Uterine evacuation with manual vacuum aspiration ... - CommonHealth

Uterine Evacuation with 

Manual Vacuum Aspiration (MVA) 

A Training 

Manual for 

Conducting 

Short Courses

ISBN:1-933095-50-4 

©2009 Ipas. 

Produced in the United States of America. 

Suggested Citation: Ipas. 2009. Uterine Evacuation with Manual Vacuum Aspiration (MVA): A Training Manual for 

Conducting Short Courses. Chapel Hill, NC: Ipas. 

Ipas is a nonprofit organization that works globally to increase women’s ability to exercise their sexual and 

reproductive rights and to reduce abortion-related deaths and injuries. We seek to expand the availability, 

quality and sustainability of abortion and related reproductive health services, as well as to improve the enabling 

environment. Ipas believes that no woman should have to risk her life or health because she lacks safe reproductive 

health choices. 

WomanCare Global LLC is an exclusive distributor of Ipas instruments. For information regarding availability or to 

report an adverse event contact WomanCare Global at customerservice@womancareglobal.com or 919 442-2600. 

Ipas 

PO Box 5027 

Chapel Hill, North Carolina 27514, USA 

Web site: www.ipas.org 

Email: training@ipas.org 

Graphic Design: Jamie McLendon 

Editor: Jennifer Daw Holloway 

Printed on recycled paper 

An Ipas international publication

Manual Vacuum Aspiration (MVA) 

Each year, nearly 67,000 women die from unsafe abortion and about 5 million 

more are injured, often permanently (WHO 2007). Many of these women could 

be saved and their injuries prevented if clinicians in their communities were 

trained and equipped to use a simple, inexpensive medical device — the manual 

vacuum aspiration (MVA) instrument. 

MVA involves the use of a plastic aspirator to evacuate the uterus for miscarriage 

management (incomplete, missed or inevitable abortion), first-trimester abortion 

(also called menstrual regulation), and endometrial biopsy. The manual vacuum 

aspirator consists of a cylinder, plunger and valve. To evacuate the uterus, the 

aspirator is attached to a cannula which is inserted through the cervix to aspirate 

the contents of the uterus. 

The MVA device is handheld and portable. The procedure is quiet, fast and 

inexpensive (Dalton 2006) and can be performed in a wide variety of clinical 

settings because it does not rely on electricity. Unlike traditional dilatation and 

curettage with a sharp curette, an MVA procedure does not typically require 

general anesthesia. In a small percentage of cases (

Because of its importance to obstetric care, WHO and the United Nations 

Population Fund (UNFPA) have included MVA instruments on their proposed list 

of essential drugs and other commodities for reproductive health care (WHO and 

UNFPA 2003) and in technical guidance for uterine evacuation (WHO 2003). 

This Resource 

Historically, Ipas and other international nongovernmental organizations have 

supported training events of five days or more with the goal of health-care 

facilities adopting a model of more comprehensive care for women (either 

postabortion care or abortion care, including MVA for treatment, as well as 

contraceptive services, counseling for other health needs, provision of other 

reproductive health services and community partnerships for prevention of 

unsafe abortion). 

Though many health-care professionals are eager to gain the knowledge and skills 

necessary to provide obstetric care with MVA, they cannot take significant time 

away from clinical responsibilities to take part in lengthy training events. Ipas 

recognizes that every clinician does not need a comprehensive course designed 

to help a team adopt a new model of care and notes that professionals come to 

training events with existing ranges of knowledge and skills and varying learning 

needs. Clinicians can avail themselves of a broad continuum of educational 

options to gain the knowledge and skills they need at a particular point in 

their professional careers and practices. The courses outlined in this manual 

are designed to meet the middle range of training needs in MVA use. For 

example, attending these courses requires more effort/time and results in more 

knowledge/skill-building than simply reading MVA product inserts or studying a 

wallchart, but not as much as performing several procedures one-on-one with an 

experienced clinical trainer supervising or attending a multi-day clinical course. 

This manual, which is specific to MVA (excluding the other elements of 

comprehensive models), will serve as a guide for MVA training facilitators to 

provide three standard courses — each with different objectives, prerequisites 

and course lengths, based on the participants’ level of familiarity with MVA and 

experience with transvaginal procedures. The courses include up-to-date content 

and are based on principles of adult learning. Participants who successfully 

complete the courses will gain the specified knowledge and skills offered in each of 

the courses. Variations of these standard courses have been delivered around the 

world. 

2 ·UTERINE EVACUATION WITH MANUAL VACUUM ASPIRATION (MVA): A TRAINING MANUAL FOR CONDUCTING SHORT COURSES

The Courses 

The three courses vary in length and scope and can be offered separately or in 

a series so that participants can attend more than one course in a convenient 

timeframe. The basic course themes are: 

• MVA and its clinical applications; 

• How to perform MVA on a pelvic model and all local instrument processing 

options (where regulatory conditions approve re-use); 

• The above topics plus supervised clinical practice, management of 

complications and guidance on monitoring of services. 

Training facilitators should select course materials based on the environmental 

context in which the learners will put their new knowledge and skills to use. The 

two key issues of environmental context to identify for course content selection 

are: 

1. Clinical applications for 

use of MVA 

In every country of the world, there are at least two clinical applications for MVA: treatment of incomplete or missed abortion 

(miscarriage) and endometrial biopsy. Additionally, in most countries, therapeutic abortion is legally permitted to save the 

woman’s life or preserve her health and/or for other indications. Most women live in countries where induced abortion is 

permitted, with or without restrictions (CRLP 2007). 

Materials on the CD-ROM included with this manual are labeled Uterine Evacuation for either 

• INCOMPLETE/MISSED ABORTION: for use in contexts that focus on treatment of incomplete/missed abortion, whether 

miscarriage management or treatment of complications of an induced procedure, and endometrial biopsy 

• Or, ALL INDICATIONS: for contexts that include treatment of incomplete/missed abortion, first-trimester induced abortion 

and endometrial biopsy 

2. Regulatory Context: Are 

cannulae labeled for 

single or multiple use? 

The use and re-use of cannulae varies among countries and clinical practices. In the United States and some other countries, 

Ipas EasyGrip ® cannulae are labeled for single use and should be discarded after use. Where local regulations permit, these 

cannulae can be reused after high-level disinfection or sterilization. Please note that flexible Karman cannulae and 3mm 

cannulae for endometrial biopsy are labeled for single use in all countries and should be discarded after use. 

