MANUAL VACUUM ASPIRATION.pptx - doct for threatened abortion

The manual describes how a uterus can be cleared following threatened abortion, that is life threatening to the mother.

1. MVA

2. OBJECTIVES By the end of the lesson, the students should be able to: define mva state the indications of MVA state contraindications of MVA explain Pre, intra and post op nursing management identify the complications of MVA

3. Definition Vacuum aspiration of uterine contents using a hand held aspirator attached to a plastic cannula. Used with a local anaesthetic Cost effective 5 to 12 Weeks Gestatio

4. Indications for MVA First trimester abortion Endometrial Biopsy Incomplete miscarriage Missed miscarriage Failed Medical abortion RPOC post abortion & miscarriage

5. contraindications Incomplete abortion with active infection Coagulation disorders or anticoagulant use Uncontrolled pelvic infection or sepsis Uterine perforation Severe hypertension or cardiovascular disease Patient refusal or lack of informed consent

6. Advantages of MVA: (i) It is simple, (ii) safe, (iii) can be done as an outpatient basis, (iv) with local anesthesia, (v) effective (98%), (vi) less traumatic and (vii) it takes less time (10–15 min).

7. Pre-Procedure Obtain informed consent Medical history assessment Pregnancy assessment Physical examination Laboratory investigations Counseling and emotional support Contraceptive counseling

8. Intra-procedure  Position the patient comfortably on the examination table with the necessary draping. Ensure the patient's privacy and dignity are maintained. create a sterile field and maintain aseptic technique throughout the procedure . Continuously monitor the patient's blood pressure, heart rate, and oxygen saturation during the procedure. Support patient comfort and pain management

9. Mva proceedure (1) Vaginal examination is done to note the size and position of the uterus and also the state of cervix. (2) Posterior vaginal speculum is introduced and an assistant is asked to hold it. (3) The anterior lip of the cervix is to be grasped by an Allis forceps. A uterine sound is to be introduced to note the length of the uterine cavity and position of the uterus. (4) The cervix may have to be dilated with smaller size graduated metal dilators up to one size less than that of the suction cannula. Instead misoprostol (PGE1 ) 400 µg given vaginally 3 hours prior to produces effective dilatation.

10. Cont.. (5) Intravenous methergine 0.2 mg is administered. (6) The appropriate suction cannula is fitted to the suction apparatus by a thick rubber or plastic tubing. The cannula is then introduced into the uterus, the tip is to be placed in the middle of the uterine cavity. The cannula is moved up and down and rotated within the uterine cavity (360°) with the pressure on. The suction bottle is inspected for the products of conception and blood loss. The suction is regulated by a finger placed over a hole at the base of the cannula.

11. Post-Procedure Care  Monitor vital signs, including blood pressure, heart rate, and oxygen saturation. Assess for any signs of complications, such as excessive bleeding or infection. Provide appropriate pain management if needed. Offer emotional support and reassurance. Inform the patient about the procedure, what was done, and any findings. Advise the patient regarding expected post-procedure symptoms and when to seek medical attention.

12. Post proceedure Discuss the possibility of cramping or mild pain for a few days post-procedure and recommend appropriate pain management, such as over-the-counter pain relievers (e.g., ibuprofen) if needed. Provide information about contraceptive options and counseling if applicable. Schedule a follow-up appointment to ensure proper healing and confirm the success of the procedure.

13. Signs and Symptoms to Monitor: increased or heavy bleeding (soaking more than one pad per hour). Severe abdominal or pelvic pain not relieved by over-the-counter pain medications. Foul-smelling vaginal discharge or signs of infection (fever, chills, malaise). Any signs of complications or concerns requiring medical attention.

14. complications Are rare - Incomplete evacuation - Uterine or cervical injury - Infection - Hemorrhage - Vaso -vagal reaction

15. References Balogh (1983) Vacuum aspiration with the IPAS modified gynaecological syringe. Contraception 27: 63-8 Belanger E, Melzack R, Lauzon P. Pain of first-trimester abortion: a study of psychosocial and medical predictors. Pain 1989;36: 339-50. Creinin MD, Edwards J. Curr Prob Obstet Gynecol Fertil 1997;20:6-32