manual vacuum aspiration with local anaesthesia marijke alblas,md western cape department of health
TRANSCRIPT
Manual Vacuum Manual Vacuum Aspiration with Aspiration with
local anaesthesialocal anaesthesia
Marijke Alblas,MDMarijke Alblas,MD
Western Cape Western Cape Department of HealthDepartment of Health
Use of MVA: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 Goal of presentation to show that: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 MVA is a safe and simple procedureprocedure
• 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’!--But: don’t do a ‘curette check’!-->to check with a curette for >to check with a curette for complete evacuation adds complete evacuation adds
unnecessary risksunnecessary 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 Can help to decentralize the service and therefore make it service and therefore make it
more accessiblemore 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 Make use of the right instruments and handle them instruments and handle them gently: the woman is awake!!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 VacuumCreate 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.
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Selecting the cannulaSelecting the cannula
Adapters for the double-valve aspirator are color-coded to the dots on the corresponding cannula
7 to 10 mm____________________10/12 mm
10 to 12 LMP____________________13 to 14 LMP
6 to 7 mm8 to 9 LMP
4 to 6 mm5 to 8 LMP
Approximate size of the cannula
Approximate uterine size(weeks LMP)
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Releasing the Pinch ValveReleasing 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.
Dilation cervix while doing Dilation cervix while doing suction: using different sizes of suction: using different sizes of
cannulacannula
• 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.)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 tissueInspecting the tissue17
• 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
Visual Inspection of the Visual Inspection of the Products of ConceptionProducts of Conception
Gestational sac
Blood clot
Decidua
Types of ComplicationsTypes of Complications
Early Complications:– Cervical Injury– Uterine injury– Haemorrhage– (Pre-existing) infection– Uterine rupture– Anaesthesia related complications
Recognising and Recognising and managing uterine managing uterine
perforationperforationSigns:• Instruments inserted beyond the fundus• Excessive bleeding• Fat or organfragments maybe in the
aspirated tissueTreatment:• Usually seals itself off as uterus contracts• If fat or organfragments:needs
laparoscopy or laparotomy
SummarySummary
• 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)Manual Vacuum Aspiration(MVA)vs. Electric Vacuum Aspiration(EVA)vs. Electric Vacuum Aspiration(EVA)
MVA• Inexpensive/re-usable• Small • Portable • Quiet• Specimen likely
to be intact• Requires repeated
reloading of suction
EVAMore costly but longer lifeBulkyLess portableNoisyFragmentation of specimen possibleConstant suction