Trainers should plan to follow country-specific labeling regarding single-use or processing of instruments for reuse. Materials 

on the CD-ROM included with this manual are labeled either 

• SINGLE USE: for settings where cannulae are used once and discarded 

• Or, MULTIPLE USE: for settings where cannulae are processed for reuse 

UTERINE EVACUATION WITH MANUAL VACUUM ASPIRATION (MVA): A TRAINING MANUAL FOR CONDUCTING SHORT COURSES · 3

The Courses at a Glance 

Title Course 101 

Introduction to MVA 

Course 201 

Pelvic Model Practice with MVA 

Course 301 

Supervised Clinical Practice with MVA 

Description • Introduction to MVA • Practice MVA on a Pelvic Model 

• Processing MVA instruments for reuse, 

where allowed 

• Supervised Clinical Practice with MVA 

• Monitoring of Services 

• Management of Complications 

Program Length ~ three hours ~ four hours ~ One six to eight hour day 

Prerequisites None • Course 101 or equivalent IpasUniversity 

course completions, which are: 

– MVA Facts and Features 

– Uterine Evacuation with Ipas MVA Plus ® 

– Stocking Facilities with MVA 

• Course 101 or equivalent IpasUniversity 

course completions, which are: 

– MVA Facts and Features 

– Uterine Evacuation with Ipas MVA Plus 

– Stocking Facilities with MVA 

AND 

• Course 201 

Topics Covered 

• Uterine evacuation methods 

• MVA facts and features: Clinical 

application and product features 

• Supervised practice on pelvic model 

• Processing instruments for reuse, where 

allowed 

• Perform a supervised MVA procedure in a 

clinical facility* 

• Monitoring of services 

• Overview of MVA procedure 

• Management of complications 

• MVA stocking and resupply 

Learning 

Objectives 

Upon completion 

participants will: 

• Be familiar with the Ipas MVA 

instruments and know how and 

when to resupply 

• Be able to simulate MVA on a pelvic model 

• Be able to process MVA instruments in 

accordance with local regulations and with 

locally available products/systems 

• Have performed a supervised MVA 

procedure in a local clinical facility* 

• Be familiar with key tools for monitoring 

services with a goal toward quality 

improvement 

• Be able to manage potential complications 

Recommended 

Trainers/ 

Presenters 

• 1 clinical trainer 

• 1 representative from local MVA 

distributor who can facilitate 

stocking and resupply of 

instruments 

• 1 clinical trainer 

• 1 representative from local MVA distributor 

who can facilitate stocking and resupply of 

instruments 

• 1 clinical trainer and 2 additional clinical 

trainers for part of the workshop 

• 1 representative from local MVA distributor 

who can facilitate stocking and resupply of 

instruments 

Recommended 

Participants 

Up to 20 participants Up to 10 participants per clinical trainer Up to 5 participants per clinical trainer 

Please note that while endometrial biopsy is an indication for MVA, specific training on endometrial biopsy is not a part of these course models. 


Ipas policy/guidelines on clinical training 

with live patients 

Promoting quality care for women is a top Ipas priority. To that end, participants 

in course 301 (Supervised Clinical Practice of MVA) must have completed course 

201. Clinical trainers and participants in course 301 must meet all professional 

requirements of the facility where supervised clinical practice is offered. 

Options for Delivering Courses 

These short courses offer training facilitators and participants great flexibility in 

finding the course and schedule that best meets participants’ needs and available 

time. For example: 

Courses offered separately 

First ___ day of the month Course 101 

Monthly, or occasionally to meet demand Course 201 

Monthly, or occasionally to meet demand Course 301 

Or, courses offered as a series 

Example 1: Courses offered on closely-scheduled days 

Tuesday Evening Course 101 

Thursday Evening Course 201 

Saturday all day Course 301 

Example 2: Courses offered on two successive days 

Friday Morning Course 101 

Friday Afternoon Course 201 

Saturday all day Course 301 


The Trainers/Presenters 

The trainers/presenters for these courses should be clinicians skilled in uterine 

evacuation with MVA and capable of training on all elements in the courses. 

Ideally, clinical trainers will be a member of Ipas’s Global Trainers’ Network 

(GTN), a network for clinical trainers and organizations that provide sexual and 

reproductive health training. Ipas ensures that GTN trainers are able to: 

• Follow current clinical guidelines 

• Utilize Ipas clinical training curricula 

• Employ effective teaching methodologies based on adult learning principles 

• Serve as effective presenters and facilitators 

For information on how to find an Ipas GTN trainer in your area, please send an 

e-mail to training@ipas.org. 

For Course 301, depending on the number of participants and clinical practice 

volume, there may be concurrent sessions that require additional clinical trainers 

or local monitoring experts during a one-hour period. 

Ipas recommends that a representative from a local MVA distributor also serve as 

a trainer/presenter at these courses. It is important that participants know where 

they can procure a sustainable supply of instruments following completion of 

a course. 

The Materials 

This manual and accompanying CD-ROM includes all the information and 

tools necessary to plan and implement Course 101, Course 201 and Course 301, 

including: 

• Course overviews for instructors 

• Participant agendas 

• Materials checklists with links to learning and instructional aids 

• Planning checklists 

• Learning assessments with answer keys 

• Evaluation forms 

• Certificates for course completion 

• Information on MVA instruments and local availability 

Please note that the CD-ROM also contains all of the PowerPoint® course slide 

sets. The slides are not reproduced in this manual. 

The detailed course overviews include the number of PowerPoint slides per topic 

and all suggested supporting materials and activities. For ease of presenter use, 

the entire course is in one slide deck. However, it is not all PowerPoint-based. 

Place-holder slides for interactive and hands-on activities are included with 

instructions. There are also “test your knowledge” question slides at the end 

of certain topics. Please note that correct answers for all “test your knowledge” 

slides are in the Speaker’s Notes. All trainers/presenters should plan to review 

the correct answers before presenting the test questions to audiences. Should 


the trainer/presenter not wish to include the “test your knowledge” slides 

in the educational session, the slides can be hidden or deleted. All slides can 

be re-ordered, and the interactive slides can be interspersed throughout the 

presentation, rather than reviewing them at the end of a topic. Ipas wants to 

ensure maximum flexibility for each individual presenter’s preferred style and 

comfort level, while maintaining standard content. 

