Manual Vacuum Aspiration

Subject: Midwifery I (Theory)

Overview

Manual Vacuum Aspiration (MVA) is a safe and effective method or procedure for the treatment of incomplete abortion that involves the evacuation of uterine contents using handheld plastic aspiration or suction. It is especially important in situations of partial abortion to avoid future complications due to retained product in the uterus causing continuous bleeding. The uterine size must be less than or equal to 12 weeks, the woman's condition must be stable, hemoglobin must be equal to or greater than 7gm percent, and per vaginal bleeding must be less than a few days. MVA has the advantages of being less expensive, being a good and effective type of treatment, and being conveniently accessible in both rural and urban locations.

Manual Vacuum Aspiration (MVA) is a safe and successful method or procedure for treating incomplete abortions that involve the evacuation of uterine contents using handheld plastic aspiration or suction.

Timing of the manual vacuum aspiration

It is especially important in situations of partial abortion to avoid subsequent complications caused by the retained product in the uterus causing prolonged bleeding.

Criteria for MVA

  1. Uterine size less than or equal to 12 weeks
  2. A woman's condition should be stable
  3. Pulse less than 110/minutes
  4. Hemoglobin is equal to or moral to 7gm%
  5. Per vaginal bleeding less than a few days

Advantages

  1. Fewer chances of complication
  2. Less expensive
  3. A good and effective method of treatment
  4. Easily available in both rural and urban areas

Precaution prior to performing MVA

Special measures should be used when the uterine size assessed by pelvic examination differs significantly from that determined by the last menstrual period or when the uterine size exceeds the first trimester.

Initial assessment

  • Respectfully greeting the lady.
  • Privacy protection
  • Examine the woman's condition for shock and other potentially fatal conditions.
  • In the event of a complication, the patient was stabilized and referred for rapid care based on the woman's state.
  • Check the woman's vital signs, blood, and any injuries before stabilizing and referring her.

Medical evaluation

  • Taking a reproductive history
  • Physical examination and pelvic examination
  • Investigation and laboratory testing
  • Appropriate counseling regarding the woman's condition
  • Comprehensive and suitable family planning counseling

Preparation for procedure

  • Proper counseling and education of the woman about the procedure before beginning in a pleasant and friendly manner.
  • By accompanying her during a procedure, you can provide emotional support and comfort.
  • Inform about any discomfort experienced during the operation.
  • Before beginning the operation, take 500mg of PCM orally.
  • Inquire about any allergic reactions to the medications.

Maintain proper hygiene and aseptic technique throughout the procedure by:

  • Hand cleaning with soap and water should be done thoroughly.
  • Instruments and gloves must be sterile and thoroughly disinfected.
  • Before introducing anything into the vagina or cervix and uterine cavity, clean the cervix and vagina with the aseptic method.

MVA instrument or equipment preparation

  • MVA syringe
  • Different sizes of cannula, adapters
  • Available emergency drugs
  • MVA sterile set
  • Surgical set

Others

  • Strainer
  • Virex
  • Plastic gown, boot, cap, mask
  • Family planning devices
  • Bladder assessment for empty or full e.t.c

Pain management

Patient preparation

  • Proper procedural counseling
  • Urinating to clear one's bladder
  • Cleaning the female perineum and vaginal region.

Pelvic examination for the uterine size conformation and vaginal condition.

Procedure

  • Insert the speculum gently and use sponge forceps and gauze to remove any blood clots or tissue from the vagina.
  • Using sterile gauze, clean the cervix and vagina with the aseptic solution.
  • Examine the cervix for any tears or protruding conception products. If present, remove with ring or sponge forceps.
  • Cervical dilatation with mechanical dilatators or suitable cannulas of varying sizes.
    To straighten the cervical canal and uterine cavity, gently apply traction to the cervix
  • While using cervix traction, carefully and slowly introduce the cannula through the cervix into the uterine cavity until it hits the fundus, but no more than 10cm.
  • Holding the forceps and syringe in one hand and the cannula in the other, attach the prepared syringe to the cannula.
  • To transfer the vacuum to the uterine cavity, open the pinch valves on the syringe.
  • Evacuate the uterine contents by gently rotating the syringe from one side to the other (10 to 2 o'clock) and then gently sliding the cannula back and forth into the uterine cavity.
  • If the syringe becomes half-filled before the process is finished, remove the syringe while leaving the cannula in place.
  • To dump the products of conception into the strainer, press the plunger.
  • Recharge the syringe, connect it to the cannula, and open the pinch valve. Ascertain that the vacuum is not lost in the syringe.
  • Examine the procedure for evidence of completion ( red or pink foam but no more tissue is seen in the cannula, a grating sensation is felt as the cannula passes over the surface of the evacuated uterus; uterus contracts around the cannula)
  • Gently remove the cannula from the MVA syringe.
  • Remove the cannula from the MVA syringe and press the plunger to pour the conception products into the strainer.
  • Before removing the speculum, remove the forceps from the cervix. Take out the speculum.
  • To assess the size and hardness of the uterus, perform a bimanual examination.
  • Inspect the tissue retrieved from the uterus quickly (amount, presence of conception products), ensure thorough evacuation, and check for a molar pregnancy.
  • Insert the speculum gently and check for bleeding.
  • If the uterus still feels mushy or bleeding continues, repeat the evacuation operation.

