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Fetal anomaly treatment

Vacuum aspiration

You can have vacuum aspiration with your choice of anaesthetic:

  • local anaesthetic - awake
  • conscious sedation - relaxed but not asleep
  • general anaesthetic - asleep
Vacuum aspiration with local anaesthetic or conscious sedation

Plan to be at the clinic for 3 to 4 hours. If you need cervical preparation, plan to be at the clinic all day

Vacuum aspiration uses gentle suction to remove the pregnancy and takes about 5-10 minutes from start to finish. Afterwards, you need to rest in the recovery area for about 30-60 minutes. This treatment can usually be done up to 12 weeks' with local anaesthetic and up to 14 weeks' with conscious sedation.  You will receive medication to reduce discomfort with the procedure but you are awake throughout.

When you arrive, a healthcare professional will talk with you and answer your questions. You will take pain tablets if you have not taken any before coming to the clinic.

You are shown into a treatment area and asked to lie on a treatment couch with supports for your legs. A healthcare professional stays with you to provide comfort and support.

If you have conscious sedation, medication is given through a cannula (fine plastic tube) in a vein in your hand or arm.

The doctor examines your uterus (womb) and inserts a speculum into your vagina. The doctor injects a numbing medication (local anaesthetic) into or near your cervix (neck of the womb) and, if needed opens the cervix using thin rods called dilators.  A tube is inserted through the cervix into the uterus. Either a hand-held suction device or a suction machine gently empties your uterus.

You will feel cramping, similar to period pains, during the procedure. For some women it is more uncomfortable but as you will be awake you can tell the doctor if you need more pain medication, and it will be provided. In some clinics, where space allows, your support person can stay with you throughout this treatment.

After the treatment you are taken to the recovery area, where you are monitored until you are ready for discharge.  You will have a light snack before going home.

If you had conscious sedation it is strongly advised that you go home with someone who can look after you overnight and you should not drive for 24 hours.

Vacuum aspiration with general anaesthetic

You should plan to be at the clinic for the whole day.

Vacuum aspiration uses gentle suction to remove the pregnancy and takes about 5-10 minutes from start to finish. This treatment can usually be done up to 15 weeks of pregnancy. You are asleep and will not feel any pain during the procedure.

When you arrive, a healthcare professional talks with you and answers your questions. You are asked to change into a gown and to lie down on a trolley. Your anaesthetist will meet you, answer your questions and take you into theatre.

A small cannula (a very fine plastic tube) is placed in a vein, normally on your hand. Medication is given through the cannula to make you sleep (general anaesthetic).

Once you are asleep or sedated, your legs are placed in supports and the doctor examines your uterus (womb). A speculum is inserted into your vagina. The opening of your cervix (neck of womb) may be stretched with thin rods called dilators. A tube is then inserted through the cervix into the uterus. Either a hand-held suction device or a suction machine gently empties your uterus.

You will wake up in the recovery area and will be observed for about 1-2 hours before going home.

You should read about your anaesthetic here. It is strongly advised that you go home with someone who can look after you overnight and you should not drive for 24 hours.

Dilatation and evacuation with general anaesthetic or conscious sedation

Plan to be at the clinic for the whole day.

This method uses instruments and suction to remove the pregnancy. It is usually performed between 14 and 24 weeks of pregnancy. In addition to the procedure described below, you will need to have cervical preparation performed on the day of surgery, or the day before. Please see how we prepare the cervix.

A healthcare professional will talk with you and answer your questions. You will be asked to change into a gown and to lie down on a trolley. Your anaesthetist will meet you, answer your questions and take you into theatre.  A small cannula (very fine plastic tube) is placed in a vein, normally on your hand. Medication is given through the cannula to put you to sleep (general anaesthetic) or sedate you.

Once you are asleep or sedated, your legs are placed in supports and the doctor examines your uterus (womb). A speculum is inserted into your vagina. The opening of your cervix may be stretched with thin rods called dilators. The pregnancy is removed using narrow forceps passed through the neck of the womb. A tube is then inserted through the cervix and a suction machine used to gently complete the evacuation.

You won't feel any pain during the procedure, which will take about 10-20 minutes from start to finish. You will wake up in the recovery area and be observed for about 1-2 hours before going home.

After general anaesthetic or sedation it is strongly advised that you go home with someon who can look after you overnight and you should not drive for 24 hours.  Read about general anaesthetic here and conscious sedation here

Medical induction

You should plan to be at the clinic for the whole day and usually overnight.

This method involves the administration of medications that induce labour. This procedure takes place over 2 days.

First appointment: You are given a mifepristone tablet to swallow. This medication makes the uterus more sensitive to a medication called misoprostol, which is used to induce contractions. You will go home and return for the rest of your treatment on a different day. If you vomit within 1 hour of taking the mifepristone you may need to return to the clinic for another dose.  If you are 22 weeks pregnant or more, it is necessary to administer an injection to the fetus to stop the hearbeat before the induction takes place.  If you are rhesus negative, you will also have an anti-D injection.

Second appointment: You will be admitted to the clinic and misoprostol is administered as a vaginal pessary, every few hours until all the fetus and placenta are passed. You are awake throughout the process and will be given painkillers and gas and air as needed. The healthcare professional looking after you will try to make the process as comfortable as possible.

On average it takes about 6 hours for the labour and delivery, but this can vary. In some cases it may be quicker but in others it may take over 24 hours and you will need to stay overnight in the clinic. In a minority of procedures, the placenta does not pass spontaneously and it is necessary to perform a procedure, usually under general anaesthetic, to remove it.

You may see large blood clots or the fetus and placenta during this procedure.  The midwife will try to make sure that you see very little, but sometimes this is not possible as events can be rapid.

It is normal to have some light bleeding 1-2 weeks after treatment and you may have spotting until your next menstrual cycle.  Using sanitary pads may make it easier to keep track of your bleeding

Side effects

It is normal to experience bleeding and cramping.  You may also:

  • feel dizzy
  • feel nauseous or have to vomit
  • have headache
  • have diarrhoea
  • have temporary flushes or sweats

A nurse or midwife will be with you at all times and will give you medicine to help control any side effects or pain you might have.