Manual Vacuum Aspiration with local anaesthesia

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Manual Vacuum
Aspiration with local
anaesthesia
Marijke Alblas,MD
Western Cape Department of
Health
Use of MVA:
• Induced abortion up to 14 weeks
• Incomplete abortions uterine size up to 14
weeks
• As a back-up for failed medical abortion
• Missed abortion
• Endometrial biopsy
• Molar pregnancy
Goal of presentation to show
that:
• MVA is a safe and simple procedure
• Safer, cheaper and more effective than
D&C
• Can help to decentralize the service and
make it more accessible
• Can be done by mid-level providers
• Has a very low failure rate
MVA is a safe and simple
procedure
• Priming of cervix with misoprostol(2 or 3
tablets) 2 to 3 hours before procedure
• Local anaesthesia
• By properly trained HCP
• With the proper instruments
• In the right setting: as an out-patient
procedure
But: don’t do a ‘curette check’!-->to
check with a curette for complete
evacuation adds unnecessary risks
•
•
•
•
Increases pain and vagal reactions
Increases chance of perforation
Increases bleeding
Many studies have demonstrated that using
only suction has an effectiveness rate of 98%
Can help to decentralize the service
and therefore make it more accessible
• Take it out of the theaters/ hospital-->OPD or office
setting
• Minimal emergency equipment necessary
• MVA needs no ‘expensive’ instruments: no electrical
suction machine, sets are re-usable
• Beds are not really necessary(not for first trimester)
• Only one trained ‘specialist’ necessary
• If allowed make use of mid-level provider
• Woman recover and return home quicker
Make use of the right instruments
and handle them gently: the woman
is awake!!
• Use the right size speculum
• Use ‘long’ needles for para-cervical block or needle
extender
• Use the ‘right’ size of cannula; dilate with the
different sizes of cannulae
• Avoid to use too big size of cannula: be aware that
woman is awake!!!
• Don’t continue too long with the suction
Create the Vacuum
• Pull the plunger
back until its arms
snap outward over
the end of the
aspirator barrel.
• Make sure the
plunger arms are
positioned over the
wide edges of the
barrel.
Selecting the cannula
Approximate uterine
size
(weeks LMP)
Approximate size of the
cannula
5 to 8 LMP
4 to 6 mm
8 to 9 LMP
6 to 7 mm
10 to 12 LMP
____________________
13 to 14 LMP
7 to 10 mm
____________________
10/12 mm
Adapters for the double-valve aspirator are color-coded to
the dots on the corresponding cannula
9
9
Paracervical block:
---
Insert cannula
Releasing the Pinch Valve
• When the pinch valve is released, the vacuum
is transferred through the cannula to the
uterus.
• Blood, tissue, and bubbles will flow through
the cannula into the aspirator.
MVA Technique: Vacuum
Aspiration
© Lisa Penalver
MVA Technique: Vacuum
Aspiration
© Lisa Penalver
Dilation cervix while doing suction:
using different sizes of cannula
• Misoprostol has been given according to
established protocol ( 2 to 3 hours before
procedure)
• Gently dilate with cannula of increasing size
taking care not to traumatise the cervix.
Dilation (cont.)
• With every cannula do suction and continue
until the appropriate cannula for the
procedure: POC are passing through the
cannula
• In between empty syringe in kidney basin
• Dilatation of the cervix only necessary
when the cervical canal will not allow
passage of appropriate cannula
Inspecting the tissue
• Strain and rinse the
tissue
• Using a transparent
container, inspect the
material by examining it
with a light from behind
• Make sure all the tissue
has been withdrawn
17
Tissue Examination
Visual Inspection of the
Products of Conception
Gestational sac
Blood clot
Decidua
Types of Complications
Early Complications:
– Cervical Injury
– Uterine injury
– Haemorrhage
– (Pre-existing) infection
– Uterine rupture
– Anaesthesia related complications
Recognising and managing
uterine perforation
Signs:
• Instruments inserted beyond the fundus
• Excessive bleeding
• Fat or organfragments maybe in the
aspirated tissue
Treatment:
• Usually seals itself off as uterus contracts
• If fat or organfragments:needs
laparoscopy or laparotomy
Summary
•
•
•
•
MVA is Simple to Use
Safe and Effective
Versatile and Cost Effective
Is used for Endometrial Biopsy and
Uterine Evacuation
• Suction is the method advised for 1st
Trimester surgical terminations by the
World Health Organisation.
Manual Vacuum Aspiration(MVA)
vs. Electric Vacuum Aspiration(EVA)
•
•
•
•
•
•
MVA
Inexpensive/re-usable
Small
Portable
Quiet
Specimen likely
to be intact
Requires repeated
reloading of suction
EVA
More costly but longer
life
Bulky
Less portable
Noisy
Fragmentation of
specimen possible
Constant suction
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