Additional resources that can be used in a blended learning 

approach 

With the goal of maximizing the time of learners and trainers, 

Ipas recommends the following tools that can be used as distance 

learning, job aids or supplemental learning for participants and 

trainers. Specifically, documented completion of selected courses from 

IpasUniversity can serve as a prerequisite to Course 201. 

IpasUniversity (www.IpasU.org) 

IpasU is a self-paced Internet learning site for reproductive health-care 

providers with a focus on safe abortion care and postabortion care. IpasU 

offers free courses for both clinicians (already in practice and those still 

in-training) as well as those who work with developing world clinicians. 

At present, IpasU courses are available in English only. 

Other Ipas curricula (online and in print) 

Ipas is a global leader in reproductive health training. Our 

performance-based Woman-Centered Abortion Care and Woman- 

Centered Postabortion Care courses are known for their participatory, 

experiential learning methods, based on principles of adult learning and 

empowerment education. These courses are normally offered as part 

of a larger in-service training program. Trainers and reference manuals 

are available on www.ipas.org/publications (use search term “womancentered”). 

Access to the Global Trainers’ Network (GTN) 

Participants who successfully complete any of the three courses outlined 

in this manual may be interested in working with an experienced Ipas 

trainer from the Global Trainers’ Network to build and strengthen their 

skills in providing MVA care, or expand their knowledge of the Woman- 

Centered approach. For more information please send an email to: 

training@ipas.org 

MVA Calculator (www.mvacalculator.org) 

Use the free online MVA Calculator to estimate facility supply needs for 

MVA at www.mvacalculator.org 


References 

Center for Reproductive Policy and Law. 2007. The World’s Abortion Laws. New 

York: CRR.(http://reproductiverights.org) 

Dalton, Vanessa, Lisa Harris, Carol Weisman, Ken Guire, Laura Castleman, Dan 

Lebovic. 2006. Patient Preferences, Satisfaction, and Resource Use in Office 

Evacuation of Early Pregnancy Failure. Obstetric Gynecology 108(1): 103-10. 

World Health Organization. 2007. Unsafe abortion: Global and regional estimates of 

the incidence of unsafe abortion and associated mortality in 2003. Geneva: WHO. 

World Health Organization and UNFPA. 2003. Essential drugs and other 

commodities for reproductive health services. Draft discussion document. Geneva: 

WHO. 

World Health Organization. 2003. Safe abortion: technical and policy guidance for 

health systems. Geneva: WHO. 

Tools 

Course 101: Introduction to MVA 

1. Course overview for trainers/presenters 

2. Sample participant agenda 

3. Recommended materials checklist (with pdfs or links to all materials) 

4. Sample planning checklist 

5. Sample course evaluation tool 

6. Sample certificate for course completion 

7. Information on MVA instruments and local availability (sample template) 

Course 201: Pelvic Model Practice with MVA 





5. Guidance on set up and training with pelvic models 

6. MVA Procedures Checklist 

7. Sample learning assessment tool (tests & answer keys) 





MVA Course 301: Supervised Clinical Practice with MVA 

1. Course overviews for trainers/presenters 




5. Guidance on setting up and running clinical practicum 


7. Sample learning assessment tool 






Tools

Tools 

1) The materials printed in this manual are for the uterine evacuation practice environment of incomplete and/ or 

missed abortion. The accompanying CD-ROM contains the materials for all indications and both regulatory 

settings (single use and multiple use of cannulae). 

2) These tools and accompanying PowerPoint slides may be adapted for specific training circumstances, only to 

the extent that the content is NOT altered. For example, if the same group of participants takes all three 

courses, certain review sections and accompanying slides in MVA 201 and MVA 301 can be deleted to avoid 

redundancy, and the timeframes on the agenda can be altered, as necessary. Additional location-specific 

information may be inserted, as well. 

A) MVA Course 101 








B) MVA Course 201 





5. Guidance on set up and training with pelvic models 






C) MVA Course 301 

1. Course overviews for trainers/presenters 




5. Guidance on setting up and running clinical practicum 






UTERINE EVACUATION WITH MVA: A TRAINING MANUAL FOR CONDUCTING SHORT COURSES Page 1

Tool A-1: 

MVA 101 Course Overview (Context: Incomplete/Missed Abortion) -- 

Approximately Three Hours 

INSTRUCTIONS: Use this Course Overview tool to study the topics, suggested timeframes and supporting 

slides/materials/activities for the course. Plan and adjust the agenda (separate tool) accordingly. 

Presentation Topic ~ # Slides Suggested Materials Suggested 

Length 

Welcome & Introductions 8 slides Informational Flyers (Ipas MVA 10 minutes 

Plus®, Ipas EasyGrip®, 3mm 

cannula, Ipas mission) 

Statistics 5 slides 10 minutes 

UE Methodologies Review 

and Comparison 

INCOMPLETE/MISSED: 

17 slides 

30 minutes 

Ipas Product Overview 

9 slides 

30 minutes 

10 slides with test 

questions 

MVA Procedure 

44 slides 


questions to use 

interactively with course 

participants (correct 

answers are in speaker 

notes). 

MVA steps wall chart 

Performing MVA + Processing 

Bifold 

Performing UE spiral notebook 

CD-ROMS: 6 min MVA 

technique using the Ipas MVA 

Plus or Performing UE with MVA 

Plus 

45 minutes 

Stocking and Resupply of 

Instruments 

18 slides mvacalculator.org 

JSI Table 

Local Distributor contact 

information 

Course Close 1 slide Course Evaluation 

Certificates 

15 minutes 

15 minutes 


Tool A-2: 

MVA 101 Sample Agenda for Participants 

INSTRUCTIONS: Adjust this Agenda accordingly and provide one for each participant at beginning of course. 

Time 

(adapt as necessary for 

local setting) 

(10 minutes) 

9:00 am – 9:10 am 

Topic 

Introduction 

Lead Presenter 

(include names, rather than roles, once 

presenters confirmed) 

Representative from Local Distributor & 

Clinical Trainer 

(10 minutes) 

9:10 am – 9:20 am 

Global and local context for MVA 


(30 minutes 

9:20 am – 9:50 am) 

(30 minutes) 

9:50 am – 10:20 am 

(15 minutes) 

10:20 am – 10:35 am 

(45 minutes) 

10:35 am – 11:20 am 

Review and comparison of uterine 

evacuation technologies 

Overview of MVA instrument 

Coffee/tea break 

MVA procedure overview 




(15 minutes) 

11:20 am – 11:35 am 

MVA stocking and resupply 

Local Distributor 

(15 minutes) 

11:35 am – 11:50 am 

Course close and evaluation 

Clinical Trainer & Local distributor 


Tool A-3: 

MVA 101 Recommended Materials Checklist with Link to PDF: 

Course Context: Incomplete/Missed Abortion INSTRUCTIONS: Use this Materials Checklist as guidance to ensure 

all audiovisual equipment and printed materials are in place for training event. 

