Steps for Performing Manual Vacuum Aspiration (MVA) Using the Ipas MVA Plus® and Ipas EasyGrip® Cannulae

Step One: Prepare the Aspirator Step Six: Insert Cannula • Position the plunger all the way inside • While applying traction to tenaculum, the cylinder. insert cannula through the , just past the os and into the • Have collar stop in place with tabs in the until it touches the fundus, and then cylinder holes. withdraw it slightly. • Push valve buttons down and forward • Do not insert the cannula forcefully. until they lock (1). • Pull plunger back until arms snap outward and catch on cylinder base (2). Step Seven: Suction Uterine Contents • Attach the prepared aspirator to the cannula if Step Two: Prepare the Patient the cannula and aspirator • Administer pain medication to have maximum were not previously effect when procedure begins. attached. • Give prophylactic antibiotics to all women, and • Release the vacuum by therapeutic antibiotics if indicated. pressing the buttons. • Ask the woman to empty her bladder. • Evacuate the contents of the by gently and slowly rotating the cannula 180° in each direction, using an in-and-out motion. • Conduct a bimanual exam to confirm uterine size and position. • When the procedure is finished, depress the buttons and disconnect the cannula from the aspirator. Alternatively, withdraw the cannula and • Insert speculum and observe for signs of , bleeding or aspirator without depressing the buttons. incomplete . Signs that indicate the uterus is empty: Step Three: Perform Cervical • Red or pink foam without tissue is seen passing through the cannula. Antiseptic Prep • A gritty sensation is felt as the cannula passes over the surface of the evacuated uterus. • Use antiseptic-soaked sponge to clean cervical os. Start at os and spiral outward • The uterus contracts around or grips the cannula. without retracing areas. Continue until os • The patient complains of cramping or pain, indicating that the uterus has been completely covered by antiseptic. is contracting.

Step Eight: Inspect Tissue Step Four: Perform Paracervical Block • Empty the contents of the aspirator into a • Paracervical block is recommended when container. mechanical dilatation is required with MVA. • Strain material, float in water or vinegar and • Administer paracervical block and place view with a light from beneath. tenaculum. • Inspect tissue for , • Use lowest anesthetic dose possible complete evacuation and . to avoid toxicity – for example, if using , the recommended dose is less • If inspection is inconclusive, reaspiration or than 200 mg. other evaluation may be necessary.

Step Five: Dilate Cervix Step Nine: Perform Any Concurrent Procedures • Observe no-touch technique when dilating the cervix and during • When procedure is complete, proceed with contraception or other aspiration. Instruments that enter the uterine cavity should not touch procedures, such as IUD insertion or cervical tear repair. your gloved hands, the patient’s skin, the woman’s vaginal walls, or unsterile parts of the instrument tray before entering the cervix. • Use mechanical dilators or progressively larger cannulae to gently Step Ten: Process Instruments dilate the cervix to the right size • Immediately process or discard all instruments, according to local protocols.

For product related information contact: WomanCare Global +1.919.442.2600 and +1.877.644.2348 © 2014 Ipas. P.O. Box 9990 · Chapel Hill, NC 27515 USA [email protected] U.S. Patent and Trademark Office Reg. No. 919-960-6453 · www.ipas.org www.womancareglobal.org Ipas MVA Plus® 2,907,186 Ipas EasyGrip® 2,768,302 PERFMVA2-E14