Manual Vacuum Aspiration (miscarriage/abortion <=12 wks)
Manual Vacuum Aspiration (miscarriage/abortion <=12 wks) operating theatre - gynaecology
IN REVIEWPENDING CLINICAL VERIFICATION
Indications
- Incomplete/missed miscarriage
- Induced abortion <=10-12 wks (provider norms per MTP Rules)
- Retained products with sepsis (post-antibiotic start)
Consent points
- Success rates/failure -> repeat
- Uterine perforation/infection/bleeding risks
- Discuss gestation- and indication-specific RhD prophylaxis
- Contraception same-day offer
Equipment
- MVA syringe 60 mL + cannulae 4-12 mm
- Tenaculum, sound, antiseptic, speculum
- Histology container (molar suspicion always)
Anaesthesia
- Paracervical block 1% lignocaine ± light sedation
Absolute contraindications: Suspected ectopic (treat as such) · Haemodynamic instability uncorrected · Molar pregnancy needs suction-evacuation setup (specialist)
Preparation
- CBC/group&save; sepsis screen if febrile
- Analgesia plan (paracervical block ± sedation)
- Aseptic prep; tenaculum traction reduces pain/perforation
- Sound to depth; choose cannula = weeks of gestation (mm)
- Create vacuum ~60 mL; evacuate with rotating strokes
- Inspect aspirate: products complete? vesicles?
- Confirm uterus contracted; minimal bleed at end
Troubleshooting:
Complications & management- No tissue obtained: reconsider ectopic/retroversion error
- Excessive bleeding: uterotonics; complete evacuation faster is haemostatic
Uterine perforation
Stop; observe stable small anterior perforations; laparoscopy/laparotomy for suspected visceral injury/unstable
Retained products
Repeat aspiration; antibiotics if infected
Infection/endometritis
Broad-spectrum course; sepsis pathway if systemic
Postoperative care
- For miscarriage, use the linked NICE NG126 2026 gestation-specific RhD criteria after confirming local applicability; induced abortion has a separate guidance context
- Analgesia + red-flag leaflet
- hCG follow-up plan
Admission & discharge
Care setting: Usually outpatient/day care if stable; admit haemorrhage, infection or unsafe symptoms
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Admit heavy ongoing bleeding/instability, suspected sepsis, severe uncontrolled pain or inability to complete safe outpatient care. Exclude ectopic pregnancy when the location/outcome is uncertain.
When clinic, day care or home care may be suitable
- Confirmed uncomplicated miscarriage can be managed expectantly, medically or by day-case surgery according to clinical suitability and patient preference.
Before going home
- Bleeding/pain and observations support home care; the diagnosis, chosen approach and possibility of incomplete treatment have been explained.
- After evacuation/anaesthesia, recovery and postoperative assessment are satisfactory, with transport/adult support when needed.
Discharge medicines and treatment changes
- Use only the regimen for the diagnosed type of miscarriage; provide analgesia and antiemetic treatment when needed. Review RhD care using the current applicable pathway.
Medicine doses — use only when indicated
Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.
Pain relief when suitable; provide the selected miscarriage regimen in the treatment section.
Paracetamol (acetaminophen) — oral pain reliefMédecins Sans Frontières · Current online monographchecked
Dose1 g (two 500 mg tablets) per dose
RouteOral
FrequencyEvery 6–8 hours when needed; maximum 4 doses in 24 hours
DurationAccording to clinical response: reduce/stop as pain improves. Record the prescribed supply and review date; persistent or increasing pain needs reassessment rather than an automatic repeat course.
PreparationCheck tablet strength: two 500 mg tablets = 1 g. Count paracetamol in every combination/OTC product towards the total; this is not an IV preparation.
Max dose4 g in 24 hours for the stated adult population. Lower weight, hepatic impairment or other risk factors require an individual reduced prescription; do not automatically use this maximum.
- Indication: Short-term maternal postoperative/postpartum pain or other mild pain after assessment; adult ≥50 kg
- MSF oral monograph: no pregnancy or breastfeeding contraindication. The dose does not replace assessment of the cause of pain.
Monitoring
- Pain and functional recovery; investigate increasing pain, fever or other warning symptoms.
- Check all prescribed/OTC paracetamol, weight and hepatic risk; suspected excess dosing requires urgent assessment.
Contraindications: Paracetamol allergy; avoid duplicate paracetamol-containing products. · Hepatic impairment needs caution and a clinician-adjusted regimen. This adult ≥50 kg card is not a weight-based prescription for smaller adults or children.
Tests, pending results and their reviewer
- NICE: after expectant management, review completion at 7–14 days; if symptoms resolve, provide a urine pregnancy test for 3 weeks.
- After medical management, urine pregnancy test at 3 weeks; a positive result or persistent bleeding, pain or fever needs assessment even when a test is negative.
Home care and counselling
- Explain expected bleeding/tissue passage, pain relief, hygiene and how to contact the early-pregnancy service. Offer grief support and contraception/future pregnancy advice.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
If bleeding has not begun within 48 hours of misoprostol | Contact the treating service for review rather than repeating treatment independently. |
3 weeks after treatment | Check the home pregnancy test and symptoms; arrange review for a positive result or ongoing concerns. |
Return urgently
- Very heavy bleeding, fainting, severe/worsening pain, fever or offensive discharge needs urgent care.
Follow-up: 1-2 wk review or urine test at 3 wks · Contraception started same day counselling · Sources: Government of India (MoHFW), NICE, NICE, NICE, RCOG, Médecins Sans Frontières, NICE, India MoHFW / NHM, WHO, RCOG, NICE
Government of India (MoHFW) · Current law as of 2026-08-23 (no later amendment found in search)checkedNICE · NG126checkedNICE · NG126, June 2026checkedNICE · NG126checkedRCOG · Current public care informationcheckedMédecins Sans Frontières · Current online monographcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedRCOG · Current public recovery informationcheckedNICE · CG50, recommendationschecked