MS SUPRIYA CHINCHPURE

Lecturer, SVCON

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Double valve syringe

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In the old fashion cannulae, the

adaptors were provided separate

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Color Coding of cannula:

Yellow= 4mm light Green 5mm

Blue=6mm

Brown=7mm

White=8mm

Tan=9mm Dark Green =10mm

No 12 mm Dark blue

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Pain Management during MVA

Women’s responses to pain vary. Goal: reduce pain and anxiety, minimize risk.

Plan should be based on woman’s individual needs and preferences.

Plan should be created by woman and provider.

Psychological pain: anxiety, fear, apprehension

Cervical pain due to dilatation.

Uterine cramping due to manipulation.

Timing:

Drug must be most effective at the time of the procedure.

Administer drugs 30 to 45 minutes before the procedure.

Non- Pharmacological

Gentle, respectful interaction and communication

Verbal support and reassurance

Gentle, smooth operative technique

Can supplement but not replace medications

Pharmacological

Anxiolytics /sedatives relieve anxiety (Diazepam).

Analgesics relieve pain (Ibuproffein).

General anesthesia should be reserved for extreme cases (paracervical block using lidocaine ).

Preparation of Client:

Explains procedure to patient & take written consent

Provide psychological support & build good IPR

Confirms patient had medication half an hour before

Asks the woman to empty her bladder and clean

perineum.

Assists mother in lithotomy position.

ARTICLES

Sr. No. Articles Qty Purpose

1 Sterile tray with lid 1 To save time & energy

2 Kidney tray 1 To collect the products from the MVA syringe

3 Cusco’s Vagi al speculu 1 To visualize the cervix

4 Bowl 1 To collect cotton swabs

5 Vulsellum 1 To hold the lip of cervix while giving anaesthesia

6 Sponge holding forceps 1 To clean the cervix

7 Vaginal drape 1 To maintain sterile environment & prevent infection

8 Sterile gloves 2 To maintain asepsis & prevent infection

9 Cotton swabs To clean the cervix

10 Vaginal pads 1 After procedure there would be bleeding & to assess amount of bleeding

11 Clean Tray 1 To save time & energy

12 MV Aspirators with cannula ( check if

working)

2 To perform the procedure & two sets to replace if any functional problem.

13 Syringe 10 Ml 1 To give local anaesthesia

14 Inj. Xylocain1% It acts as a anaesthetic (paracervical block)

15 Betadine solution It act as disinfectant

Preparation of Environment &

Self:

Privacy should be maintained (screen or closed

room)

All the articles are arranged near procedure site

All the ornaments, finger rings, bangles etc are

removed.

Put on all Universal protective devices

Wash hands

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The size of cannula is roughly

the number of gestational weeks

i.e. 7wks= 7mm cannula

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Reuse of the instrument:

HLD in 0.5% Chlorine Solution

HLD by Boiling

HLD in Cidex

Sterilization using Autoclave

Sterilization using ETO

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Post Procedure:

Reassure the woman that the procedure is finished.

Help her into a comfortable position.

Ensure she is escorted to the recovery area.

Care provided after uterine evacuation completed

Any physical complications addressed

Woman informed about her condition and self-care

Ends when she is discharged

Physical monitoring:

Ensure that the woman is resting comfortably.

Take her vital signs immediately.

Review chart for condition, history.

Monitor her physiological status.

Assess and manage complications: Significant physical decline

Dizziness, shortness of breath, fainting

Severe vaginal bleeding

Severe abdominal pain, cramping

Support her recovery.

Evaluate bleeding and

cramping twice.

Evaluate pain level, patterns.

Offer choices for pain relief:

Analgesics, NSAIDs

Administer, monitor pain

medications.

Offer support, including

compresses and

compassionate touch.

If a woman’s pain increases, she needs attention.

Post procedure contraceptive counseling

Women may be able to focus on their contraceptive

needs.

Women may be motivated to prevent unwanted

pregnancies.

Discuss the woman’s reproductive plans. Ensure she receives counseling and a contraceptive

method or referral.

Remember that some women may desire another

pregnancy.

Normal recovery:

A few days of menstrual-like bleeding, cramping

Analgesics, baths, compresses for cramping

Next menses: four to eight weeks

Can get pregnant almost immediately

Intercourse, tampons when any complications

resolved

Provide Instructions for medications

Alarming Signs:

Fever, chills, fainting, vomiting

Swollen, tender abdomen

Foul discharge

Cramping, bleeding more than normal menses

Delay in resumption of menstruation (more than

eight weeks)

The Follow Up Visit:

Scheduled before discharge from facility.

Timing varies; usually scheduled within one week.

May not be at same facility.

Woman may be referred to provider in her

community.

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