This document presents a case of a 29-year-old woman who is 3 months pregnant and experiencing bleeding and abdominal pain. On examination, she is found to have an incomplete miscarriage. The document then discusses manual vacuum aspiration (MVA) as a procedure to evacuate the uterine contents in cases of incomplete miscarriage. It covers the advantages, indications, contraindications, equipment, precautions, procedure steps, and potential complications of MVA. MVA is described as a safe, affordable option for uterine evacuation that is easy to learn and use without requiring electricity.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
First Stage of Labour nsg management.pptxitisha prasad
first stage of labour is the time period from the time of true labour to the full dilation of the cervix. it is most crucial time which requires proper and efficient care and support. Nursing managment during this time is very essential in order to procced with the normal labour. Partograph is one of the biggest tool to asess the progress of labour . It is very important to know the care to be provided during labour to the mothers including the care of bowel, bladder, ambulation, rest, positions, all of this help to keep a track of labour and they assist in the progress of labour.
It is the expulsion or extraction from its mother of an embryo or fetus weighing 500 gm or less when it is not capable of independent survival (WHO).
The 500gm of fetal development is attained approximately at 22 weeks of gestation.
Expelled fetus- Abortus
Hope it helps.. This presentation describes about labour induction, its types, methods, management and responsibilities. also the procedure of performing the methods. pictures as per need attached for the reference. like and comment if any suggestion.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Case presentation
Introduction
Advantages of MVA
Indications
Contraindications
MVA equipments
Precautions
Procedure
Complications of MVA
Conclusion
References
3. A 29-year old woman G1P0+0 with a history of
amenorrhea for 3 months and a positive home urine
pregnancy test.
Presented with PV bleeding or lower abdominal pain of 2/7
duration and intends to continue the pregnancy, though it
was unplanned.
O/E: Pale, afebrile
V/E: NVV, cervical os open, smeared with altered blood.
Results of urgent ultrasonography to assess fetal viability
reveal an intrauterine gestation with a fetal pole but no
cardiac activity.
Clinical assessment of incomplete miscarriage was made.
Plan : Manual Vacuum Aspiration after stabilizing.
4. Manual vacuum aspiration (MVA) is an aseptic
procedure that involves the evacuation of
uterine contents by the use of a hand-held
plastic aspirator.
Used commonly in both developed and
developing countries.
Approximately one in four women will
experience a miscarriage in her lifetime.
5. First trimester (≤12Weeks)
1. Medical
– Mifepristone(RU 486)- Antagonist to progesterone
– Mifepristone & Misoprostol
– Misoprostol alone
2. Surgical
– MVA
– EVA
– Dilatation & Curettage (now obsolete)
6. The World Health Organisation recommends
Manual Vacuum Aspiration for uterine
evacuation because it is:
1. Safe, high-quality, affordable
2. Easy to learn, Easy to use
3. Small, portable, quiet, no electricity
required
4. Ideal for performing procedures in the
outpatient setting.
7. 1. Less pain therefore less need for analgesia
2. Reduced risk of complications-bleeding
3. Less post abortal morbidity
4. Less hospital stay
5. Less time (about 10-15 minutes)
8. Therapeutic
1. Treatment of incomplete abortion for GA up to
12 weeks
2. First trimester abortion(menstrual regulation)
when indicated.
3. Missed abortion GA ≤ 12weeks
4. Gestational trophoblastic diseases-molar
pregnancy
5. Septic abortion ≤12 weeks GA
6. Inevitable abortion ≤ 12 weeks GA
7. Blighted ovum or anembryonic gestation.
9. Diagnostic
1. Endometrial biopsy
2. Dysfunctional uterine bleeding
3. Retained product of conception (2o PPH)
4. Confirmatory test for ovulation
5. Molar pregnancy (up to 24 weeks)
10. ABSOLUTE
1. TOP > 12 weeks GA because, bony tissue
and other body tissue is formed which is
difficult to be evacuated via suction.
RELATIVE
1. Purulent cervicitis and pelvic infection
2. Coagulation disorders
20. 1. Any serious medical conditions such as
shock, haemorrhage, cervical or pelvic
infection, sepsis, as may occur with incomplete
miscarriage be addressed immediately (e.g
Urgent PCV,BGXM ).
