

Improving options in miscarriage treatment

We are so sorry to hear about your sad loss and offer our condolences at this sad time. To help you through this difficult time, you will already have received information on different treatment options. This leaflet gives you information about a surgical option called Manual Vacuum Aspiration (MVA), which can be done using local anaesthesia.

Research has found MVA to be:
• 98-99% effective
• Less blood loss
• Less pain
• Shorter time to complete than other surgical methods
• No general anaesthetic risks as you are awake during the procedure

What does it involve?
You will be admitted to our ward for a few hours. We may insert vaginal tablets at least 2 hours before the procedure to help soften and open the neck of the womb (cervix). This helps make the MVA procedure easier and safer. However, these tablets can sometimes cause cramping pains and bleeding and rarely cause a complete miscarriage on their own. If you do have pain we can offer
you painkillers. The MVA will be performed in a clinical environment where a health care professional will use a speculum (similar to that used in a smear test) to look at the neck of the womb.

Local anaesthetic may be injected into the neck of the womb to numb this area, and then, using a tube and syringe, the tissue remaining from the miscarriage will be removed. The actual procedure should only take a few minutes although you will be on the couch for longer. During this time you will experience moderate pain which should settle after the procedure. However, we do want you to be as comfortable as possible during the procedure. Nitrous oxide (known as gas and air) is also available for pain relief and clinical staff will help you to use this if it is needed. For some women morphine may be required but this will depend on the clinical circumstances.

Painkillers will be offered at the end of the procedure and may be administered by mouth or via the back passage. We like you to stay for up to 2 hours to make sure there are no problems. We would like someone to accompany you home as you should not drive yourself.

What are the risks of the procedure?
Although MVA has been proven to be very safe, like any treatment there are risks:
• There is a small risk that we may not remove all the tissue, therefore the procedure might have to be repeated another time.
• There is a small risk of bleeding, and an even smaller risk of severe bleeding, which may result in needing a blood transfusion.
• There is a minimal risk of infection, – which can be treated with antibiotics
• There is a very rare chance of perforating the womb (a hole in the uterus)
• You may also feel faint after, or near the end of the procedure. This reaction is normal, and usually disappears soon after.

What alternatives are available?
There are several alternatives to managing your miscarriage and these will have already been discussed with you by the staff. These include:
• Conservative Management i.e. doing nothing and allowing the natural expulsion of the miscarriage.
• Medical Management using tablets to make you miscarry (this is an option that is not currently offered at this hospital).
• Surgical Management under general anaesthetic where you will be put to sleep for the procedure.

What if I cannot decide?
Please feel free to take as much time as you feel necessary. Please do not feel you have to choose this option, or be rushed into a decision. We understand that choice may be difficult, but previous
research has found that women generally coped better when they were able to choose the management option that they felt was best for them at the time. Please feel free to contact us if you have any questions.

If you want to discuss any of the options for the management of your miscarriage further, please contact the Early Pregnancy Assessment Unit on 01908 996434.

The Miscarriage Association: 01924 200799
The Milton Keynes Miscarriage and Pregnancy Loss Support Group: 01908 582441
Messages can be left at the City Counselling Centre 01908 231131
Early Pregnancy Assessment Unit (EPAU) 01908 996434
Bereavement Midwife 01908 826665, 07833 482243
Hospital Chaplains 01908 243700