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  • Manual Vacuum Aspiration

    Patient Information & Consent Form
  • This procedure requires your formal consent.

    This form has been written to enable you to make an informed decision in relation to agreeing to the procedure. 

    The consent form is a legal document therefore please read it carefully. Once you
    have read and understood all the information including the possibility of complications and you agree to undergo the procedure, please sign and date the consent form.

    If however, there is anything you do not understand or wish to discuss further, do not sign the form but bring it with you and sign it after you have spoken to a Health Care Professional.


    What is manual vacuum aspiration (MVA)?

    MVA is a method of removing pregnancy remains from inside the womb. It uses gentle suction under local anaesthetic while you are awake. This is an alternative to having a general anaesthetic in theatre. This method is used to treat women who had a miscarriage where pregnancy tissue is left behind after a miscarriage. This is a day care procedure, and you should be well enough to go home after the procedure.


    Who are suitable candidates for this procedure?

    If you had a
    - Missed miscarriage.
    - Incomplete miscarriage
    - Failed medical management of miscarriage.


    Who may not be suitable candidates for this procedure?

    - Previous failed surgical management of miscarriage
    - Molar pregnancy- abnormal type of pregnancy
    - Abnormalities in uterus
    - Fibroid uterus of size > 12 weeks
    - Previous history of surgery to neck of the womb i.e. LLETZ
    - Allergy to local anaesthetic
    - Severe anxiety
    - Excessive bleeding
    - Unable to tolerate speculum examination.


    What happens prior to the procedure?

    You would be required to sign the informed consent form. Baseline blood tests are
    done. You will receive a prescription for painkillers and a tablet to soften the neck of the womb or cervix, to be taken 1 hour before the procedure.

    What happens on the day of the procedure?

    You can eat and drink normally. You will have to take the painkillers orally and cervical softening tablet sublingually (under your tongue). The latter helps to open the neck of the womb and ease the procedure.

    What happens during the procedure?

    You will be with the doctor, a nurse and a healthcare support worker in the procedure room. You will be asked to lie down on the couch with your legs in stirrups. We will then insert a tube-shaped tool (a speculum) into your vagina. This will stay in place while the procedure takes place. A local anaesthetic (numbing injection) will be injected into your neck of the womb. The neck of the womb is then dilated (stretched) gradually. A narrow suction tube is then inserted into the womb to remove the remaining pregnancy tissue. You may hear some sounds because of the suction working. If you would like some calming music to be played in the room during the procedure, please let the nurse or doctor know.
    After the tissue has been removed, you may have an ultrasound scan to check if the pregnancy tissue has been removed. The procedure takes about 20 minutes.


    Will the procedure hurt you?

    The numbing injection given into your neck of the womb is a very good pain relief.
    While you may feel some pressure, you should not feel any pain. If pain persists, we will stop the procedure and offer alternative treatment options for you.

    What happens to the pregnancy tissue removed?

    If you had consented for microscopic examination of the pregnancy tissue, the sample will be sent to the laboratory for further testing. We will contact you with the results once ready. Otherwise, all pregnancy tissue will be sensitively disposed by the hospital.


    What are the benefits of the procedure?

    - General anaesthetic is avoided.
    - It is quicker which avoids waiting for spontaneous miscarriage to happen.
    - Quicker recovery time

    What are the possible risks?

    Immediate
    - Discomfort
    - Feeling faint or dizzy.
    - Excessive bleeding requiring transfusion.
    - Need to abandon procedure in case of situations like difficulty in dilating neck of
      the womb or if you are unable to tolerate the procedure.
    - Loss of consciousness (medically known as vaso-vagal attack)
    - Injury to neck of the womb
    - Perforation of uterus, with a possible need to perform keyhole surgery          (Laparoscopy) to exclude or manage any internal injuries.

    Delayed
    - Risk of some pregnancy tissue remaining in the uterus, requiring a repeat procedure.
    - Infection, presenting as foul-smelling vaginal discharge, lower abdominal pain or fever.
    - Excessive bleeding (heavier than your period), passing blood clots.


