1. MVA
PRESENTED BY
DR.SURYA PRATAP SINGH RAJPUROHIT
MODERATOR:
DR.PRAVIN SHAH (CONSULTANT)
DR.SARUNA (3rd year RESIDENT)

2. OUTLINES:
• INTRODUCTION
• INDICATION
• ADVANTAGE OF MVA
• CONTRAINDICATION
• COMPLICATIONS
• MVA EQUIPMENTS
• PROCEDURE
• REFERENCES

3. INTRODUCTION
• MVA meaning Manual Vacuum Aspiration
- A surgical method of termination of pregnancy to enhance safe abortion
within the 1st trimester of pregnancy ( ≤ 12 weeks).
• MVA uses a specially designed, Hand-held 60 ml plastic double valve
vaccum syringe with a flexible plastic cannula[upto 12 mm size] to apply
suction in order to remove the product of conception (POC) from the
uterus.

4. MANUAL VACUUM ASPIRATION (MVA)
SYRINGE
INDICATIONS:
Therapeutic:
1. Treatment of incomplete abortion for GA up to 12 weeks
2. Missed abortion GA ≤ 12weeks
3. Gestational trophoblastic diseases-molar pregnancy
4. Septic abortion ≤12 weeks GA
5. Inevitable abortion ≤ 12 weeks GA
6. Blighted ovum or anembryonic gestation.

5. Diagnostic
1. Endometrial biopsy
2. Molar pregnancy

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).
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)

7. CONTRAINDICATION
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

8. COMPLICATIONS
EARLY
1. Primary hemorrhage
2. Retained products
3. Pelvic infection
4. Uterine perforation
5. Genital tract laceration
6. Incomplete evacuation
7. Air embolism
8. Hematometra .
9. Vagal reaction

9. LATE:
1.Ashermann’s syndrome
2. Sepsis
3. Chronic pelvic pain
4. Chronic PID
5. Ectopic pregnancy
6. Infertility

10. Manual Vacuum
Aspirator Syringe
• A valve with a pair of
buttons that control the
vacuum , a cap and a
removable liner
• A plunger with a plunger
handle and O-ring
• A 60 cc cylinder for
holding evacuated uterine
contents, with a retaining
clip for the collar stop
• A collar stop

11. Equipments Used
• 1. MVA Kit :
-Karman syringe (MV
aspirator)
-Plastic Suction
Cannula[Karman’s Type]
• 2. Instruments:
-Vulsellum
-Sponge holding forceps
-Kidney dish
-Hegar’s dilators
-Cusco or Sim’s
speculum

12. Equipment Used Contd...
•
3. Drugs used:
-1% Lidocaine(xylocaine)
-Tramadol
-Oxytocin
4. Others:
-Cotton swabs
-Vaginal/perineal pads
-Vaginal drapes
-Sterile gloves
-Syringes(10 ml)
-Light Source

13. Karman’s cannula
• Size of cannula
corresponds to size of
Pregnant uterus in weeks.
• These are of different sizes
[diameters] : 4,5,6,7,8,9,10,
and 12 mm.
• Usually, 8-12 mm size
cannula is used for 9-12
weeks pregnant uterus.
• Plastic cannula is preferred
over metallic one.

14. PROCEDURES: General anesthesia is usually not needed. If the patient is apprehensive,
intravenous diazepam 5–10 mg (conscious sedation) supplemented by paracervical block is
quite effective.
The patient is put on the table after she empties her bladder
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.
3. Privacy should be maintained (screen or closed room)
4. All the articles are arranged near procedure site. 5. All the ornaments, finger rings,
bangles etc are removed. 6. Put on all universal protective devices(apron, boots). 7. Scrub
and wear sterile gloves 8. Assemble the aspirator

15. (1) Vaginal examination is done to note the size and position of the uterus and
also the state of cervix. USG (TAS/ TVS) should be performed when there is any
doubt about the gestational age.
(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. Feeling of “snap” of the
endocervix around the dilator is characteristic. Instead laminaria tent 12 hours
before (osmotic dilator) or misoprostol (PGE1) 400µg given vaginally 3 hours
prior to surgery produces effective dilatation.

16. (5) 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. Suction evacuation
(7) The pressure of the suction is raised to 400–600 mm Hg. 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.

17. STEPS OF MVA
• Step One: Prepare the Aspirator
• • 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).
• Step Two: Prepare the Patient
• • Administer pain medication to have maximum effect when procedure begins.
• • Give prophylactic antibiotics to all women, and therapeutic antibiotics if indicated.
• • Ask the woman to empty her bladder.

18. • Conduct a bimanual exam to confirm uterine size and position.
• Insert speculum and observe for signs of infection, bleeding or incomplete abortion.
Step Three: Perform Cervical Antiseptic Prep
• 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.
Step Four: Perform Paracervical Block
• Paracervical block is recommended when mechanical dilatation is required with MVA.
• Administer paracervical block and place tenaculum.
• Use lowest anesthetic dose possible to avoid toxicity – for example, if using lidocaine, the
recommended dose is less than 200 mg.

19. Step Five: Dilate Cervix
• Observe no-touch technique when dilating the cervix and during aspiration. Instruments
that enter the uterine cavity should not touch your gloved hands, the patient’s skin, the
woman’s vaginal walls, or unsterile parts of the instrument tray before entering the cervix.
• Use mechanical dilators or progressively larger cannulae to gently dilate the cervix to the
right size
Step Six: Insert Cannula
• While applying traction to tenaculum, 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.

20. Step Seven: Suction Uterine Contents
• 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 180° in each direction, using an in-and-out motion.
• When the procedure is finished, depress the buttons and
disconnect the cannula from the aspirator. Alternatively, withdraw
the cannula and aspirator without depressing the buttons
Step Eight: Inspect Tissue
• Empty the contents of the aspirator into a container.
• Strain material, float in water or vinegar and view with a light
from beneath.

21. • Inspect tissue for products of conception, complete evacuation and molar
pregnancy.
• If inspection is inconclusive, re-aspiration or other evaluation may be
necessary
Step Nine: Perform Any Concurrent Procedures
• When procedure is complete, proceed with contraception or other
procedures, such as IUD insertion or cervical tear repair.
Step Ten: Process Instruments
• Immediately process or discard all instruments, according to local
protocols.

22. The endpoint of suction is denoted by:
(a) No more material is being sucked out
(b) Gripping of the cannula by the contracting smaller size
uterus
(c) Grating sensation and
(d) Appearance of bubbles in the cannula or in the transparent
tubing.

23. (8) The vacuum should be broken before withdrawing the
cannula down through the cervical canal to prevent injury to
the internal os.
(9) It is better to curette the uterine cavity by a small flushing
curette at the end of suction and the cannula is reintroduced to
suck out any remnants.
(10) After being satisfied that the uterus is remaining firm, and
there is minimal vaginal bleeding, the patient is brought down
from the table after placing a sterile vulval pad.
Use of USG during the procedure shortens the operative time
and reduces complications

24. REFERNCES:
DC DUTTA OBS 26th edition