Chapter 23: Manual vacuum aspiration (MVA)
Deciding when to do MVA
Women who have tissue left in the womb after an incomplete miscarriage or
abortion can die from infection or bleeding. MVA can help save their lives.
But MVA is also dangerous unless it is
done carefully. To do MVA, you must put
something into a woman’s womb. Putting
anything inside a woman’s womb is risky
because if it is not done correctly, it can give
her a serious infection, or injure her womb.
Also, MVA can be done safely only up to
12 weeks of pregnancy.
Before you do an MVA, you should be
sure that there is not a safer alternative.
Is there a medical center nearby where
health workers can empty the womb?
Would this be an appropriate time to use misoprostol (see page 408) instead of
MVA? Only use MVA if it is the safest way to empty the womb. To make an MVA
safe you must:
Have sterilized equipment
Everything that goes inside a woman’s womb must be
sterilized (see page 59). If you cannot sterilize your tools
before doing an MVA, you cannot make it safe and you
should not do it!
Be trained and experienced
You cannot learn enough from any book, including this book, to do an MVA
safely. You must be trained by an experienced person. Learn as much as you can
from books, classes, and teachers. Help someone more experienced when she is
doing an MVA so you can watch and learn.
Know that MVA is the appropriate care for the woman
Talk with the woman about why she needs an MVA. Check her physical signs,
like pulse and temperature, to see if she needs other medical care as well. Find out
how long she has been pregnant. MVA is only safe during the first 12 weeks (or
3 months) of a pregnancy. That is 12 weeks after the woman’s last monthly
bleeding. After that, the pregnancy is too far along for MVA to work. Only try to
do MVA after 12 weeks if the woman is in serious danger after incomplete abortion
or miscarriage, and you have no other way to help her. See page 88 for methods to
help you know how long a woman has been pregnant.
To be sure that a woman is less than 3 months pregnant, you should do a
bimanual exam (see page 384) before doing an MVA.
A Book for Midwives (2010)