2. Uterine aspiration/uterine evacuation is
often an important component of definitive
management in these cases and once the
patient is stabilized, the procedure should not
be delayed.
21. 3. In cases where the woman has a history of a
blood-clotting disorder, the aspirators and
cannulae should be used only with extreme
caution and only in facilities where full
emergency back-up care is available.
4. The procedure may be done with local
anaesthesia or under analgesia with sedation.
22. 1. Explain procedure to patient and obtain a
written or verbal consent.
2. Priming the cervix with agents such as a
prostaglandin (inserted into the vagina or
taken sublingually) around 3 hours prior to
procedure reduces the risk of cervical
trauma and haemorrhage.
23. 1. Privacy should be maintained (screen or
closed room)
2. All the articles are arranged near procedure
site.
3. All the ornaments, finger rings, bangles etc
are removed.
4. Put on all universal protective
devices(apron, boots).
5. Scrub and wear sterile gloves
6. Assemble the aspirator
24. Goal: reduce pain and anxiety.
Choice may be based on woman’s individual
needs or presentation.
1. Psychological pain: anxiety, fear,
apprehension
2. Cervical pain due to dilatation
3. Uterine cramping due to manipulation
TIMING:
Drug must be most effective at the time of
the procedure
Administer drugs 30-45 minutes before the
procedure.
25.
Non Pharmacological
I.
Gentle, respectful interaction and
communication
II.
Verbal support and reassurance
III.
Gentle, smooth operative technique
IV.
Can supplement but not replace
medications
27. Ask the woman to empty
her bladder
Clean adequately and
drape.
Clean vagina and vulva
Assist her in lithotomy
position.
Conduct a bimanual
exam to confirm uterine
size and position
Insert speculum and
conduct speculum exam
to confirm findings of
clinical assessment
28. Position the plunger all
the way inside the
cylinder
Have collar stop in place
with tabs in the cylinder
holes
Push valve buttons down
and forward until they
lock (1)
Pull plunger back until
arms snap outward and
catch on cylinder base (2)
Negative pressure (600-
660mmHg) is created in
the cylinder.
29. Follow No-Touch
Technique- no instrument
that enters the uterus can
contact contaminated
surfaces, including vaginal
walls, before insertion
through the cervix
Use antiseptic-soaked
sponge to clean cervical os.
Start at os and spiral
outward without retracing
areas.
Continue until os has been
completely covered by
antiseptic
30. Paracervical block is
recommended when
mechanical dilatation is
required with MVA.
Using local protocols,
administer paracervical
block (at 2,4,8,10 o’
clock sites) and place
tenaculum.
Use lowest anaesthetic
dose possible to avoid
toxicity-e.g if using
lidocaine, the lowest
recommended dose is
less than 200mg
31. Dilatation of the cervix is required to allow a
canula to pass into the uterine cavity, and the
greater the gestation of the pregnancy, the
greater the amount of dilatation required.
Dilate cervix to allow a cannula approximate
to the GA to fit snugly through the os.
If cervix is insufficiently dilated, use
mechanical dilators or progressively larger
canulae to dilate.
32. While applying traction to
tenaculum, sound the
uterus then insert
cannula through the
cervix, just past the os
and into the uterine
cavity until it touches the
fundus, and then
withdraw it slightly.
Do not insert the cannula
forcefully
The size of cannula is
roughly the number of
gestational weeks i.e
7wks=7mm cannula
33. Attach the prepared aspirator
to the cannula if the cannula
and aspirator were not
previously attached
Release the vacuum by
pressing the buttons
Evacuate the contents of the
uterus by gently and slowly
rotating the cannula 180o in
each direction, using an in-
and-out motion.
Re-charge aspirator if
necessary.
When the procedure is
finished, depress the buttons
and withdraw the instruments.
34. 1. Red or pink foam without tissue is seen
passing through the cannula
2. A gritty sensation is felt as the cannula
passes over the surface of the evacuated
uterus.
3. The uterus contracts around or grips the
cannula.
4. The patient complains of cramping or pain,
indicating that the uterus is contracting.
35. Empty the contents of
the aspirator into a
container.
Strain material, float in
water or vinegar and
view with a light from
beneath
Inspect tissue for the
products of
conception, complete
evacuation and molar
pregnancy.
Send products for
histology.
