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Home , Dilation and curettage, Vacuum aspiration

PRODUCT BRIEF Caucus on New and Underused Reproductive Health Technologies

Manual

Description Studies demonstrate that the efficacy of MVA is comparable to EVA and is successful in approximately Manual vacuum aspiration (MVA) can be used to 99 percent of cases for early elective and manage a number of maternal health conditions— management of early pregnancy loss. Studies show such as incomplete and spontaneous abortion or that 98 percent of vacuum aspiration procedures unsuccessful —and can be used occur without complications, much higher than to perform first trimester induced and the alternative D&C method, which may induce endometrial biopsies. MVA allows for evacuation of incidences of excessive blood loss, pelvic , the using a hand-held plastic aspirator attached cervical injury, and uterine perforation.8 to a cannula (a thin tube). MVA and electric vacuum aspiration (EVA) share a common mechanism of action—using suction as the force to remove uterine Current program/sector use contents via the cannula. Unlike electric suction, Vacuum aspiration, both electric and manual, is the suction used for uterine evacuation with MVA used for about 97 percent of first-trimester surgical is created manually by extending the plunger of induced abortions in the United States. Canada, the syringe-like aspirator. For EVA, a large electric China, New Zealand, Singapore, the United Kingdom, machine generates the suction, and the aspiration is and other countries use vacuum aspiration for most performed using a long tube connected to the EVA of their first-trimester surgical-induced abortions.9 In machine. The need for electricity, the large size, and many developing countries, such as Bangladesh and the cost of the machine precludes the use of EVA in Vietnam, MVA has been used for several decades to many parts of the world, whereas MVA can be used in provide early induced abortion, including procedures any location where basic medical care is provided. referred to as “menstrual regulation.” MVA is well MVA is safe, effective, easy to use, portable, and suited for use in conjunction with medical abortion* reusable. It is appropriate for use in many different if there is a concern that the uterus has not been clinical settings (including developing country completely evacuated. outpatient centers), does not require lengthy training for proper operation, and has yielded both high patient and provider satisfaction.1,2 Additionally, there Manufacturer/supplier is substantial evidence that mid-level providers— MVA is available in many countries. Many for example, midwives, clinical officers, nurse governments have identified MVA in clinical practitioners, physician assistants—can perform MVA guidelines as the preferred method for uterine procedures safely and effectively in a range of health evacuation. Inclusion in clinical guidelines also helps care settings.3,4,5,6 to ensure adequate and reliable supplies of MVA instruments in their public health systems. Efficacy The original MVA device was developed by Ipas—an international organization that works to MVA has been demonstrated to be effective and very increase women’s ability to exercise their sexual and safe through clinical studies over the last 30 years. , and to reduce abortion-related The World Health Organization (WHO) recommends deaths and injuries. WomanCare Global (WCG) is the MVA as a preferred method of uterine evacuation.2 exclusive distributor of Ipas MVA instruments (single- When compared to sharp curettage (also known as and double-valve aspirators and cannulae), which or D&C), MVA is a safer, more are CE marked and manufactured in Taiwan. WCG readily accessible, and potentially less expensive way adheres to ISO 13485 quality standards, audits their to offer high-quality services to women.7 manufacturers, and has conducted verification testing

* For more information on medical abortion, please see the Caucus’ brief on and for medical abortion. CAUCUS ON NEW AND UNDERUSED REPRODUCTIVE HEALTH TECHNOLOGIES PRODUCT BRIEF document relative their quality. variable. Some efforts have made been to assess and available from other manufacturers, but quality can be Currently, there are anumber of other MVA products care developing inboth and developed countries. ofproviding reproductive spectrum full the health CEmark.the MSI nonprofit is aglobal organization single- andboth double-valve MVA. possess Both Malaysia,in China, and Taiwan manufacture who Marie Stopes International (MSI) has manufacturers in more than 100countries. productshealth public the inboth and private sectors for compliance. WCG provides access to reproductive endorsement by theCoalition orits wider membership. For additional information, please contact health sectors. Responsibility for theselectionand contents of theproduct briefs rests solely with theCaucus and does not imply broaden thediscussion within theCoalition of reproductive health technologies that are not well integrated into thepublic orcommercial Technologies, athematic group established under theauspices of theReproductive Health Supplies Coalition. The Caucus’ aimis to This publication forms part of aseries of technical briefs, written by members of theCaucus onNewand Underused Reproductive Health http://www.rhsupplies.org/working-groups/caucus-on-newunderused-rh-technologies.html For more information ontheCaucus onNewand Underused RHTechnologies, please visit our web page at ([email protected]) for MSI MVA instruments. Ipas MVA instruments or Marie Stopes International ([email protected])Global for Procurers are encouraged to contact WomanCare at time. this There are knownno public-sector pricing agreements Public-sector price agreements individual registrations country are not required. is sufficient the for countries where itoperates so procurers. The CE marking on MSI’s MVA products in MSI clinics, but are they available to external Currently, MSI’s MVA products are mainly used and approved devices. medical throughout world the as accepted procedures clinical CE marked and are registered by WCG incountries Ipas MVA products (aspirators and cannulae) are Registration status 10

7. 6. 5. 4. 3. 2. 1. References 10. 9. 8. preventable pandemic. Grimes DA, J, Benson Singh S,etal. : The American Journal of Public Health and physician assistants waiver. under legal aCalifornia byperformed nurse practitioners, midwives,nurse certified J, Battistelli MF, Drey EA.Safety of aspiration abortion Weitz TA, Taylor D, S,Upadhyay Desai UD, Waldman 2013;120(1):23–31. safe termination of pregnancy care? asystematic review. BJOG. Renner RM,Brahmi D, Kapp N.Who can provide effective and Lancet The and Vietnam:Africa arandomized controlled equivalence trial. abortion done by doctors and midlevel providers inSouth complications infirsttrimester manual vacuum aspiration Warriner IK,Meirik O, HoffmanRatesal. M,et of 2004;94(8). abortion services. RH. Physician assistants as providers of surgically induced Goldman MB, Occhiuto JS,Peterson LE,Zapka JG, Palmer WHO. Technical and policy guidance for health systems World Health Organization (WHO). 2003. aspx?ht. Accessed January 6,2011. Manual_Vacuum_Aspiration_ _Frequently_Asked_Questions. page. Ipas website. Available at: www.ipas.org/Library/FAQs/ Manual vacuum aspiration—frequently asked questions Obstetrics aspiration instruments. S,RuminjoGirvin J. An evaluation of manual vacuum 2001. Women’s Access to Safe Abortion Services Baird TL,FlinnSK. Press; 1981. sterilization: Medical and social aspects Unitedin the States. In: Hodgeson, JEed. Cates WJ, Grimes DA. Morbidity and mortality of abortion . 2003;83(2):219–232. . 2006;368:1965–1972. American Journal of Public Health Manual Vacuum Aspiration: Expanding [email protected] The Lancet The International Journal of Gynecology & This brief was last updated May 2013 May updated waslast brief This . 2013;103(3):454–461. . 2006;368(9550):1908–1919. . London: Academic . Chapel Hill, NC: Ipas; . Abortion and and Abortion Safe abortion: abortion: Safe . Geneva: . Geneva: . ,

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