Recommended 

Quantity 

Quantity 

Ordered 

Status Item Link to pdf, where applicable 

1 Computer and LCD projector for 

powerpoint presentations 

1 per participant 

plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 

Participant Agenda 

Informational flyers (MVA Plus, 

EasyGrip, 3mm, mission) 

Contact information from local 

supplier/vendor of MVA, including JSI 

Table and link to 

www.mvacalculator.org 

Peforming Uterine Evacuation with the 

Ipas MVA Plus Aspirator and Ipas 

EasyGrip® Cannulae: Instructional 

booklet 

Performing Uterine Evacuation with Ipas 

MVA Plus and Ipas EasyGrip® 

Cannulae: Instructional CD-ROM OR 

CD-Rom of 6 minute video 


Performing MVA + Processing Bifold 

List of on-line resources 

Certificates of participation and 

completion 

Plus Flyer 2007 

Easy Grip Flyer 

3 mm Flyer 2007 

Performing UE with Ipas MVA 

Plus 

MVA Procedure Steps Wallchart 

PAC MVA Steps and Processing 

www.IpasU.org 


www.ipas.org 

www.womancareglobal.com 

Tool A-9 


plus extras 

Course evaluation tool Tool A-8 

1 per participant Ipas MVA Plus® aspirators and Ipas 

EasyGrip® cannulae 


Tool A-4: 

MVA 101 Sample Planning Checklist 

INSTRUCTIONS: Use this Planning Checklist as guidance to ensure all necessary steps and planning details for 

setting up the training event are followed with enough time for completion. 

Target date Action Person 

responsible 

5-6 weeks prior to Secure venue for course 

course 

(training room with space for the number of participants and 

adequate seating arrangements for participatory learning and 

appropriate viewing of audiovisual materials) 

Status 

Ensure computer, projector, screen, audio will be available at 

venue 

Contract appropriate clinical trainer and product 

representative for course 

For full series of three courses: Ensure trainer has required 

credentials for clinical training/patient care 

Ensure participants will have MVA instruments for use 

during and after course and ensure resupply mechanism 

Ensure required learning aids and printed materials are 

ordered in appropriate numbers (see materials list for items 

and quantities) 

5 weeks prior Advertise, invite participants 

4 weeks prior Make any necessary travel arrangements and ensure travelers 

are aware of all details (including potential airport pick-up 

and hotel) and requirements for reimbursement for any 

expenses 

Monitoring plan: Plan for follow-up with each course 

participant 

2 weeks prior Finalize slidesets, have file and back-up file for projection; 

print any handouts for participants; check ordered learning 

aids and printed materials 

Reconfirm venue arrangements 

Reconfirm arrangements with clinical trainer and product 

representative (Local Distributor) 


Tool A-5: 

MVA 101 Course Evaluation 

INSTRUCTIONS: Insert date and location at top of evaluation and delete instructions. Provide Course Evaluation to 

all participants at the end of the course and ask them to complete and turn in before leaving. Study the responses 

after the course, with the goal of using responses to improve and adapt the course for future offerings. 

MVA 101: Introduction to MVA Course Evaluation 

DATE:______________________________LOCATION:_________________________ 

Course Objective: 

Be familiar with the Ipas MVA product line and know how to re-supply 

4 = strongly agree 3 = agree 2 = disagree 1 = strongly disagree 

Rating 

1. The course fulfilled its goal and objective (see above). ______ 

Comments: 

2. The trainers were responsive to participants’ needs. ______ 

Comments: 

3. Because of this course, I have a better understanding of the importance of MVA and how to use it. 

Comments: 

_______ 

4. Now that I have completed this course, I feel (please circle the appropriate response): 

a. Ready to take the next two courses before offering care with MVA to women 

b. That this procedure is not one I would choose to provide 

c. Prepared to promote (but not provide) MVA services 

d. Other [please describe] 


5. What suggestions can you offer to improve this course in the future? 

6. I came to this course with (please circle the appropriate response): 

a. No experience providing transvaginal procedures 

b. Less than three years clinical experience including transvaginal procedures 

c. Between three and five years of clinical experience including transvaginal procedures 

d. More than five years of clinical experience including transvaginal procedures 

7. My clinical background is: 

a. Professional midwife or nurse-midwife 

b. Other advance practice or midlevel clinician (physician’s assistant, clinical officer, professional 

nurse, etc) 

c. Medical doctor (non specialist) 

d. Ob-Gyn specialist 

e. Public Health (non practicing clinician) 

f. Other (please describe) 


Tool A-6: 

MVA 101 Certificate Template 

(full page version on CD-ROM) 

INSTRUCTIONS: Add logos of sponsoring organizations, include names of trainers and date and print one copy of 

Certificate Template for each participant, customized with each individual participant name, and distribute to 

participants at the close of course. 

Insert logo of 

sponsor/host 

organization 

Introduction to 

Manual Vacuum Aspiration 

Course 101 

Add Logo of 

sponsoring 

Organization 

CERTIFICATE OF COMPLETION 

Awarded to 

____________________________________ 

NAME 

________________________________ 

PLACE 

________________________ 

DATE 

Insert name of Clinical Trainer 

Insert name of Course Sponsor 


Tool A-7: 

Information on Instruments and Availability 

INSTRUCTIONS: Insert specific contact information of local MVA instruments supplier in template, delete 

instructions and print one copy for each course participant. 

[Name and contact information for MVA instruments supplier(s):] 

For information on planning and calculating instruments supply, 

see www.mvacalculator.org and/or use the following table: 


B) MVA Course 201 

The materials printed in this manual are for the uterine evacuation practice environment of incomplete 

and/ or missed abortion. The accompanying CD-ROM contains the materials for all indications and 

both regulatory settings (single use and multiple use of cannulae). 