36. STEP 9: Perform any concurrent procedure
When procedure is complete, proceed with
contraception or other procedures, such as
IUD insertion or cervical tear repair.
STEP 10: Process Instruments
Immediately process or discard all
instruments, according to local protocol.
37. 1. Apply perineal pad and ensure that the
woman is resting comfortably
2. Monitor vital signs and blood loss for at
least 2 hours.
3. Pain is moderate and relieved by analgesics.
4. Verify and update tetanus immunization if
unsafe abortion is suspected + Rhogam if
Rh-ve.
5. Run IV Normal saline + Oxytocin(5-10IU) to
help contract uterus.
6. Document your findings for legal purposes.
7. Patient can go home if vitals are stable, if
she can walk and counselled.
38. Is part of post-abortal care.
This is the package of care given to women
who have undergone an abortion to prevent
the complications which arises from it.
39. 1. Treatment of any complications.
2. Counselling -to identify and respond to
woman’s emotional and physical health needs.
3. Contraceptive and family planning service to
help her prevent future unwanted pregnancies
or miscarriages.
4. Reproductive and other health services
provided in the facility or referral
5. Community and service provider partnership-
mobilizing resources to ensure timely care.
40. Warm-baths, compresses for cramping
Light menstrual-like bleeding or spotting
(few days).
Next menses:4-8 weeks
Pregnancy is advised after 2-3 consecutive
normal menstrual cycles.
Give antibiotics, haematinics and analgesics
before discharge home.
Advice on hygiene; no vaginal douches
41. 1. Fever, chills, fainting, vomiting.
2. Swollen, tender abdomen.
3. Foul discharge.
4. Bleeding more than normal menses or more
than 2 weeks.
5. Delay in resumption of menstruation(more
than 8 weeks).
43. Maternal death is lowest (about 0.6/100000
procedures) in first trimester termination
specially with MVA.
44. Scheduled before discharge from facility
Timing varies; usually scheduled within one
week
May not be at same facility
Woman may be referred to provider in her
community.
45. 1. High Level Disinfection in 0.5% Chlorine
solution
2. HLD by boiling (abt 20mins)
3. HLD in cidex
4. Sterilization using Autoclave (1210c for
30mins).
5. Sterilization using Etylene oxide(ETO).
46. Aspirator-discard or replace if:
◦ Cylinder is brittle or cracked or mineral deposits inhibit
plunger movement
◦ Valve parts are cracked, bent or broken
◦ Buttons are broken
◦ Plunger arms do not lock
◦ Aspirator no longer holds a vacuum
Cannulae-discard or replace if:
◦ Has become brittle
◦ Cracked, twisted or bent, particularly at the aperture.
◦ Cleaning the cannula does not completely remove
tissue.
47. Early pregnancy failure is a distressing
situation
The physician needs to be sympathetic to
patients who suffer miscarriage and take
prompt actions when cases that require MVA
present in emergency to mitigate bleeding
and other complications.
It is important to keep an MVA checklist to
ensure safety and effectiveness of procedure.
49. 1. Monga A.,Dobbs S., Gynaecology by Ten Teachers.2011.Hodder Arnold .19th
Ed.pp96-98.
2. Ameh A.B., A Management Guide to Gynaecology.2012.Aboki .1st Ed.pp38-48.
3. Agboola A.,Textbook of Obstetric and Gynaecology for Medical
Students.2006.2nd Ed.pp95-100
4. Konar H.,DC Duttal Textbook of Obstetrics.2015.Jaypee.8th Ed.pp-203-
207,644-646,753.
5. Manual vacuum aspiration (slideshare.net)
6. Mona S.,Manual vacuum aspiration:an outpatient alternative for surgical
management of miscarriage.The Obstetrician and Gynaecologist.Vol 17(3).pub
25th July,2015.https://doi.org/10.1111/tog.12198
7. MVA:Performing uterine evacuation with Ipas MVA plus aspirator and easygrip
cannulae.2007.Essential obstetric and newborn care.Chapter 9. 2nd
Ed.http;//medicalguidelines.msf.org
8. MVA:Indications for MVA use.Association of Reproductive Health
Professionals.Pub June 2008.
9. Piyapa P., and Anne R.D.,MVA:A safe and effective treatment for early
miscarriage.OBG Management.Vol 27 No 11.Pub Nov 2015.