Definition and Overview

Miscarriage is definitely a time for grief and mourning for expectant mothers, but the patient’s emotions are not the only ones that need management. In the event of a miscarriage, the patient’s physical, emotional and reproductive health are at risk.

Miscarriage, also known as spontaneous abortion, refers to the natural death of the foetus before it develops the ability to survive independently from its mother. One of its most common symptoms is bleeding from the vagina, which could appear clotted and painful at times.

Any patient who suffered a miscarriage should immediately visit an OB-GYN (obstetrician-gynaecologist) to determine the condition of her womb, as well as to find out the causes of the condition.

There are three stages of miscarriage management, namely:

  • Expectant management, where the patient waits for the foetal tissue to pass naturally out of her womb

  • Medical management, in which the patient takes the medication prescribed by an OB-GYN to expel leftover tissue from the womb

  • Surgical management, where surgical techniques are performed to remove the dead tissue from the patient’s uterus.

One of the surgical management techniques used is vacuum aspiration. This can be performed through manual or electric means. Electric vacuum aspiration, or EVA, uses an electric vacuum device to suck out the dead tissue from the patient’s womb while manual vacuum aspiration, or MVA, employs a handheld pump (or a 25cc or 50cc syringe) to perform the procedure.

Who Should Undergo and Expected Results

Patients who have suffered a miscarriage before 20 weeks of gestation can undergo vacuum aspiration to remove dead tissues from their wombs, especially if they have already tried expectant or medication management but did not achieve the desired results.

The expected result of this procedure is a clean, healthier womb. Some studies also cite emotional benefits for the patient.

How is the Procedure Performed?

Vacuum aspiration takes around 15 minutes, but the preparatory and post-care procedures can add more hours to the whole procedure.

To begin, the OB-GYN will perform a pelvic exam or an ultrasound to determine the size, position, and condition of the patient’s uterus. The ultrasound can also be used to guide the doctor throughout the process of aspiration.

The doctor will then insert a speculum into the patient’s vagina, which will separate the vaginal walls and allow the doctor to see the cervix. The patient might feel a bit of pressure in the process, but will typically not hurt. The doctor can easily adjust the speculum if it starts to cause pain or discomfort.

The patient’s cervix will be treated with an antiseptic solution before a tenaculum is introduced to the opening. The tenaculum will hold the cervix in the proper position during the entire procedure. A local anaesthetic will then be injected in two or more places in the patient’s cervix to minimise the pain and discomfort during the procedure. Once the anaesthetic has set it, the doctor will insert dilators to gradually increase the opening of the cervix. This step is typically performed in two minutes or less.

A cannula, which is connected to a handheld or electric vacuum device, is then inserted into the opening of the cervix and then into the womb. This straw-like tube will be moved back and forth to suck out the remaining tissue inside the patient’s womb. The aspiration typically takes a couple of minutes, depending on the amount of tissue present in the uterus.

The patient will feel cramping in the lower stomach as the womb contracts and eventually emptied. These contractions are natural and are responsible for squeezing shut the blood vessels in the womb. The cramps usually range from mild to intense, and will gradually disappear after the procedure has been completed.

After the aspiration, the removed tissue will be examined to determine if the uterus is indeed clean.

After the whole procedure, the patient will be moved into a recovery room for a brief post-procedure observation. Another ultrasound procedure can be ordered to determine if the procedure has been successful and all remaining pregnancy tissues are indeed aspirated completely.

A follow-up appointment is usually scheduled two weeks later, where the doctor will perform or order tests for infection. Another follow-up procedure can be scheduled if pregnancy tissues are not completely removed.

Possible Risks and Complications

While vacuum aspiration for miscarriage management is generally safe, there are rare cases when a patient suffers from the following:

  • Infection
  • Perforation of the uterus and neighbouring organs
  • Scarring in the uterine lining
  • Extreme heavy bleeding after the procedure
  • Incomplete removal of pregnancy tissues
  • Severe allergic reaction caused by anaesthesia

    Reference:

  • Sakornbut EL. Intrapartum procedures. In: Ratcliffe SD, Baxley EG, Cline MK, Sakornbut EL, eds. Family Medicine Obstetrics. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 18.

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