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- 2. OUTLINE • Case presentation •Introduction • Advantages of MVA • Indications • Contraindications • MVA Equipments • Precautions • Complications of MVA
- 3. A 29yrs oldwomen G1p0+0 with a history of amenorrhea for 3months and a positive home urine pregnancy test.Presenting with PV bleeding or lower abdominal pain for 2/7 and intends to continue the pregnancy, though it was unplanned O/E; Pale, afebrile. V/E; cervical os open, smeared with altered blood. Result of urgent ultrasonography to assess fetal viability reveal an intrauterine gestation with fetal pole but no cardiac activity. Write the management of the condition
- 4. INTRODUCTION 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 in both developed and developing countries, approximately one in four women will experience a miscarriage in the lifetime
- 5. METHODS OF TERMINATIONOF PREGNANCY First trimester(12weeks) Medical; Mifepristone Mifepristone & Misoprostol Misoprostol alone Surgical; MVA EVA D&C
- 6. ADVANTAGES OF MANUALVACUUM ASPIRATION Safe ,high-quality ,affordable Easy to learn, easy to use Small,portable,quiet no electricity required Ideal for performing procedures in the outpatient department
- 7. ADVANTAGES OF MANUALVACUUM ASPIRATION OVER OTHER TECNIQUES •Less pain therefore less need for analgesia •Reduced risk of complications-bleeding •Less post abortal morbidity •Less hospital stay •Less time (about 10-15minutes)
- 8. THERAPEUTIC INDICATION Treatment ofincomplete abortion for GA up to 12weeks First trimester abortion(menstrual regulation when indicated Missed abortion GA < 12weeks GTD e.g. molar pregnancy Septic abortion GA <12weeks Inevitable abortion <12weeks Blighted ovum of an embryonic gestation
- 9. DIAGNOSTIC INDICATION Endometrial biopsy Dysfunctionaluterine bleeding Retained product of conception secondary to PPH Confirmatory test for ovulation Molar pregnancy
- 10. CONTRAINDICATION OF MVA ABSOLUTE •Pregnancy>12Weeks GA because, bony tissue and other body tissue is formed which is difficult to be evacuated RELATIVE •Purulent cervicitis and pelvic infection •Coagulation disorders
- 11. EQUIPMENTS USED MVA KIT; •Karman syringes(MV aspirator • Cannula INSTRUMENTS; • Vulsellum or tenaculum • Sponge holding forceps • Kidney dish • Hergar’s dilators • Uterine sound • Cusco or sims speculum
- 12. DRUGS USED • 1%Lidocain •Diazepam • Tramadol • Normal saline • Oxytocin OTHERS • Cotton swab • Vaginal /perineal pads • Sterile gloves • Syringe 10mls • Light source
- 13. PRECAUTIONS Any serious medicalconditions such as shock, haemorrhage, cervical or pelvic infection, sepsis, as may occur with incomplete miscarriage be addressed immediately 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 In case where the women has history of blood-clotting disorders the aspirator and cannula should be used only with extreme caution and only if facilities where full backup care is available The procedure may be done with local anaesthesia or under analgesia with sedation
- 14. PREPARATION OF CLIENT •Explain procedure to patient and obtain a written or verbal consent • Priming the cervix with agents such as a prostaglandin by inserted in to the vagina or taken sublingually around three hours prior to procedure reduce the risk of cervical trauma and haemorrhage
- 15. SIGNS THAT INDICATETHE 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
- 16. POST PROCEDURE • Applyperineal pads and ensure that the woman is resting comfortably • Monitor vital sign and blood loss for at least 2hours • Pain is moderate and relieved by analgesics • Verify and update tetanus immunization if unsafe abortion suspected and rhogam if RH-ve • Run iv normal saline plus oxytocin 5-10IU to help contract uterus • Document your finding for legal purpose • Patient can go home if vitals are stable, she can walk and counselled
- 17. POST ABORTAL CARECOMPONENTS • Treatments of any complication • Counselling to identify and respond to woman emotional and physical health needs • Contraceptive and family planning services to help her prevent future unwanted pregnancies or miscarriages • Reproductive and other health services provided in the facility or referral • Community and service provider partnership by mobilizing resource to ensure timely care
- 18. NORMAL RECOVERY Warm-bath, compressesfor cramping Light menstrual like bleeding or spotting in few days Next menses 4-8 weeks Pregnancy is advised after 2-3 consecutives normal menstrual cycle Give antibiotics, haematenics and analgesics before discharge home Advice on hygiene no vaginal douches
- 19. COMPLICATION OF MVA EARLY Primary haemorrhage Retained product Pelvic infection Uterine perforation Genital tract laceration Incomplete evacuation Air embolism Haematometra Vagal reaction
- 20. LATE Ashermann’s syndrome Sepsis Chronic pelvicpain Chronic PID Ectopic pregnancy Infertility
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- 23. STEPS FOR MVAPROCEDURE
- 24. STEPS FOR MVAPROCEDURE
- 25. STEPS FOR MVAPROCEDURE
- 26. STEPS FOR MVAPROCEDURE
- 27. STEPS FOR MVAPROCEDURE
- 28. STEPS FOR MVAPROCEDURE
- 29. STEPS FOR MVAPROCEDURE
- 30. STEPS FOR MVAPROCEDURE
- 31. SIM’S SPECULLUM SPONGEHOLDING FORCEPS
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