Manual vacuum aspiration: an outpatient alternative for surgical management of miscarriage

Abstract

Key content Manual vacuum aspiration (MVA) is a safe and effective alternative method for surgical management of miscarriage. MVA can be performed in the outpatient setting under local anaesthesia. MVA reduces patient waiting time for surgery, cost of hospital stay and avoids general anaesthesia-related complications and increases patient choice. Complication rates are similar to those of electric vacuum aspiration carried out under general anaesthesia in the operating theatre. The necessary skills are easy to acquire and require minimal additional training and resources. Learning objectives To understand the indications, procedure and advantages of MVA. To review the data on effectiveness and complications of MVA. To review the feasibility of implementing the service in National Health Service hospitals while delivering a quality service which is safe, cost-effective and acceptable. Ethical issues How safe is it to perform MVA in an outpatient setting? Is it ethical to perform MVA under local anaesthesia, in emotionally vulnerable miscarrying women? Is the outpatient department an ideal setting in which to train doctors to perform MVA?