Professional Documents
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Module 2 - Session 2
Uterine Evacuation Methods
Module 2 - Session 2
Objectives
2
Uterine Evacuation
3
Uterine Evacuation Methods
4
Vacuum Aspiration (VA)
5
Manual Vacuum Aspiration (MVA)
6
Single-Valve Syringe with Cannulae
7
Double-Valve Syringe with Cannulae
8
MVA Plus
9
Foot Pump Suction Evacuation (FSE)
10
Foot Pump Suction Evacuator
11
Comparison of MVA and Foot Pump Suction
Evacuation
• A study published in the South Africa Medical Journal compared
the foot pump suction evacuator with the manual vacuum
aspirator for uterine evacuation.
• Findings showed that the FSE and MVA were similar in
effectiveness and outcomes. The time to perform the FSE was
not significantly different in operative blood loss estimation or
the time needed to perform the procedure.
• There were no cases of uterine perforation, cervical injuries or
blood transfusions. Both techniques were easy to use.
12
Electric Vacuum Aspiration (EVA)
13
Electric Vacuum Aspiration (EVA) (2)
14
Electric Vacuum Aspiration Machine
15
Vacuum Aspiration: Advantages
• MVA and FSE do not require electricity and can be used in remote
settings, extending a woman’s access to emergency treatment.
• EVA, MVA and FSE have the same effectiveness rate. There is no
evidence showing a significant difference in the rate of
complications.
• Patient satisfaction for EVA and MVA is also comparable.
• Flexible cannula (MVA, FSE):
– Can reach deep into the uterus even when it is anteverted or
retroverted
– Rounded tip and narrow width requires little dilatation
16
Vacuum Aspiration: Advantages
17
Vacuum Aspiration: Contraindications (MVA,
FSE)
18
Vacuum Aspiration: Precautions
19
Vacuum Aspiration: Precautions (2)
20
Dilatation and Curettage (D&C) Sharp Curettage
(SC)
• WHO recommends that this method be used only when vacuum
aspiration is not available.
• Uses a curette or a similar metal surgical instrument to empty
the uterus.
• Usually performed under general or regional anesthesia, or
heavy sedation.
• Recent studies show that it can be performed as an outpatient
procedure in hospitals/some health centers.
21
Comparison of Vacuum Aspiration and
Dilatation and Curettage
22
Comparison of VA and SC
MVA: D&C:
• Vacuum suction with plastic • Scraping with sharp, metal
cannula, lowering the risk of curette, increasing the risk of
uterine perforation
uterine perforation
• Minimal cervical dilatation
required • Mechanical dilatation often
• Analgesia, light sedation and/or required
local anesthesia can be used • Heavy sedation, analgesia
• Can be performed by midwife, and/or general anesthesia
general MD or other trained often used
health provider • Usually performed only by
• Outpatient procedure, reducing
trained gynecologist or general
the need for hospital stay
MD
• Operating theater procedure,
often requiring hospital stay
23
D&C Instruments
• Sharp curettage has been effectively used for many conditions. Some of the
indications include:
– Excessive vaginal bleeding
– Abnormal vaginal bleeding
– Polyps
– Incomplete abortion:
• When VA not available
– Molar pregnancy:
• Risk of uterine perforation is high with SC; VA may be safer and
associated with less blood loss
– Diagnostic:
• Endometrial cancer
• Determine cause of vaginal bleeding
25
Pharmacological Methods of Uterine
Evacuation: Misoprostol
• A prostaglandin initially developed to treat gastrointestinal
problems:
– Prostaglandins are a group of chemicals made by nearly all
of the body's cell membranes.
• Different prostaglandins have different effects on the body:
– They can help treat inflammation and pain, raise or lower
blood pressure, affect the immune system and stimulate
uterine contractions and labor.
26
Pharmacological Methods of Uterine
Evacuation: Misoprostol (2)
• Research indicates that 600 ug of misoprostol (oral) is an
effective dosage for use in postabortion care.
• Studies for sublingual dosage amounts for use in postabortion
care are ongoing.
• WHO has included misoprostol on its list of essential medicines
for miscarriage and incomplete abortion.
27
Expectant Management
28
Indications for Expectant Management
29
Uterine Evacuation: Integrating Counseling
30