APPLICATION

Indications for use of the Vacuum Aspiration Method in gynecology:

·       Removal of the contents of the uterus

§  First trimester abortion

§  Miscarriage

§  Incomplete abortion

§  Chorionadenoma (molar pregnancy, bubble skid)

§  Missed abortion

§  Infected abortion

·   Endometrial biopsy

§  Primary or secondary infertility

§  Abnormal uterine bleeding

§  Amenorrhea

§  Hyperplasia

§  Chronic Endometrial Infections

§  Monitoring during hormone replacement therapy

§  Intrauterine neoplasia

Uterine remote content 
abortion in the first trimester / menstrual regulation and treatment of incomplete abortion

INDICATIONS 
First trimester abortion / regulation of menstruation:

Syringes with one or two valves can be used to terminate early pregnancy (up to 12 weeks).

Treatment of incomplete miscarriage:

An incomplete miscarriage can be spontaneous or the result of an unsuccessful or incomplete induced abortion. Syringes for vacuum aspiration with one or two valves can be used with a 6 mm cannula in the treatment of incomplete miscarriage with the size of the uterus (bimanual examination), no more than 8 weeks of pregnancy from the first day of the last menstruation (NPM). Syringes with two valves can be used with cannulas up to 12 mm in the treatment of incomplete miscarriage with uterus sizes corresponding to 8-12 weeks of NPM.

CONTRAINDICATIONS

When abortion in the first trimester (regulation of menstruation) or in the treatment of incomplete miscarriage, a syringe with one valve should not be used for uterine sizes (according to a bimanual examination) corresponding to more than 8 NPM; corresponding to more than 12 NPM. The presence of acute purulent cervicitis or pelvic infection are contraindications for manual vacuum aspiration of uterus contents (except in emergency cases). In addition, syringes and cannulas should not be used on an outpatient basis if the woman has uterine fibroids or blood clotting disorders.

WARNINGS

For any invasive procedures there is a risk of infection for patients and medical personnel due to contact with blood or other body fluids. For safety, you should always follow standard precautions, including the use of personal protective equipment, careful handling of waste and sharp tools.

Manual vacuum aspiration is not accompanied by trauma to the body and cervix. However, in a small percentage of cases, the following complications are possible: incomplete aspiration of uterus contents, bleeding, acute hematometer, endometritis, salpingo-oophoritis, pelvioperitonitis, hypotension, vagal reactions, air embolism. 
The presence of obscure aspirated tissue during abortion in the first trimester or in the treatment of incomplete miscarriage. If the aspirated tissue is small or it does not contain obvious products of conception, this may indicate incomplete removal of the contents of the uterus or indicate that such products have already been removed earlier or to ectopic pregnancy.

Anesthesia for Manual Vacuum Aspiration - watch

Incomplete aspiration of uterus contents

Using too small a cannula or premature termination of aspiration may result in incomplete removal of tissue, hemorrhage, and infection. During the MBA, careful observation of the signs of uterus emptying and careful examination of the removed tissue is necessary. In case of incomplete aspiration, a repeat procedure is required and, as a rule, the introduction of antibiotics.

Ectopic pregnancy

The absence of villi, membranes or parts of the embryo when examining aspirated tissue may indicate ectopic pregnancy. Ultrasonography, chorionic gonadotropin determination and, possibly, laparoscopy are required to clarify the diagnosis.

Perforation of the body or neck

These complications are extremely rare and most likely if the technique of the operation and co-infection are not observed. To prevent these complications, it is important to correctly position the cervix and uterus. Perforation of the uterus can damage internal organs and blood vessels. If uterine perforation is suspected, appropriate measures should be taken, including laparoscopy and, in some cases, laparotomy.

Pelvic infection

Postoperative use of antibiotics is recommended to prevent pelvic infection.

Bleeding

Treatment of bleeding depends on its cause and severity, and may include repeated aspiration, administration of uterotonic agents, uterus massage, transfusion of blood and its components, surgical measures.