Tool B-1: 

MVA 201 Course Overview (Contexts for samples for course 201: 

Incomplete/Missed Abortion; Multiple use) – Approximately Four Hours 


slides/materials/activities for the course. Plan and adjust the agenda (separate tool) accordingly. This 

Overview can be adapted depending on whether this course is offered immediately after course 101 or 

offered on its own without 101 as an immediate precursor. 

Presentation Topic ~ # Slides Suggested 

Materials/Activities 

Suggested 

Length 

Welcome & Introductions 

Review of Content from MVA 

101 

14 slides Informational flyers (Ipas MVA 


cannula, Ipas mission 

30 minutes 

Hands-on Practice 

18 slides 

44 slides 

MVA Procedures Checklist 

Practice with instrument 

disassembly and re-assembly 

Procedure demonstration and 

practice with pelvic model 

2-4 hours 

Instruments Processing 

33 slides 

Processing wall chart 

30 minutes 


questions 

Resupply of Instruments 39 slides mvacalculator.org 

JSI Table 


information 

30 minutes 

Learning Assessment 1 slide Administer learning assessment 15 minutes 

Course close (same as above) Administer course evaluation 

Give out certificates 

15 minutes 


Tool B-2: 

MVA 201 Sample Agenda for Participants: 

INSTRUCTIONS: Adjust this agenda accordingly and provide one for each participant at beginning of course. This 

Agenda can be adapted depending on whether this course is offered immediately after course 101 or offered on its 

own without 101 as an immediate precursor. 

Time 

(adapt as necessary 

for local setting) 

(30 minutes) 

1:00 – 1:30 

(120 minutes) 

1:30 pm – 3:30 pm 

(15 minutes) 

3:30 pm – 3:45 pm 

Topic 

Welcome, introductions, review of content 

from 101 (or IpasU equivalent) 

Demonstration and practice on pelvic model 

(Use skills assessment from procedure 

checklist) 

Coffee/Tea break 


(include names, rather than roles, once 

presenters confirmed) 

Clinical Trainer and Representative from 

Local Product Distributor 


(30 minutes) 

3:45 pm – 4:15 pm 

MVA instruments processing 

Representative from Local Product 

Distributor 

(30 minutes) 

4:15 pm – 4:45 pm 


Representative from Local Product 

Distributor 

(15 minutes) 

4:45pm – 5:00 pm 

Learning assessment 

Clinical Trainer & Representative from Local 

Product Distributor 

(15 minutes) 

5:00 pm – 5:15 pm 

Course close 

Clinical Trainer & Representative from Local 

Product Distributor 


Tool B-3: 

MVA 201 Sample Materials Checklist with Link to PDF 

INSTRUCTIONS: Use this Materials Checklist as guidance to ensure all audiovisual equipment, training aids, 

medical supplies and printed materials are in place for training event. This checklist should be adjusted, depending 

on whether this course is offered immediately after MVA 101 or offered on its own without 101 beforehand 

(participants who just took MVA 101 will already have most of these materials). 

Recommended 

Quantity 

Quantity 

Ordered 

Status Item (Link to pdf) 


powerpoint presentations 

1 TRAINER TIPS FOR USE OF PELVIC 

MODELS FOR MVA CLINICAL 

TRAINING 


Participant agenda 

plus extras 

Pelvic Model 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 

Informational flyers (Ipas MVA 


cannula, Ipas mission) 


supplier/vendor of MVA, including 

JSI Table and link to 


Peforming Uterine Evacuation with 

the Ipas MVA Plus Aspirator and 

Ipas EasyGrip® Cannulae: 

Instructional booklet 

Performing Uterine Evacuation with 

Ipas MVA Plus and Ipas 


CD-ROM OR 




Easy Grip Flyer 

3 mm Flyer 2007 

Performing UE with Ipas 

MVA Plus 

MVA Procedure Steps 

Wallchart 



plus extras 


plus extras 


plus extras 


plus extras 


Bifold 


UE for incomplete and 

missed abortion : 

PAC MVA Steps and 

Processing 

MVA Processing Wallchart 

List of online resources: 

www.IpasU.org 


www.ipas.org 


Procedure checklists Tool B-6 


plus extras 


completion 

Tool B-9 


plus extras 


plus extras 

1 for every 2 

participants 

Learning assessment tool Tool B-7 

Course evaluation tool Tool B-8 

Pelvic models 

1 for each 

participant or for 

each pelvic model 

1 for each pelvic 

model 

Ipas MVA Plus® aspirators and 

Ipas EasyGrip® cannulae (for each 

participant or for each pelvic 

model) 

One speculum, tenaculum and 

injection syringe per pelvic model 

Drape for each pelvic model (when 

not in use) 

1 for each pelvic 

model 

Buckets and supplies for 

demonstrating instrument 

processing (include solution for 

decontamination soak, locally 

available products for high-level 

disinfection (HLD) or sterilization, 

including wrappers for autoclave.) 

1 set Samples of locally available 

contraceptives and pain medications 

(optional) 


Tool B-4 



setting up training event are followed with enough time for completion. 


responsible 


course 

(training room with space for the number of participants and 


appropriate viewing of audiovisual materials) 

Status 

Ensure computer, projector, screen, audio will be available at 

venue 

Contract appropriate clinical trainer and product 

representative for course 




ordered in appropriate numbers (see materials checklist for 

items and quantities) 

NOTE: Be sure to include pelvic models, procedural supplies 

and instruments processing supplies, as shown on materials 

checklist 





expenses 


participant 




Reconfirm venue arrangements 

Reconfirm arrangements with clinical trainer and product 

representative 


Tool B-5: 

MVA 201: Guidance for Setting Up and Training with Pelvic Models 

INSTRUCTIONS: The enclosed CD-ROM includes a 4-page guide on preparing for and training with pelvic 

models. Facilitators should use the guide to ensure that all components of pelvic model training are in place prior to 

a course. Trainers and presenters should review it in advance of course for specific suggestions on pelvic model 

training. 


Tool B-6: 

MVA Procedure Checklist: Incomplete/Missed Abortion 

INSTRUCTIONS: Provide a copy to each participant for use during training on pelvic models. 

