First Trimester Uterine Aspiration


Materials and Preparation


Answers to Common Questions

  • Remember that this is a simulation. Nothing can be as exact as real life, but this is a close approximation.
  • Reiterate that what is important is the learner going through the steps of the procedure from start to finish, so they are more familiar with them when they actually do the procedure in the office.

Common Pitfalls to Monitor

  • Getting a green papaya may make the aspiration more difficult. Try to make sure that the papayas are ripe.

Lab Sequence

  1. Assemble all of the equipment as described above
  2. Begin counseling the patient on all of the risks, benefits, and alternatives to procedure (if using a SP, if not proceed to step 4)
  3. Conduct a timeout
  4. Bimanual exam for size/position of uterus (if using a hemipelvis with papaya)
  5. Insert speculum and clean cervix with betadine (if using hemipelvis with papaya)
  6. Perform a paracervical block
    1. Using 0.5 or 1% lidocaine- with or without a vasoconstrictor
    2. Continuous injection in and out to 3cm at 2, 4, 8, and 10 o’clock at the cervicovaginal junction
  7. Place tenaculum on anterior lip
    1. Close ratchets slowly to lessen pain
    2. Exert traction on cervix for dilation
  8. Prepare the MVA syringe
    1. Attach the curette
    2. Close the valve
    3. Pull back the plunger
  9. Select cannula
    1. Gestational age or gestational age+1mm
  10. Insert cannula and perform curettage a. Release valves once inserted
  11. Once an adequate specimen is obtained, remove the tenaculum
    1. You would inspect the tenaculum site for bleeding in a live patient
    2. Apply hemostatic treatment if needed (i.e., silver nitrate sticks)
  12. Remove speculum
  13. Examine tissue to ensure gestational sac is present
    1. Strain and rinse the tissue
    2. Place tissue in a clear container
    3. Recommended: Backlight to inspect tissue

Competency Assessment

  • The resident will be able to identify indications and contraindications for MVA in the office setting and be able to counsel the patient appropriately
  • The resident will be able to identify the equipment and supplies necessary for an in office MVA
  • The resident will be able to demonstrate in a simulated environment the steps of an in office manual vacuum aspiration