Acute Hematometer

This complication is a violation of the outflow of blood from the uterus, which leads to the expansion of the uterus. It is manifested by severe cramping pains and vagal symptoms that appear, usually within two hours after the procedure. Palpation can detect an increase in the uterus, its pain, heterogeneity of consistency. Confirmation of the diagnosis is possible with ultrasound. Treatment includes re-aspiration of the uterus contents, administration of uterus toning agents, or massage, resulting in uterine contraction.

Air embolism

This is rarely the case when the plunger of the syringe moves forward while the cannula is still in the uterus.

PRECAUTIONARY MEASURES

In the following cases, cannulas and syringes should be used with caution and with all the necessary emergency equipment:

·       Bleeding in history.

·       Suspected perforation of the uterus.

·       With anemia.

·       In diseases of the circulatory system, septic conditions.

·       With uterine myoma.

In cases of coagulation disorders in history, cannulas and syringes should be used with extreme caution in the presence of all means of emergency care.

If an infection is present, the procedure should be carried out with antibiotic administration. 
Manual vacuum suction kit can be used by experienced professionals or under their supervision. The patient should receive complete information about the risk of this procedure, and other treatment options. It is recommended to follow standard protocols for obtaining informed consent for treatment.

In order to protect patients and medical personnel from blood-borne diseases during aspiration, when examining removed tissue, and when handling instruments and waste, generally accepted precautions should always be followed. Throughout the procedure, contactless techniques are used. Parts of the cannula and other instruments inserted into the uterus should not touch non-sterile surfaces.

Note: Cannulas are sterilized with ethylene oxide and remain sterile in unbroken packaging. Cannulas should be discarded after a single use.

PREPARATION OF CANALS AND VACUUM SYRINGES

Only sterile instruments are inserted into the cervix. Parts of expanders, cannulas or probes intended for insertion into the uterus should not touch non-sterile surfaces or objects, including the walls of the vagina.

1. Have in place several cannulas of approximately the size that is needed according to the size of the uterus. Each cannula is sterile if its packaging is intact. Check the integrity of the package before deploying it. In cases of abortion in the first trimester / regulation of menstruation and treatment of incomplete miscarriage, the largest cannulas should be used, which can be inserted through the cervical canal of the cervix. It is better to use a cannula that passes tightly through the cervix so that the vacuum is transferred from the syringe to the uterus without leakage. It is desirable to have on hand cannula of several sizes. The estimated sizes of the cannulae are listed below.

2. Select syringes, cannulas and adapters (if necessary). Before the procedure, it may be helpful to prepare two syringes, because it is difficult to predict the amount of material being sucked. The size (4, 5.6, etc.) is placed on the cannulas, and the colored dots on the cannulas correspond to the color of the desired adapter.

3. Check the syringe. The syringe must hold the vacuum. Throw away syringes with visible cracks or defects or not holding a vacuum.

4. Attach the adapter (if necessary) to the tip of the syringe or cannula. The cannula can be attached to the syringe via an adapter later, after the tip of the cannula has been inserted into the cervix.

5. Check plunger and valve. The plunger must all go into the syringe body, and the pressure valve must be open (the button is extended).

6. Check the pressure valve by pressing the button (s) down and forward to the tip of the syringe. You will see and hear the valve snap into place.

7. Prepare the syringe by taking its container with your hand and pulling the plunger until its pens come out of the syringe body, holding the plunger in place. Check the stability of the plunger handles on the shoulders of the syringe. Both handles must fully disperse to the brim and harden on the edge of the case. When the knobs are in this position, the plunger does not move forward and the vacuum is maintained. Improper positioning of the handles may cause them to slide into the body and release the contents of the syringe into the uterus. In no case do not grasp the handles of the plunger.

8. Before use, check the syringe for vacuum. Leave the syringe for a few minutes with a vacuum. Open the pressure valve by releasing the button. You will hear the noise of air entering the syringe, which confirms the presence of a vacuum in it. If there is no sound of air, lubricate the O-ring with silicone and check the vacuum again. Replace the O-ring or take another syringe if this one does not keep a vacuum.

9. Repeat steps 5-8 to restore the vacuum for the procedure.