Manual vacuum aspiration – an outpatient alternative for surgical management of miscarriage TOG 2015

Question 1

How much of a vacuum can a MVA syringe create?

Answer 1

610-660mmHg, similar to elective

Question 2

Size of MVA syringe

Answer 2

24cm long
Diameter 4-12mm depending on gestational and estimated size of uterus

Question 3

Which consent required

Answer 3

Written

Question 4

What medication can be given pre-op

Answer 4

Miso 400mcg 2-3 hours before if missed miscarriage, closed Cx, TOP

Pain NSAIDS 1 hour before

Question 5

What analgesia is given to cervix

Answer 5

Lidocaine 2% gel topically
Paracervical injection in 4 quadrants (prilocaine & felypressin) 1-5ml

Question 6

How long after procedure can women go home?

Answer 6

1-2 hours

Question 7

Selection criteria for MVA?

Answer 7

Stable
Parous women
Well motivated women
USS CRL <25mm
USS RPOC <5cm
No clinical signs of infection

Question 8

Who are not suitable for MVA?

Answer 8

> 10 weeks
Panic attacks
Cervical stenosis
Fibroids >12 weeks
Uterine malfiamtion
Haemorrhage disorder or anticoagulant
Alleger to miso or LA
PN RPOC
Uterine infection
Unable to tolerate pelvic examination
RPOC >5cm

Question 9

Success rate of MVA

Answer 9

95%, 5% need further Tx