Post-operative Patient Care

  • Maintain a comfortable position for the patient.
  • Vital indicators should be monitored and recorded.
  • Before discharge, check for bleeding and make sure the cramping has subsided.
  • Other health treatments, such as tetanus prevention counseling and family planning methods, are provided.
  • Encourage a balanced and nutritious diet, as well as a liquid diet.
  • In the case of straightforward instances, discharge within one to two hours of procedure completion.
  • Inform the woman about the normal indicators of recovery.
  • Vaginal bleeding and spotting for a few days, but no more blood than with a normal menstrual period.
  • Analgesic medication can help with uterine cramping.
  • Inform the woman of the following signs and symptoms that require quick attention:
  • Cramping that lasts longer than a few days.
  • Bleeding for more than 2 days
  • Bleeding more than usual during menstruation
  • Pain that is severe or increasing
  • Malaise, fever, or chills
  • Fainting
  • Tell the woman when she should return for a check-up and to call you right away if there is an emergency.

Complication

  • Inadequate evacuation
  • Perforation of the uterus
  • Laceration of the cervix
  • Inflammation of the cervix
  • Shock and hemorrhage
  • Significant vaginal bleeding
  • Embolism of the lungs
  • Dysmaturity due to uterine rupture
  • Ectopic pregnancy, preterm labor

References

  • SlideShare. https://www.slideshare.net/sweetututu/manual-vacuum-aspirat
  • The Free Dictionary. http://medical-dictionary.thefreedictionary.com/Manual+vacuum+aspiration
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
  • Web MD. 2005. 2017 http://www.webmd.com/women/manual-and-vacuum-aspiration-for-abortion
  • Midwifery manual for certificate level nursing student, 2000, 2nd edition. HLMC, TUIOM, P.O. Box2533
  • Dawn, C.S., 1991, Textbook of Gynecology and contraception (Described for students, teachers, and practitioners) 10th edition (revised), Dawn books, 25-13, CII Road, Calcutta.
Things to remember
  • Manual Vacuum Aspiration (MVA) is a safe and successful method or procedure for treating incomplete abortions that involve the evacuation of uterine contents using handheld plastic aspiration or suction.
  • It is especially important in situations of partial abortion to avoid subsequent complications caused by the retained product in the uterus causing prolonged bleeding.
  • The uterine size must be less than or equal to 12 weeks, the woman's condition must be stable, hemoglobin must be less than 7gm percent, and per vaginal bleeding must be less than a few days.
  • MVA has the advantages of being less expensive, a good and effective way of treatment, and conveniently accessible in both rural and urban locations.
Questions and Answers

MVA, which involves the evacuation of the uterine contents using a handheld plastic aspirator or suction, is a safe and efficient method or procedure for treating incomplete abortions.

Criteria for MVA

  • Less than or equivalent to 12 weeks
  • The state of the woman should be stable.
  • Fewer than 110 beats per minute.
  • Greater than or equal to 7gm% hemoglobin.
  • Less than a couple days of monthly bleeding.

 

Advantages

  • Less potential complications.
  • Less costly.
  • A good and efficient approach to therapy.
  • Available readily in both urban and rural regions.
  • Incomplete evacuation.
  • Uterine perforation.
  • Cervical laceration.
  • Pelvic inflammation.
  • Haemorrhage, Shock.
  • Severe vaginal bleeding.
  • Air embolism.
  • Rupture of the uterus.
  • Dysmaturity.
  • Preterm labour, Ectopic pregnancy.

Precaution prior to performing MVA

When the uterine size is determined differently by the pelvic examination and differs significantly from that determined by the last menstrual period or by the uterine size beyond the first trimester, special precautions should be taken.

  • Initial assessment:
    • Showing the woman courtesy.
    • Protecting privacy.
    • Check the woman for shock and other potentially fatal conditions.
    • Stabilized the patient in the event of any complications and referred her for emergency care based on her health.
    • Check the woman's vital signs, look for any blood or injuries, stabilize her, and then refer.
  • Medical evaluation:
    • Recording reproductive history.
    • Physical and genital exam.
    • Laboratory assessments and research.
    • Adequate counseling regarding the woman's condition.
    • Comprehensive and suitable family planning counseling.
  • Preparation for procedure:
    • Appropriate counseling and respectful, polite education of the woman about the operation before beginning.
    • Support and comfort for her emotionally while undergoing a procedure.
    • Explain any discomfort experienced during the operation.
    • Prior to beginning the operation, administer 500mg of PCM orally.
    • Inquire about any medication allergies.
    • Throughout the treatment, maintain good hygiene and aseptic technique by:
      • Hands should be washed properly and thoroughly with soap and water.
      • using gloves and sterile, properly disinfected equipment
      • Before introducing anything into the vagina, cervix, or uterine cavity, use the aseptic technique to clean the area.

 

© 2021 Saralmind. All Rights Reserved.