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Manual Vacuum Aspiration

(Published June 2008)

Vacuum Uterine Aspiration in the United States

Vacuum uterine aspiration allows for the simple evacuation of the uterus through a cannula attached to either an electric or manual vacuum source. Both methods of evacuation are safe and can easily be performed in any setting, including an office, emergency room, or the operating room. When conducted in the outpatient setting rather than operating room, vacuum uterine aspiration can result in substantial cost savings1,2 and significantly reduce patient waiting periods for services.3

The standard technique for vacuum uterine aspiration requires only the stabilization of the cervix with a tenaculum, application of local anesthesia, and insertion of a plastic cannula into the uterus (if the cervix is inadequately dilated, dilation may be needed). The cannula is then attached to a vacuum source (manual or electric) and the contents of the uterus are aspirated. In manual vacuum aspiration (MVA), the uterine contents are aspirated by manually generating negative air pressure (vacuum) into a large syringe. During electric vacuum aspiration (EVA), the cannula is attached to tubing, which is connected to the electric aspirator and the contents of the uterus are evacuated through the tubing into a container.

MVA Advantages

  • Safe and effective
  • Portable
  • Low cost
  • Easy to use
  • Reusable
  • Quiet
  • Appropriate for many different clinical settings
  • High patient and provider satisfaction
  • Products of conception easily visible

Overall effectiveness, patient satisfaction, and complication rates are comparable for EVA and MVA.4 MVA is highly portable, virtually silent, reusable, and available at a low cost. In patients who are less than 50 days of gestation, MVA results in less patient perception of pain as compared to EVA, but takes longer to complete.4 Additionally, pregnancy tissue may be easier to identify after MVA than EVA.5-7 Clinicians also report high satisfaction in the use of MVA.8

MVA also can be used for any indication that requires suction evacuation of the uterus, including:5,9,10

  • Early pregnancy loss
  • Elective termination of early pregnancy
  • Completion of failed medical abortion

References

  1. Dalton VK, Harris L, Weisman CS, Guire K, Castleman L, Lebovic D. Patient preferences, satisfaction, and resource use in office evacuation of early pregnancy failure. Obstet Gynecol. 2006;108(1):103-10.
  2. Blumenthal PD, Remsburg RE. A time and cost analysis of the management of incomplete abortion with manual vacuum aspiration. Int J Gynecol Obstet. 1994;45:261-7.
  3. Patel A, Panchal H, Patel R, Keith L. Decreased waiting periods in a public pregnancy termination clinic. Contraception. 2008;77(2):105-7.
  4. Wen J, Cai QY, Deng F, Li YP. Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review. BJOG. 2008;115(1):5-13.
  5. Edwards J, Creinin MD. Surgical abortion for gestation of less than 6 weeks. Curr Probl Obstet Gynecol Fertil. 1997;20 (1):11–19.
  6. MacIsaac L, Darney P. Early surgical abortion: an alternative to and backup for medical abortion. Am J Obstet Gynecol. 2000;183:S76-83.
  7. Paul M, Lackie E, Mitchell C, Rogers A, Fox M. Is pathology examination useful after early surgical abortion? Obstet Gynecol. 2002;99:567-71.
  8. Dean G, Cardenas L, Darney P, Goldberg A. Acceptability of manual versus electric aspiration for first trimester abortion: a randomized trial. Contraception. 2003;67:201-6.
  9. Creinin MD, Schwartz JL, Guido RS, Pymar HC. Early pregnancy failure—current management concepts. Obstet Gynecol Surv. 2001;56(2):105-13.
  10. Castleman LD, Oanh KT, Hyman AG, Thuy le T, Blumenthal PD. Introduction of the dilation and evacuation procedure for second-trimester abortion in Vietnam using manual vacuum aspiration and buccal misoprostol. Contraception. 2006; 74(3):272-6.