Skills Yes No Comments 

Creates pain management plan 

Tailors pain management plan with woman according to her needs 

Discusses sources of pain, options, potential side effects 

Includes combination of support and pharmacological measures 

Takes into account woman’s medical and psychological status, dilatation 

necessary, staff skill, nature of procedure and availability of supplies 

Prepares the instruments 

Checks vacuum retention of aspirator 

Has more than one instrument available 

Prepares the woman 

Administers pain medication in timely fashion 

Asks woman to empty her bladder 

Asks what supportive measures she would like and provides them 

Asks for permission to start 

Puts on barriers and washes hands 

Performs pelvic exam to confirm assessment findings 

Warms and inserts speculum gently 

Removes foreign bodies in os; refers if bowel present 

Performs cervical antiseptic prep 

Follows No-Touch Technique 

Uses antiseptic sponges to clean os and, if desired, vagina 

Administers paracervical block 

Uses less than 200mg lidocaine 

Aspirates before injecting 1–2mL at tenaculum site 

Places tenaculum 

Applies slight traction to expose tissue transition 

Slowly injects 2–5mL lidocaine to 1–1.5 inches at 3,5,7 and 9 o’clock 

Dilates cervix if needed 

Inserts cannula 

Applies gentle traction to cervix 

Rotates cannula while gently applying pressure 

Inserts cannula to just past internal os OR to fundus and pulls back 

Suctions uterine contents 

Holds tenaculum and end of cannula in one hand 


Attaches charged aspirator 

Releases buttons to start vacuum 

Rotates cannula 180 degrees each direction 

Uses an ―in and out‖ motion 

Does not withdraw aperture beyond os 

Uses gentle operative technique 

Uses positive, respectful, supportive reassurance 

Stops when pink foam without tissue passes, gritty sensation is felt, uterus 

contracts around cannula and uterine cramping increases 

Removes the instrument 

Is ready to evacuate again after inspecting tissue if needed 

Inspects tissue 

Empties aspirator into container 

Looks for products of conception (POC) 

Evaluates amount based on estimated gestation 

Determines all POC have been removed 

Completes remaining steps: 

Wipes cervix to assess bleeding 

Considers if pelvic exam is advisable 

Reassures woman that procedure is finished 

Performs post-procedure care 

Processes instruments 

Removes barriers and washes hands 

Ensures woman is escorted to recovery area 

Resolves technical problems that arise 


Tool B-7: 

MVA 201 Sample Learning Assessment Tool (test & answer key) 

(Note that the CD-ROM contains a version for participants, that does not indicate correct answers) 

INSTRUCTIONS: Select the appropriate learning assessment and make one copy for each participant and 

administer at end of course to all participants. Review answers with all participants after they have completed test. 

This test is appropriate for all four course versions (with answer on #10 different for Multiple Use versus Re-Use) 

Learning Assessment: MVA 201 (Pelvic Model Practice with MVA) 

Name: ____________________________________ Date: ______________________ 

1. The steps of processing include which of the following? 

a) Decontamination soak 

b) Cleaning 

c) High-level disinfection (HLD) or sterilization 

d) Storage 

e) All of the above [correct] 

2. Following an MVA procedure, all instruments that will be reused should be 

a) Kept wet until they can be cleaned [correct] 

b) Kept dry until they can be cleaned 

c) Kept in an air-tight storage device 

d) Immediately sterilized 

3. Which of the following methods is NOT acceptable for processing Ipas MVA Plus® aspirators? 

b) Sterrad Processor 

c) HLD with chemicals 

d) Dry heat [correct] 

e) Steam Sterilization 

4. Active Stock of MVA is 

a. New devices, in original packaging, in the facility store room 

b. The devices kept in the procedure room to serve women needing MVA in any given day or shift 

[correct] 

c. The devices in the central warehouse to send to facilities when requisitioned 

d. The devices the chief health practicioner keeps at her private practice to serve her patients 

5. The primary goal of forecasting MVA needs for health-care facilities is: 

a) To reduce the length of time between ordering and receiving new MVA aspirators 

b) To reduce the number of women whose health and lives are at risk when providers lack MVA 

when needed [correct] 

c) To increase the number of providers trained and equipped to offer care with MVA 

d) To help provide program information for potential donors 

6. When a clinic storeroom reaches the reorder point quantity for MVA devices, how many should be 

reordered? 

a. The Total Initial Stock 

b. The Reserve Maximum minus the reorder point quantity [correct] 

c. The Active Stock plus the Reserve Stock quantities 

d. The Reserve Maximum 


7. You are planning MVA needs for a small hospital, open 24 hours per day. Based on your facility’s past 

experience, you project that you will provide MVA care to an average of 70 women each month. Use the 

MVA Initial Supply and Resupply table to determine how many aspirators should be available in the active 

inventory: 

a) 2 

b) 4 

c) 6 [correct] 

d) 8 

8. For that same facility that serves 70 women per month with MVA, what is the maximum number of 

aspirators that should be held in reserve, unused in the facility storeroom? 

a) 2 

b) 7 [correct] 

c) 13 

d) 29 

9. The steps for preparing the instrument and checking vacuum retention are out of order below. Please order 

the steps correctly by numbering them 1-5. 

a) Pull the plunger straight back until the plunger arms snap outward and catch on the cylinder base 

[2] 

b) Let the aspirator sit for several minutes [3] 

c) Push the valve buttons to release the vacuum [4] 

d) Listen for a rush of air into the vacuum, indicating that the vacuum has been retained [5] 

e) Push both valve buttons down and forward at the same time until they lock into place [1] 

10. Ipas EasyGrip® cannulae (select all that apply) 

[ANSWER CHANGES DEPENDING ON REGULATORY CONTEXT: C FOR REUSE, C and D FOR 

SINGLE USE] 

a) Can be used after cleaning 

b) Cannot be autoclaved or boiled 

c) Must be HLD or sterile before entering the sterile uterus [correct] 

d) Cannot be reused [correct for SINGLE USE regulatory context) 

11. Put the 10 steps of the procedure in order : 

a) Process instruments [10] 

b) Aspirate tissue [7] 

c) Prepare instruments [1] 

d) Prepare the woman [2] 

e) Prepare the cervix [3] 

f) Insert Cannula [6] 

g) Dilate cervix [5] 

h) Perform any concurrent procedures [9] 

i) Perform paracervical block [4] 

j) Inspect tissue [8] 

12. The recommended cannula sizes for a woman seeking uterine evacuation for an 8 week LMP procedure, 

with a closed cervix is 

a) 4 mm-5mm 

b) 6 mm-8mm 

c) 7mm – 9 mm [correct] 

d) 10mm or 12 mm 

e) TBD 


13. Paracervical block by itself is necessary and sufficient pain management for most women undergoing 

MVA: 

a) True 

b) False [correct] 

14. Pain management for an MVA procedure can include 

a) Conscious sedation 

b) Paracervical block 

c) Anxiolitics 

d) Analgesics 

e) Any one or more of the above [correct] 


Tool B-8: 


INSTRUCTIONS: Insert date and location at top of evaluation and delete these instructions. Provide 

Course Evaluation for each participant at the end of the course and ask them to complete and turn in 

before leaving. Study the responses after the course, with the goal of using responses to improve and 

adapt the course for future offerings. 


