Wednesday, May 12, 2010

MVA Training

A manual vacuum aspirator is a wonderful thing.

It allows for uterine evacuation very easily. Without suction, a D&C requires a lot of scraping, which is slow and more dangerous (higher risk of uterine perforation)

An MVA looks like a giant plastic syringe with a long tube on the end of it. The long tube is called the curette. It is plastic, bendable and soft, which has a lower risk of perforation than a metal sharp curette. By pulling back on the syringe, a vacuum is created inside, and once the curette is inserted into the uterus, the vacuum creates enough suction to remove the uterine contents (aka products of conception).

It is remarkably easy to use, and is efficient and gentle enough that it can even be done without anesthesia in the right patient.

I thought that learning how to use an MVA would be great for the Labor Ward nurses. Normally, when a patient comes in with incomplete abortion, they need to call for a doctor who may never come. If she is bleeding and in pain, the best thing for her is to take care of the problem quickly. Since her cervix is already dilated, there is no need for painful manual dilation. In fact, once the pregnancy is removed, the patient feels better so quickly that the whole MVA process is essentially rapid pain relief.

So the other day I had a training with the TDH midwives to introduce them to MVAs.

I had heard that a papaya (or paw-paw, as it is called here) is a good replacement for a uterus because of the size and the texture inside. I bought 2 papayas at the market (for $1) and brought 2 MVAs to the Labor Ward yesterday.
Hence the papaya seeds inside the "products of conception."

The training was a great success. The midwives seemed apprehensive at first, but in the end, each one wanted her proper turn, and demanded to have her photo taken while suctioning the papaya!

Now that they have practiced using the MVA, I hope to teach them when real incomplete abortions come in, so that at least a few of them get comfortable with it. Instead of calling a doctor who won't come, or referring a bleeding patient to a place where she will be turned away for lack of money, they can quickly and safely evacuate the uterus and save the woman's life.


danengber said...

oh man do I hate papayas. They smell like sweaty feet. Would it be gross for me to say that I'd rather eat a fetus than a papaya? (yes.)

Veronica, did you see the big NYT article about HIV in Uganda? I printed it out but haven't yet read the whole thing.

Veronica said...

I hate papaya. It tastes like vomit.
Although I will admit that the African papaya doesn't have the vomity taste, but it's still not great.

Yes, read the article. Everyone in our clinic was very moved by it. They posted it in the break room.

Paul said...

I also hate papayas. But love MVAs on papayas! They're how I learned how to do them the first time. although we used slight small asian papayas, and were training for abortions. cool that you taught the nurses how to do that. my residency faculty has been trying to get more Family med docs to incorporate it into their practice as well. why do people like the taste of papaya, anyways?

Anonymous said...

Can MVA cause asherman syndrome?...