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Fetal anomaly treatment

Vacuum aspiration with local anaesthetic/sedation

Plan to be at the clinic for at least 3 hours. (You may need to be at the clinic all day if your surgeon recommends additional cervical preparation.) 

Vacuum aspiration uses gentle suction to remove the pregnancy and takes about 5-10 minutes from start to finish. Afterwards, you will need to rest in the recovery area for about 30-60 minutes. 

You will receive medication to reduce discomfort with the procedure and you can also choose to be sedated (relaxed and sleepy). 

You are shown into a treatment area and asked to lie on a treatment couch with support for your legs. A healthcare professional stays with you to provide comfort and support and monitor you throughout. The doctor examines your uterus (womb) and a speculum is inserted into your vagina. The doctor injects a numbing medication (local anaesthetic) into or near your cervix (neck of the womb) and, if needed, gently 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. 

After treatment you are supported to walk to the recovery area, where you are monitored by specially trained staff until they are satisfied with your recovery.

Vacuum aspiration with general anaesthetic

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. You are asleep and will not feel any pain during the procedure.

When you arrive, a healthcare professional will talk with you and answer 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, 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. Do not drive for 24 hours after a general anaesthetic.

Dilatation and evacuation

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 15 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 the section on preparing the cervix.

You will be asleep for this procedure.

When you arrive, 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 (a very fine plastic tube) will be placed in a vein, normally on your hand. Medication will be given through the cannula to put you to sleep (general anaesthetic).

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

Read about your anaesthetic here. Do not drive for 24 hours after a general anaesthetic.

Medical induction

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.

Day 1: You are given a mifepristone tablet to take by mouth. This medication makes the uterus more sensitive to a medication called misoprostol, which is used to induce contractions. You will return home and return for the rest of your treatment on a different day. If you vomit within 1.5 hours of taking this tablet you may need to return to the clinic for another dose.

Day 2: You are admitted to the treatment unit 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. You may see the fetus or other pregnancy tissue during this procedure.

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.

If you are 22 weeks pregnant or more it is necessary to administer an injection into the fetus to stop the heartbeat before the induction takes place. This is called ‘feticide’ and is discussed here.