ESMOE: Miscarriage

Manual vacuum aspiration procedure
Post miscarriage advice
Safe miscarriage
Unsafe miscarriage
Level of treatment

Miscarriage can lead to haemorrhage and sepsis. 

Products should be evacuated by MVA if less than 14 weeks gestation.

Manual vacuum aspiration procedure

• Voltaren/brufen 1 hour before procedure
• Assess uterine size
  • Uterus ≤ 12 weeks size - perform intra-cervical block with 1% lignocaine
• Check uterine size & position
• Insert speculum & remove tissue from vagina & os
• Straighten cervical canal by pulling gently with sponge-holding forceps, & dilate the canal if necessary
• Select appropriately sized cannula & insert using 'no-touch' technique
• Attach MVA syringe - release valve to activate vacuum
• Evacuate contents, rotating & moving cannula gently
• Remove cannula, forceps & then speculum
• Perform bi-manual examination
• Check products - if no POC, think of ectopic pregnancy

Post miscarriage advice

• What to expect in the next few days
• When to resume coitus
• Contraceptive advice
• Next pregnancy
• Follow-up appointment
• Doxycycline 100mg PO BD x 7-10 days

Safe miscarriage

• Temperature <37.2 oC,
• Systolic BP >100mmHG
• Pulse <90 beats per minute, 
• Respiratory rate <20 per minute,
• Uterus <12 weeks in size,
• POC not foul smelling,
• Haemoglobin >10g/dl
• No clinical signs of infection
• No system or organ dysfunction or failure
• No suspicious findings on evacuation of the uterus

Unsafe miscarriage

• Anything else!

Level of Treatment

Safe miscarriage

• MVA at CHC/Level 1 institution

Unsafe miscarriage

• Level 1 with theatre facilities (provided no organ system dysfunction)
• Level 2 or 3