DATE:_____________________________ LOCATION:_________________________ 

Course Objectives: 

• Be able to simulate procedure on a pelvic model. 

• Be able to process MVA instruments in accordance with local regulations and with locally available 

products/systems 


Rating 

1. The course fulfilled its goal and objectives (see above). ______ 

Comments: 


Comments: 

3. Because of this course, I have a better understanding of how to use MVA. ______ 

Comments: 


4. Now that I have completed this course, I feel 

a. Ready to offer care to women with MVA 

b. Ready to take the next course, before offering care with MVA to women 

c. That this procedure is not one I would choose to provide 

d. Prepared to promote (but not provide) MVA services 

e. Other [please describe] 


6. I came to this course with 

a. No experience providing transvaginal procedures 

b. Less than three years clinical experience including transvaginal procedures 

c. Between three and five years of clinical experience including transvaginal procedures 

d. More than five years of clinical experience including transvaginal procedures 

7. My clinical background is as: 

a. Professional midwife or nurse-midwife 

b. Other advance practice or midlevel clinician (physician’s assistant, clinical officer, professional 

nurse, etc) 

c. Medical doctor (non specialist) 

d. Ob-Gyn specialists 

e. Public Health (non practicing clinician) 

f. Other (please describe) 

8. As a pre-requisite for this course, I took: 

a) MVA 101 

b) Equivalent IpasUniversity courses 


Tool B-9: 



INSTRUCTIONS: Insert logos and names of trainer and sponsor. Print one copy of Certificate Template 

for each participant, customized with each individual participant name, and distribute at the close of 

course. 


sponsor/host 

organization 

Pelvic Model Practice with 


Course 201 

Add Logo of 

sponsoring 

Organization 


Awarded to 

____________________________________ 

NAME 

________________________________ 

PLACE 

___________________________ 

DATE 




Tool B-10: 

Information on Instruments and Availability 

INSTRUCTIONS: Insert specific contact information of local MVA instruments supplier in template, delete 

instructions and print one copy for each participant in course. There is only one version of this template. 

Contact information for MVA instruments supplier(s): 




MVA Course 301 

Tool C-1: 

MVA 301 Course Overview – Approximately six to eight hours 

(context: incomplete/missed abortion; reuse) 


slides/materials/activities for the course. Plan and adjust the agenda (separate tool) accordingly. This Overview 

can be adapted depending on whether this course is offered immediately after MVA 101 and 201 or offered 

separately. 

Presentation Topic ~ # Slides Suggested 

Materials/Activities 

Suggested Length 

Welcome & Introduction 

Review MVA 101 201 content 

20 slides Highlight procedure, including 

pain management and postprocedure 

care 

30 minutes 

Follow-Up Care 9 slides 10 minutes 

Orientation to clinical practicum and 

other rotations 

1 slide Discussion and orientation to 

practicum and rotation to other 

topics 

20 minutes 

Clinical practicum rotation 

Monitoring to Improve Services 

rotation 

Management of Complications 

rotation 

Procedure checklist 

Clinical skill evaluation 

checklist 

60 - 90 minutes (concurrent 

with two other rotations) 

15 slides 60 - 90 minutes (concurrent 

with practicum) 

38 slides 60- 90 minutes (concurrent 

with practicum) 

Resupply of Instruments 18 slides Mvacalculator.org 

JSI Table 


information 

Learning assessment 1 slide Administer learning assessment 

Review clinical skill evaluation 

with individual participants (if 

not completed during clinical 

practicum) 

Course Close (same as above) Administer course evaluation 

Distribute certificates 

15 minutes 

30 minutes 

15 minutes 


Tool C-2: 

MVA 301 Sample Agenda for Participants 

INSTRUCTIONS: Adjust this Agenda and provide one for each participant at beginning 

of course. This agenda can be adapted depending on whether this course is offered 

immediately after MVA 101 and 201 or offered separately. 

Time 

(adapt as necessary for 

local setting) 

(30 minutes) 

8:30 – 9:00 

(10 minutes) 

9:00 – 9:10 

(20 minutes) 

9:10 – 9:30 

(180 – 270 minutes) 

9:30 – 1:00 

Topic 

Welcome, introductions, review of content 

from MVA 101 and 201 

Follow-up care 

Orientation to clinical practicum and rotations 

through classroom topics 

Three Concurrent Sessions, with rotations 

through each: 


(include names, rather than roles) 

Clinical Trainer & Representative local 

Distributor 



1. Clinical practicum Clinical Trainer 

2. Monitoring of services Clinical Trainer B 

3. Management of complications Clinical Trainer C 

(60 minutes) 

1:00 – 2:00 

(15 minutes) 

2:00 – 2:15 

(30 minutes) 

2:15 – 2:45 

(15 minutes) 

2:45 – 3:00 

Meal break 


Learning assessment 

Course close 

Representative from Local Distributor & 



Clinical Trainer & Representative from 

Local Distributor 


Tool C-3: 

MVA 301 Recommended Materials Checklist with Link to PDF 

INSTRUCTIONS: Use this Materials Checklist as guidance to ensure all audiovisual equipment, training aids, 

medical supplies and printed materials are in place for training event. The Materials Checklist should be adjusted, 

depending on whether this course is offered immediately after MVA 101 and 201 (participants who just took 101 

and 102 will already have most of these materials). 

