Fetal anomaly treatment

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.

A healthcare professional will show you into the treatment area. You will be asked to lie on a couch with supports for your legs. You will meet your doctor at this stage and can ask any last-minute questions. Any sedation will be given to you before the procedure begins. A nurse will stay with you throughout for support and comfort.

After examining you and placing a speculum into your vagina, the doctor may need to open the cervix using thin rods called dilators. A tube will then be inserted through the cervix into the uterus. Either a handheld suction device or a suction machine gently empties your uterus. If you are awake for your procedure, you will feel cramping, like period pains.

After your treatment you will be taken to the recovery area where you will be monitored until staff consider that you are ready for discharge. You will have a light snack before going home. You will be given an anti-sickness drug.

If you have sedation or anaesthetic, please refer to the relevant pages below for recommendations:

• local anaesthetic
• conscious sedation
• general anaesthetic

Significant, unavoidable or frequently occurring risks

These are usually easy to treat and rarely have any long-term health effects.

• Retained products of conception - where the pregnancy has been successfully ended but some of the pregnancy tissue is left behind in the womb (1 in 600)
• Infection (1 in 6,500 as reported to BPAS but may be higher)
• Unpredictable bleeding after the procedure (variable)
• Pain during the procedure (variable)
• Injury to the cervix (1 in 11,000)
• Psychological problems (variable)
• Continuing pregnancy (1 in 1,500)

These may require transfer to hospital or surgical procedures, and may have serious long-term health effects

• Perforation of the uterus/womb (1 in 6,500)
• Haemorrhage - very heavy bleeding (1 in 8,000)
• Injury to bowel, bladder or serious injury to cervix (very rare)

Extra procedures that may be necessary

• Repeat surgical procedure or uterine aspiration
• Blood transfusion
• Laparoscopy or laparotomy – operation to look inside the abdomen
• Repair of damage to cervix, uterus, bladder, bowel or blood vessels
• Hysterectomy – surgical removal of the womb (1 in 35,000)

Death is very rarely linked to treatment - less than 1 in 100,000 for all terminations of pregnancies.

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 heart beat 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.

Significant, unavoidable or frequently occurring risks

These are usually easy to treat and rarely have any long-term health effects.

• Unpredictable time to complete the procedure
• Side effects of drugs, such as nausea, vomiting, diarrhoea, headache, dizziness, fever/chills (common)
• Retained placenta (1 in 60)
• Infection (may be up to 1 in 400)
• Unpredictable, irregular, or prolonged bleeding after the termination of pregnancy (variable)
• Pain during the procedure (common)

These may require transfer to hospital or surgical procedures, and may have serious long-term health effects.

• Psychological problems (variable)
• Continuing pregnancy/failure to deliver (1 in 150)
• Haemorrhage – very heavy bleeding (1 in 200)
• Rupture of the uterus/womb (1 in 1,000)

Extra procedures that may be necessary

• Surgical termination of pregnancy or uterine aspiration
• Blood transfusion
• Laparoscopy or laparotomy – operation to look inside the abdomen
• Hysterectomy – surgical removal of the womb (very rare)

Death is very rarely linked to treatment - less than 1 in 100,000 for all terminations of pregnancies.