    What happens after the procedure?
    - We will ask you to wait for up to 2 hours to make sure you are well enough to go
      home.
    - You can expect some vaginal bleeding which should not be more than your periods.
    - Antibiotics may be given based on our assessment of your infection risk.
    - We will also assess you for your risk of blood clots for which you may need blood thinning injections.
    - If you have a Rhesus negative blood group, we will offer you Anti- D injection.
    - You may return to work in 24-48 hours after the procedure.
    - You should do a home pregnancy test in 3 weeks. If it is positive, please contact
      the Hospital at 08114163781.

    When should you contact Hospital?

    - Excessive bleeding, passing clots
    - Foul smelling vaginal discharge
    - Fever
    - Positive pregnancy test at 3 weeks post-procedure

    What should you consider for speedy recovery?

    Avoid swimming, tampons, baths or sexual intercourse for a week

    CONTRACEPTION

    If you wish to have a MIRENA coil or Copper coil inserted for contraception, we can
    do this for you at the end of the procedure. If you have any heavy bleeding or worries following your appointment,

    please contact us on the following number:-

    Halimatu Musa Hospital

    08114163781

    General points to remember:-
    • If you are unable to keep your appointment, please notify the Hospital.
    • It is our aim for you to be seen and treated as soon as possible after your arrival.
    However, the Department is very busy and your procedure may be delayed. If
    emergencies occur, these patients will obviously be given priority over the less
    urgent cases.
    • The Hospital cannot accept any responsibility for the loss or damage to personal
    property during your time on these premises.

    YOU WILL NEED TO BRING SOMEONE WITH YOU TO TAKE YOU HOME
    FOLLOWING THE PROCEDURE.

    Patient agreement to Gynaecology investigation or treatment:

    Name of procedure: Manual Vacuum Aspiration


    Statement of patient/parent
    You have the right to change your mind at any time, even after you have signed this form.


    I have read and understand the information outlined above, including the benefits and any risks.


    I agree
    to the procedure described in this booklet and on the form.


    I understand
    that you cannot give me a guarantee that a particular person will
    perform the procedure. The person will, however, have appropriate experience.
    When a trainee performs the examination it will be undertaken under the
    supervision of a fully qualified practitioner.

     

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  • Confirmation of consent (to be completed by a health professional when the
    patient is admitted for the procedure)

    Statement of health professional (to be filled in by the health professional with
    appropriate knowledge of proposed procedure, as specified in consent policy).

    In response to a request for further information, I have explained the procedure
    to the patient/parent. In particular I have explained:

    The intended benefits:

    • To treat miscarriage

    Significant, unavoidable or frequently occurring risks:

    Immediate
    - Pain and discomfort
    - Feeling faint or dizzy.
    - Excessive bleeding requiring transfusion.
    - Need to abandon procedure in case of situations like difficulty in dilating neck of
      the womb or if you are unable to tolerate the procedure due to pain.
    - Loss of consciousness (medically known as vaso-vagal attack)
    - Injury to neck of the womb
    - Perforation of uterus, with a possible need to perform keyhole surgery (Laparoscopy) to exclude or manage any internal injuries.
    - Injury to neck of the womb

    Delayed
    - Risk of some pregnancy tissue remaining in the uterus, requiring a repeat procedure
    - Infection, presenting as foul-smelling vaginal discharge, lower abdominal pain or fever.
    - Excessive bleeding (heavier than your period), passing blood clots.

    I have also discussed what the procedure is likely to involve, the benefits and risks
    of any available alternative treatments (including no treatment) and any particular
    concerns of those involved.

    I have confirmed that the patient/parent understands what the procedure involves,
    including the benefits and any risks. The patient has no further questions and
    wishes the procedure to go ahead.

     

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  • Statement of interpreter (where appropriate) I have interpreted the information above on the patient/parent to the best of my ability and in a way in which I believe she can understand.

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