USING MVA AND EVA EQUIPMENT

• Begin with valve buttons open and
  plunger pushed fully into the barrel.
• Close valve by pushing the buttons
  down and forward until locked in place.

• Pull the plunger back until its arms
  snap outward over the rim at end of the barrel.
• Make sure the plunger arms are positioned
  over wide edges of the barrel rim.

• Use dilators of increasing size to accommodate
  cannula size chosen based on gestational weeks.
• Dilator:
  • Denniston – dilate to cannula size
    (e.g. size 7 for 7 mm cannula)
  • Pratt – dilate to cannula size x 3
    (e.g. 21 French for 7mm cannula)

• Flexible: longer with two openings at tip
• Rigid: larger single opening at tip
• No significant difference in safety or efficacy
  (Kulier 2001)

• Larger: faster aspiration, intact tissue
• Smaller: less dilation and resistance

NAF Provider’s survey (O’Connell 2009):

• 54% used size (in mm) = weeks gestation
• 37% used 1-2 mm < weeks gestation
• 9% used 1-3 mm > weeks gestation

• Apply traction to tenaculum to straighten uterus.
  Then holding cannula with fingertips, gently
  insert through cervix with rotating motion.
• Attach aspirator to cannula.
• Do not grasp aspirator by plunger arms.

• When the pinch valve is released, the vacuum is
  transferred through the cannula into the uterus.
• Blood, tissue, and bubbles will flow through the
  cannula into the aspirator

• Rotate the cannula and move it gently from fundus
  to the internal os, applying a back and forth motion as clinically indicated until:
  • Grittiness is felt through cannula
  • Uterus contracts and grips cannula
  • There is increased cramping, and / or
  • No more blood passes through cannula

• Availability / preference determine use
• MVA is FDA approved to 12 weeks
• Some use > 1 MVA to facilitate emptying, or switch to EVA > 9 weeks
• Minimal differences in pain, anxiety, bleeding, or acceptability (Dean 2003)
• EVA sound disturbs some patients; silent, in-wall suction is available.

EVA use:

• Attach cannula and close thumb valve
• Place cannula into uterus
• Turn on and check suction gauge
• To modify: turn dial or adjust valve
• Release suction (open thumb valve) when passing through cervical canal.

• Rinse and strain the tissue
• Place tissue in a clear container
• Backlight is recommended to inspect
  tissue if gross visual inspection is non-diagnostic.

• Shredded (on left) vs. intact
• To minimize shredding, consider using MVA
  (< pressure than EVA); slightly larger cannula.

• Frond-like villi
• Clumps held by membrane
• Transparent like plastic wrap
• Luminescent; light refractory
• Turns white if vinegar added
• More stretchy
• Floats more in liquid media
• Size: see coin sizes above

• No fronds
• No villi or thin membrane
• Opaque like wax paper
• Less light refractory
• Minimal color change
• More breakable
• Sinks more in liquid media
• Quantity variable