Manual Vacuum Aspiration. House Officer Presentation by Dr Salamipptx

A Guide to manual vacuum aspiration

1. Manual Vacuum Aspiration Federal Teaching Hospital Gombe Department of Obstetrics & Gynecology House officers presentation Presenter: Dr Salami Daniel Moderator: Dr Usman

2. Outline Introduction Indications Pre procedure Technique Post procedure Follow up Advantages Complications Conclusion References

3. Introduction Manual vacuum aspiration (MVA) is a procedure that uses a hand-held vacuum source to remove product of conception from the uterus MVA was pioneered by Drs Wu Yuantai and Wu Xianzhen in 1958 in China, but has become a widely performed procedure around the world Harvey Karman in the United States refined the procedure and invented the flexible, plastic Karman cannula

4. Indications Therapeutic Incomplete miscarriage (<13wks GA) Molar pregnancy Diagnostic Endometrial sampling

5. Pre procedure MVA is an outpatient procedure and requires no hospital admission in most cases, however the following are important considerations: Clinical evaluation Consent Assistant Position Anesthesia Equipment Empty bladder

6. Position

7. Anesthesia Paracervical block Intracervical block Conscious sedation

8. Equipment Sterile drapes, gowns, gloves, facemask & caps MVA syringe and cannula Cusco’s speculum Tenaculum, vulsellum, sponge holding forceps Oxytocin

9. Equipment

10. Equipment

11. Equipment

12. Technique Prepare the aspirator

13. Technique Bimanual examination

14. Technique Insert speculum and clean the cervix

15. Technique Perform local anesthesia

16. Technique Insert cannula

17. Technique Suction uterine contents

18. Technique

19. Technique Inspect tissue

20. Post procedure Document findings Post abortal care Bedside USS Monitoring of vital signs Analgesics e.g. arthrotec Antibiotics e.g. doxycycline & secnidazole Rhogam (if Rh negative) Histology Discharge and counsel on alarm symptoms

21. Follow up Review histology report Contraception

22. Advantages Safe, high success rate Outpatient procedure Less blood loss Cheaper Portable Doesn’t require electricity

23. Complications Early Uterine perforation Injury to contiguous structures Persistent bleeding 2o incomplete evacuation Air embolism Late (delayed) Pelvic inflammatory disease Hematometra

24. Conclusion MVA remains a safe outpatient procedure for 1 st trimester miscarriages with minimal risks MVA has largely replaced dilatation and curettage in the management of 1 st trimester miscarriages MVA syringe and cannula are re-usable but require disinfection after each use

25. References Standard Operation Protocol for Management of Emergency Gynecological Conditions, Dept of Obstetrics & Gynecology, FTH Gombe Ipas. (2018). Clinical Updates in Reproductive Health. L. Castleman & N. Kapp (Eds.). Chapel Hill, NC: Ipas. https://ipas.azureedge.net/files/CURHE18-march-ClinicalUpdatesinReproductiveHealth.pdf Manual vacuum aspiration (MVA) https://medicalguidelines.msf.org/en/viewport/ONC/english/9-5-manual-vacuum-aspiration-mva-51417954.html

26. Thank you for listening