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MVA

MVA. Prof. Ashis Kumar Mukhopadhyay Professor, G & O Medical Superintendent-cum-Vice Principal CSS College of Obstetrics & Gynaecology , Kolkata National Chairperson, Medical Education Committee of FOGSI. WHAT IS MVA ?.

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MVA

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  1. MVA

  2. Prof. Ashis Kumar Mukhopadhyay Professor, G & O Medical Superintendent-cum-Vice Principal CSS College of Obstetrics & Gynaecology, Kolkata National Chairperson, Medical Education Committee of FOGSI

  3. WHAT IS MVA ? • MVA meaning Manual Vacuum Aspiration – a surgical method of TOP to enhance safe abortion within the 1st trimester of pregnancy (WHO-2003). • MVA actually is the resurrcation of original MR method by MR syringe & Karman canulae.

  4. With the expectation that MM & Morbidity will be reduced, but on the contrary it is seen that the no. of unsafe abortions have much more increased with a disastrous result on MM & Morbidity.

  5. So new techniques started becoming introduced for safe abortion & MVA is one of them. • This method is safe, simple, effective and economical too.

  6. Parivar Seba Sangstha (PSS), a national level NGO for quality abortion and family planning procedures – has experiences on MVA for more than 25 years. They also have the same experience in their Kolkata branch. 5% - Med. Abortion 95% - MVA

  7. Manual Vacuum Aspiration • Safe & updated technology for termination of 1st Trimester Pregnancy • Recognized by FIGO, WHO, GOI, NAF, USAID for Post Abortion Care and World Bank

  8. Mechanism of Action • MVA acts via vacuum extraction of the uterine contents through a cannula • Cannula is attached to the vacuum syringe which has been previously charged and locked having created vacuum in the syringe • Vacuum extracts the entire contents of the uterus with minimal damage to the lining of the uterus

  9. Origin • The Single Valve Syringe, the earlier version originated in the USA in early 70's • Karmen (Batelle Labs) • Was studied intensively in India and around the world • Single valve syringe was originally designed to be a technique of Menstrual Regulation

  10. Double Valve MVA Syringe • Designed to evacuate the uterus up to 12 weeks • Proven safe and effective for termination of incomplete abortion, endometrial biopsy and backup for medical abortion

  11. MVA - Features • Flexible Plastic Cannulae • Manual Vacuum Syringe with double valve adapter • Portable Non-Electric • Practical use in Medical Office, Clinic or Hospital

  12. Summary of StudiesEffectiveness of EVA - MVA * Effectiveness defined as complete evacuation - Adapted from Greenslade et al., 1993

  13. Recent Clinical Experience • Edward 19972399 MVA procedures of less than 6 weeks, found to be effective in 99.2% of cases • Westfall et al 19981677 MVA procedures, of less than 10 weeks, found to be effective in 99.5% of cases • FOGSI Multicentric study 2001926 Cases between 6-12 weeks, found to be effective in 98.6% of cases

  14. Comparison between Two Contemporary Methods Manual Vacuum Aspiration (MVA) Electrical Vacuum Aspiration (EVA) - Takes 1 Second to create 26” (660mm) Hg Vacuum - 360O Rotation possible because of easy maneuverability - Pre-created vacuum gets transferred to the uterine cavity which is highly effective - Takes 1-1.5 minutes to create 26” Hg Vacuum - 180O Rotation possible on either side because of kinking of tubing - Vacuum is created gradually in the uterine cavity, hence less effective

  15. Comparison between Two Contemporary Methods Electrical Vacuum Aspiration (EVA) Manual Vacuum Aspiration (MVA) - Pre created transfer of vacuum helps to find cleavage between the sac and the endometrial lining. This allows sac to get sucked into the aperture of the cannula en mass causing minimum bleeding - Since vacuum takes time to reach 26” of Hg, not possible to create cleavage easily and therefore, material comes in pieces causing more bleeding

  16. Comparison between Two Contemporary Methods Manual Vacuum Aspiration (MVA) Electrical Vacuum Aspiration (EVA) - In case of perforation, the vacuum creation continues endangering pulling out mesentery or intestines if plugged into the aperture of cannula - In case of uterine perforation, the vacuum drops to less than 10mm of Hg and therefore, prevents sucking of mesentery or intestines

  17. EVA Vs MVA Comparison of 5 week’s gestation Removed with electric suction machine (left) and MVA syringe (right) From: Creinin and Edwards, Curr Problems in Obs Gyn Fert, 20 (1) 1997

  18. INSTRUMENTS

  19. MVA Plus Aspirator (recent) Can be autoclave at 1210 c with a pressure of (15 lbs/in2)

  20. Colour coated & graduated canulae – they can also be autoclaved

  21. Loading the Syringe Close the pinch valve of an assembled syringe

  22. Creation of Vacuum Withdraw plunger till catcher arms locked

  23. Insertion of Cannulae Serial insertion with gentle rotatory movements

  24. MVA Procedure Pinch valve released to create intrauterine vacuum

  25. Evacuation of Uterus Back & forth & rotatory movements of cannula

  26. Care of Instruments • Care of instruments comprises of following steps : • Decontamination • Cleaning • High Level Disinfection (HLD) or Sterilization • Storage / Reassembly

  27. Processing of the Instruments • Syringe & cannulae decontaminated in a bleach solution for 10 minutes (optional) • Wash well with detergent and water • Soak in 2% Glutaraldehyde (Cidex) or 0.5% chlorine solution for 20 minutes Do not boil the Syringe or use any heat technique or autoclave

  28. Cervical Ripening : • For pregnancies up to eight weeks, no priming is required. For pregnancies of 9-12 weeks in nulliparous women and <18 years old. • Prostaglandin in cervical ripening • Prostodin – 250mcg by intramuscular injection 45 minutes before the procedure. • Misoprostol – 400mcg tablet administered either vaginally or sublingually/orally 3-4 hours before the procedure.

  29. The instruments are reusable (disposable in developed countries), provided those are very well maintained. The aspirators described, could be reused from 50-200 times and the new canulae can be reused for 10 – 20 times.

  30. Post Operative Contraception :

  31. For pain control, Para cervical block – all that is necessary for complete evacuation • A sedative or anxiolytic may be necessary if the patient is apprehensive

  32. EFFICACY :Several authors have shown that the efficacy of MVA in general - 98%

  33. MVA – in Low tech rural & High tech urban :

  34. OTHER USES OF MVA There are other uses of MVA and they are:- • Endometrial Biopsy / sampling (using 4mm cannulae) • Blighted ovum • Hydatidiform mole • Incomplete abortion

  35. CONCLUSION • To conclude, MVA technology can be used as the first line surgical method for uterine evacuation within 1st trimester of pregnancy. MVA is safe, simple and effective & a low cost procedure, reusable for many many times. The method is highly recommended by FIGO, FOGSI, WHO & GOI. MVA today is considered as the NEW GOLD STANDARD for early abortion and there is no place for other traditional method like D & C. (ICPD, WHO, FIGO, 1997)

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