Manual Vacuum Aspiration

What is MVA?

MVA is a surgical procedure where the pregnancy tissue is removed from the womb using a handheld narrow suction tube. This procedure is performed under local anaesthesia (numbing injection) and you will be awake during the procedure. An ultrasound scan is also performed during the procedure to reduce the risk of complications and make sure that all the pregnancy tissue is removed. The success rate is as high as 96-98%. It is only suitable for pregnancy less than 10 weeks gestation.

What are the advantages of MVA?

• You avoid exposure to a general anaesthetic
  
• You can eat and drink normally; no need to fast
  
• Quicker recovery after the procedure
  
• Early return to normal activity
  

Who may not be suitable for MVA?

Some women are worried about pain or anxious of the procedure happening and feel that it will be easier for them to be unaware of what is happening. In this event, you may choose to have the procedure done under general anaesthesia instead. If you find it challenging to undergo a PAP smear test, having the procedure under general anaesthesia may be a more comfortable and suitable option for you.

What happens on the day of the procedure?

You should have your usual meals on the day of procedure and arrive at the clinic by 1pm. You may bring your partner, a family member or a friend with you. The doctor will discuss the results of your blood test and go over the consent form with you. You may check with the staff on that day if you have any questions. Sensitive disposal of the pregnancy tissue will also be discussed on that day.

Preparation for the procedure

You will be given some tablets about one to three hours before the procedure:

• Misoprostol tablets (medication to soften the cervix and make the procedure safer) to be placed under your tongue or into the vagina
  
  
• Pain relief tablets (mefenamic acid or arcoxia) to be swallowed
  
  

What to Expect During Manual Vacuum Aspiration

What should you expect during the procedure?

The procedure takes place in a clinic room. You will need to change into a hospital gown. You will be asked to lie on a couch with your feet on the footrests. A speculum is placed in the vagina, like during a PAP smear test. A local anaesthetic will be injected into your cervix (neck of the womb). The cervix is then dilated (stretched) gradually. A suction tube is then inserted into the womb to remove the pregnancy tissue. An ultrasound scan is also performed during and at the end of the procedure. The whole procedure will take less than 30 minutes.

Some women may experience a period-like cramp which passes quickly. You may also hear some sound because of the suction working.

If you have opted for an insertion of intrauterine contraceptive device (IUCD) or contraceptive implant, this can also be performed at the end of the procedure.

With your consent, a sample of the tissue removed may be tested to check for an uncommon type of pregnancy called molar pregnancy.

What can you expect after the procedure?

• Immediately after the procedure, you will be brought to the recovery area. You will stay there for about an hour. You can go home once you feel well and have been reviewed by the doctor/nurse.
• You may experience a period cramp-like pain and light vaginal bleeding. This should gradually reduce over the next two weeks. You will be given some painkiller tablets to bring home, which can be taken as required over the next few days. You should continue to use sanitary pads and not tampons until your next period. We also recommend that you avoid sexual intercourse until the bleeding stops.
• If you have a Rhesus negative blood group, you will be given an anti-D immunoglobulin injection before you go home.
• You will be prescribed antibiotics to reduce your risk of getting infection. A dose of azithromycin tablet will be given to you before you go home, and a course of metronidazole tablets will be given to you for completion at home. It is advisable not to consume any alcohol with metronidazole tablets.

When should I seek medical attention?

Some symptoms of the risks and complications of MVA can present after you have been discharged from the hospital. If you experience any of the below symptoms, you should return for medical assessment:

1. Excessive vaginal bleeding: If you experience heavy bleeding (TWO pads an hour for TWO consecutive hours)
   
2. Abdominal pain: If you experience severe lower abdominal pain not relieved by prescribed painkillers
   
3. Fever
   
4. Foul-smelling vaginal discharge
   
5. Feeling generally unwell
   

When do I return for a follow-up appointment?

You will be given a teleconsultation or a physical clinic appointment 4 to 6 weeks after your procedure. You may also be advised to take a pregnancy test during the follow-up appointment.

Treatment locations at SingHealth

• Urgent O&G Centre (UOGC)
  Basement 1, Women’s Tower, KKH
• Women’s Hub
  Basement 1, Women’s Tower, KKH
• Clinic L
  Level 1, Children’s Tower, KKH
  

The information above is also available for download in pdf format.