Management of miscarriage under local anaesthetic (MVA)

We are sorry that you have had a miscarriage.

To help you get through this difficult time, you should have already 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 anaesthetic.

MVA is a way of emptying the uterus (womb) while you are awake. It uses a narrow tube to enter and empty the womb using gentle suction. Anaesthetic is applied to the cervix (neck of the womb) to numb any physical sensations felt, including pain.

Research has found MVA to be:

• 98-99% effective.
• Associated with less blood loss.
• Associated with less pain.
• Takes a shorter time to complete than other surgical methods.
• No general anaesthetic risks as you are awake during the procedure.

MVA is offered to women in the following situations:

• Incomplete miscarriage (where some of the pregnancy tissue remains inside the uterus).
• Missed miscarriage at gestations less up to 10 weeks (where a pregnancy has stopped growing but the pregnancy sac is still present inside the uterus).

You will be admitted to our ward for a few hours. Before the procedure we will give you some medication for pain relief to take and we may insert vaginal tablets (misoprostol) to help soften and open the neck of the womb (cervix). This helps make the MVA procedure easier and safer. These tablets can sometimes cause cramping pain and bleeding. We would also insert a cannula in your hand / forearm so we can give you fluids or medications if required.

The MVA will be performed in a private clinic on the ward where a doctor 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. A nurse will be with you at all times to monitor the need for pain relief and extra support. Your partner will be able to be present during the procedure.

The actual procedure itself should take only a few minutes although you will be on the couch for longer. During this time you will experience some cramping, abdominal pains, which should settle after the procedure.

We 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 this is what you choose. If you needed medication for pain relief you will be offered some at the end of the procedure.

We would ask you to stay for a short while after the procedure to ensure you are well enough for discharge. We would like someone to accompany you home, as you should not drive yourself.

Misoprostol is the medicine inserted into the vagina before the procedure to help soften the neck of the womb. Possible side effects include:

• Nausea
• Vomiting
• Diarrhoea
• Abdominal pain
• Headache
• Hot flushes
• An unpleasant taste in the mouth.

We will monitor you for a couple of hours after the procedure. This will include taking your blood pressure, your pulse and checking if you are in pain. You can go home once you have passed urine and feel well enough. We recommend someone escorts you home after the procedure.

You can expect some bleeding after the MVA which will usually settle within seven days. We recommend using sanitary towels instead of tampons and advise you not to have sexual intercourse until the bleeding has stopped. This reduces the risk of infection. You may return to work in 48 hours, or when you feel able.

If your blood group is rhesus negative we would offer an injection of Anti-D.