Vaccum for Evacuation of the Uterus Through Electric Or Manual Vaccum Aspiration

Manual Vaccum Aspiration

Vaccum for evacuation of the uterus through electric or manual vaccum aspiration

Both are safe and effective

Recognised by WHO as a method through 12 weeks

Remains under utilized inspite of its advantange

Indications:

-  Early Pregnancy Loss

-  Completion of failed medical abortion for uterine size upto 12 wks

-  Elective abortion

-  Endometrial biopsy

Parts:

-  Aspirator (60cc)

-  Adapter

-  Piston

-  Canulae (4- 12mm)

-  Pratt Dilators

Cannulae

The smaller cannulae (4mm-8mm) have two opposing apertures.

The larger cannulae (9, 10 and 12mm) have a larger single scoop aperture.

The cannulae are semi rigid

Dots imprinted on each cannula indicate the location of the main aperture; the first dot is 6cm from the cannula tip and dots thereafter are spaced at the 1cm interval.

Other requirements

-  Antiseptic solution, gauze

-  Speculum

-  Tenaculum

-  Syringe , Needle 5, 10 or 20ml syringe with 21- or 22-gauge (or finer) regular or spinal needle

Anaesthesia:

IV Sedation

Para Cervical block (0.5% or 1.0% Lidocaine) without epinephrine

Steps for Performing MVA

Assembly of the MVA apparatus

Step one : Attach adapter to aspirator

Step two : Attach piston to the aspirator

Step three: Withdraw piston to create vacuum

Step four: Attach cannula to aspirator

Procedure

-  Give prophylactic antibiotics to all women, and therapeutic antibiotics

-  Under aseptic precautions grasp the anterior lip of cervix

-  Observe no touch technique

-  Serial Dilatation of the cervix

-  Insert the canula into the cervical os first or attach it to the MVA.

-  Insert the canula through the cervix, just past the os and into the uterine cavity. Take care not to touch the fundus.

-  Do not insert the cannula forcefully, as forceful movements may cause uterine perforation or damage to the cervix, pelvic organs or blood vessels.

-  Draw the piston , create vacuum and attach it to the canula

-  Release the vaccum lock to allow suctioning

-  50 -60mm Hg pressure is built up in the MVA

-  The MVA should be rotated gently 180o in both directions to allow the products to pass through

-  The MVA is gently withdrawn as more products appear in the canula

-  If aspirator becomes full or vacuum is lost, disconnect it from the cannula and either replace it with another aspirator or empty its contents into a receptacle and reattach it to the cannula. Never push aspirated contents through the cannula into the uterus.

-  Post operative examination of the tissue

-  When the procedure is fnished, depress the buttons and disconnect the cannula from the aspirator. Alternatively, withdraw the cannula and aspirator together without depressing the buttons.

Signs that indicate the uterus is empty:
• Red or pink foam without tissue is seen passing through the cannula.
• A gritty sensation is felt as the cannula passes over the surface of the evacuated uterus.
• The uterus contracts around or grips the cannula.
• The patient complains of cramping or pain, indicating that the uterus is contracting.

Post procedure care

Monitor the woman’s recovery. Have the woman rest in a comfortable position.
Assess and respond sensitively to her emotional state. Monitor her until she has:
• pulse and blood pressure that is normal for her
• the ability to walk and drink fluids
• normal bleeding and cramping

Signs and symptoms requiring immediate care
• fever, chills, nausea or vomiting for more than 24 hours
• cramping for more than a few days
• tenderness, pain or distention of the abdomen
• heavy bleeding (more than normal menstrual bleeding)
• foul-smelling vaginal discharge
• delay in resumption of menstrual period by more than eight weeks
• fainting or dizziness

Advantages of MVA over electrical evacuation

-  Faster & cheaper

-  Easy to use

-  The products of conception are evacuated en sac , hence reduced bleeding

-  If there is a perforation there is sudden drop of pressure, this acts as a protective mechanism preventing suction of bowel through the perforated site

-  It does not require electricity , can be done in low resource settings

-  Portable

-  Reusable

-  High patient and provider satisfaction

Use with caution

-  Uterine anomalies

-  Coagulation problems

-  Active pelvic infection

-  Extreme anxiety

Complications:

Cleaning the instrument:

Detach the parts. Clean thoroughly with water

Sterilization:

Chlorine (dilute to 0.5%), Boiling water, 2% Glutaraldehyde - 20 min

Cidex – 12 min

Sporox II – 30 min