What is surgical termination of pregnancy using vacuum aspiration?

A surgical termination of pregnancy using vacuum aspiration is a procedure where a thin tube is inserted through the neck of the womb and gentle suction is used to remove a pregnancy. This is done using general anaesthetic. 

Who is this type of procedure for?

You can have a surgical termination of pregnancy using vacuum aspiration under general anaesthetic up to 15 weeks of pregnancy. This is a safe option for most women, but for some it might not be recommended, for example if you have large fibroids (harmless growths) in the womb or if you have had previous surgery to the neck of the womb. 

What will happen before the procedure? 

Before the procedure, the doctor or nurse will carry out a medical assessment where you will be asked questions about this pregnancy, and whether you have any medical problems or take any regular medications. This is to ensure that surgical abortion using vacuum aspiration is a safe and appropriate option for you. 

They will also ask you how you are feeling about your decision to have a termination. This is to check that no one is pressuring you into this, and to offer further support if you need it. Whether or not you have a termination is your choice and you will be treated in a non-judgemental and respectful manner. If you have any worries or concerns, or are unsure about what to do, please discuss it with the doctor or nurse. There is also a counselling service available if you need further support. 

You will be advised about the process of having a surgical termination of pregnancy and the possible complications. You will then be asked to sign a consent form to confirm that you understand the information given to you. This does not mean that you are obliged to proceed with the procedure, you can change your mind at any time. You will also be asked about whether you would like contraception and informed about the different options available. 

A blood test will be needed to determine your blood group and you will be offered a self-taken swab for sexually transmitted infections (STIs).

What are the risks of this type of procedure?

Termination of pregnancy is a very common and safe procedure and complications are rare, especially earlier in pregnancy. Possible complications include:

  • Infection of the womb – around one in 100
  • Failure of the procedure (where the procedure fails to end the pregnancy) - less than one in 100
  • Retained products of conception (where some of the pregnancy tissue may be left inside the womb) - around one in 100
  • Severe bleeding (very heavy bleeding that may require a blood transfusion) - less than one in 1000
  • Cervical tear (damage or a small tear to the neck of the womb) – less than one in 100
  • Uterine perforation (making a small tear in the womb) – less than one in 1000

If you experience any complications, you may require further procedures such as a repeat vacuum aspiration, laparoscopy (keyhole surgery) or a blood transfusion. 

Is there an alternative to a surgical termination of pregnancy? 

It is possible to have a medical termination of pregnancy instead of a surgical procedure, where medication is taken to end the pregnancy. Please ask the doctor or nurse/midwife if you would like more information on this option.

What to expect on the day of the procedure?

You should avoid eating or drinking from midnight on the day of your procedure, except for sips of water. The doctor or nurse will give you clear instructions about what to do beforehand. 

When you arrive at the ward you will be given a medication called misoprostol. This softens the neck of the womb in preparation for the procedure and takes around one hour to work. When it is time to start the procedure, you will be given anaesthetic medication though a vein in your hand, which will put you to sleep. 

During the procedure, a speculum (plastic tube) will be inserted into the vagina, narrow rods (called dilators) are then used to open the neck of the womb if needed, and a thin suction tube is inserted through the neck of the womb. A suction machine will then be used to gently empty the womb.

The procedure usually takes around 15 minutes. You will wake up from the operation in the recovery room and will be able to go home later that day if you feel well enough. You will not be able to drive after the general anaesthetic and you will need someone to escort you home, as you may feel a little groggy for a while afterwards.

What will happen with the pregnancy tissue?

A pregnancy loss of any kind may open questions as to what happens next. Some people do not wish to have an individual funeral. There is nothing wrong or uncaring about that. Others find preparing for a funeral and attending a service or ceremony helpful. Ward staff, the Bereavement Midwife or the chaplains are available to explain what the hospital can offer and to support you during this time. We are here to help regardless of how involved you may choose to be following your loss. 

A Bereavement form will be discussed with you at some point during your visit. This form gives you the opportunity to decide about what happens next and enables us to gain your consent at the time you make your decision. It also ensures that the hospital fulfils its responsibility to care for all pregnancy losses that happen at this trust. There are three options available to and below will provide you with some basic information about these. 

No wish for an individual cremation or burial 

If you do not wish to have an individual cremation or burial and prefer the hospital to decide without your involvement, then a free dignified communal cremation will be carried out on your behalf. A communal cremation is where babies are placed in a shared coffin. They are cremated with other babies at Islington/Hendon Crematorium with a hospital representative in attendance. The babies’ ashes are then scattered in the Children’s Garden of Remembrance. 

Private arrangements 

There may be many reasons why you may prefer to make private arrangements with a funeral director of your choice. There may be a minimal cost implication which will be your responsibility. 

Individual cremation or burial 

If you wish, the hospital can arrange an individual cremation at Golders Green Crematorium or/and individual burial at St Pancras Cemetery in East Finchley or in Hendon. This comes at no cost to you. It is your choice if you wish to attend or not. 

At East Finchley, there are three baby burial areas at the cemetery: 

  1. Roman Catholic 
  2. Muslim
  3. A general area. 

At Hendon, there are two: 

  1. Muslim
  2. A general area. 

The graves in all areas are shared graves. This means that your baby is buried alongside other babies. Your baby has its own grave reference number so that, if you wish, you can mark the grave or put up a small headstone at a later date.

If you choose to have an individual cremation, you will be asked whether or not you wish to have your baby’s ashes. You may choose to retain or scatter baby’s ashes in an area meaningful to you. If you decide you do not wish to have your baby’s askes, they are scattered in the Children’s Garden of Remembrance. 

You may choose to have a service, and this can take many different forms. Some choose to take their own service, whilst others ask someone from their own faith community to lead or assist. You may prefer one of the chaplains to help you plan a ceremony. There will be plenty of opportunity to explore your wishes about this. 

If you have further questions, please contact the Bereavement Midwife who can assist you. 

What to expect after a surgical termination of pregnancy

You may experience bleeding similar to a period, for up to 10 days, which should get lighter with time. Most women feel well enough to return to work and other normal activities within a day or two. You can resume sexual activity whenever you feel comfortable to do so.

It can be normal to go through a range of emotions including sadness and grief. If you would like to talk to someone about how you are feeling after the procedure you can contact the women’s health counselling service on 020 7830 2791 or Antenatal Results and Choices (ARC) on 020 7713 7356.

You do not need to attend the clinic again after a surgical termination of pregnancy unless there is a problem, or you have any concerns.

When should I seek help? 

You should seek help if you have any of the following:

  • Bleeding that is not getting lighter with time, is worsening or very heavy
  • Vaginal discharge that smells unpleasant
  • Constant lower abdominal pain or deep pain during sex
  • Fever or feeling shivery 

You can call the clinic within working hours on 020 7830 2495, or alternatively your GP or 111. In an emergency, please call 999 or attend A&E.

When should I start using contraception again?

If you have decided to start using contraception after the procedure and have been given contraception such as pills or patches these should be started straight away, ideally on the day of the procedure, or as soon as possible afterwards. This is because you are at risk of getting pregnant again very quickly, as early as one week afterwards. 

If you have chosen to have an implant or contraceptive coil, these can be fitted at the same time of the procedure. You can read more about contraceptive coils and the implant on the Sexwise website.