Recommended 

Quantity 

Quantity 

Ordered 

Status Item (link to pdf) 


powerpoint presentations (need two 

for concurrent rotation modules) 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 


plus extras 

Participant agenda 

Informational flyers (Ipas MVA 

Plus, Ipas EasyGrip, 3mm cannula, 

mission) 


supplier/vendor of MVA, including 

JSI Table and link to 


Peforming Uterine Evacuation with 

the Ipas MVA Plus Aspirator and 

Ipas EasyGrip® Cannulae: 

Instructional booklet 

Performing Uterine Evacuation with 

Ipas MVA Plus and Ipas 


CD-ROM OR 




Bifold 


Article: ―Manual vacuum aspiration 

for uterine evacuation: Pain 

management‖ 

List of on-line resources 


EasyGrip Flyer 

3mm Flyer 2007 

Performing UE with Ipas 

MVA Plus 

MVA Procedure Steps 

Wallchart 

PAC MVA Steps and 

Processing 

MVA Processing Wallchart 

Pain Management MVA- 

2009 

www.IpasU.org 


www.ipas.org 




plus extras 

Procedure Checklists Tool C-6 


plus extras 

Learning assessment tool (includes 

clinical skill evaluation) 

Tool C-7 


plus extras 

Course evaluation tool Tool C-8 


plus extras 

1 for each 

participant 


completion 

Ipas MVA Plus® aspirators and 

Ipas EasyGrip® cannulae 

Tool C-9 

1 set Samples of locally available 

contraceptives and pain medications 

(optional) 


Tool C-4 



setting up training event are followed with enough time for completion. 


responsible 


course 

(Training room with space for the number of participants and 


appropriate viewing of audiovisual materials.) 

NOTE: During course rotations, two training rooms are 

required for concurrent sessions, in addition to the separate 

clinical training venue. 

Status 

Ensure computers, projectors, screens, audio will be available 

at venue 

Secure venue for clinical training where: 

Trainer can provide clinical care, and 

Participants from outside the facility are able to provide 

patient care in training context. 

Coordinate with facility staff to ensure that both: Women 

are cared for in a timely way 

Clinical training needs for participants are met. (Course 

participants should demonstrate knowledge and skills on 

pelvic model before offering clinical care.) 

Contract appropriate clinical trainers and representative from 

Local Distributor for course 

There is a 3-to-4 hour block of time with concurrent sessions 

that requires three clinical trainers: 

Supervised Clinical Practicum 

Management of Complications 

Monitoring Services (could be a monitoring expert 

who is very familiar with MVA services, but not a 

clinician) 

Ensure clinical trainer has all required credentials for clinical 

training/patient care at the facility where clinical practicum 

will take place. 




ordered in appropriate numbers (see materials checklist for 

items and quantities) 






expenses 


participant 




Reconfirm venue arrangements, including reconfirmation 

with clinical facility 

Reconfirm arrangements with clinical trainers and 

representative from Local Distributor 


Tool C-5: 

MVA 301: Guidance on Setting Up and Running Clinical Practicum 

INSTRUCTIONS: Use this guide for facilitators to ensure that all components of running a clinical practicum are in 

place and for trainers/presenters to study in advance of practicum for specific guidance and suggestions on planning 

and conducting a clinical practicum. There is only one version of this guidance tool. 

Advance Preparation 

❑ Ensure that all learners have reached competency in simulated skills practice prior to 

partaking in the clinical practicum. 

❑ Obtain approval for site(s) used for training. 

❑ Plan the design of the practicum. 

❑ Organize trainers and discuss their roles, emphasizing teamwork. 

❑ Determine how to involve practicum-site staff in the practicum. 

Clinical Practicum 

Note to trainer: 

This document may need to be adapted for your setting. Consider the length of time needed and available for 

practice, the order of topics, the need for additional trainers, the amount of review required at the start of each topic 

and other logistics when adapting the module. 

❑ Determine what each learners’ role will be during the practicum. 

❑ Determine how to configure teams of learners and trainers. 

❑ Arrange for learners to observe or assist with care for women with complications. 

❑ Prepare and duplicate materials (flipcharts, checklists, evaluation forms). 

❑ Ensure readiness of equipment and supplies needed for the practicum. 

❑ Have alternative activities ready for learners to do when client caseload is slow. 

❑ Review the Clinical Training Approaches and Coaching Skills session of the Effective Training 

in Reproductive Health: Course Design and Delivery Trainer’s Manual. 

❑ Review Conducting This Clinical Practicum (below). 

Conducting This Clinical Practicum 

Time required 

The time required for this clinical practicum can vary significantly depending on the practicum design, the needs 

and skills of learners, the amount of time available, and many other factors. 

Format 

This practicum module is divided into practicum sessions by skill set. The content of each session reflects the 

module of the same name in the didactic part of this training. Each session of the practicum should begin with a 

short content review—a mini-lecture using flipcharts and a review of the checklist(s) for that skill. After completing 

the content and checklist review, brief learners on the details of the session and then release them to their 

assignments. At the end of each practice session, have learners regroup to debrief and discuss. 

Designing the Practicum 

❑ The design of the practicum depends on the needs of the learners and realities of the practicum site. Determine 

whether the practicum can be held with several learners and several trainers at one time at the same site or at several 

sites at the same time. A modular or other adapted approach can be used, staggering place, times, learners, 

trainers and/or skills. 

• Consider designing the practicum so that learners practice skills that logically go together during clinical 

care. 

• Utilize the time well. 


❑ If the learners will be divided into groups or will practice at different sites, arrange for additional trainers, 

because each learner must be directly supervised by a trainer. 

❑ Employ principles of adult learning and maintain a positive learning environment. 

Before the Practicum 

❑ Identify when caseload at the practicum site is highest. To build caseload, consider asking local facilities to refer 

women coming for abortion services to the practicum site during the training period. Alternatively, schedule women 

for endometrial biopsy during the practicum and allow learners to perform the procedure, as the skill is similar to 

uterine evacuation. 

❑ Ensure that practicum-site protocols, equipment and supplies are consistent with skills to be taught; decide how 

to handle any noted discrepancies. 

• If necessary, adapt training activities to more closely reflect practicum-site practices, or create additional 

activities. 

❑ Determine where review and debrief discussions can take place before and after practice. This may be a private 

room on- or off-site. 

❑ Determine how to keep track of learners who have successfully achieved competency and those who need more 

practice, as well as how the latter will receive that additional practice. 

During the Practicum 

❑ Refer to the Reference Manual frequently during review, debriefing and other discussions with learners. 

❑ Assign learners to practice procedures according to their skill level. 

❑ Assign a few learners and a trainer to work together in ―practice groups.‖ Pair strong learners with weaker ones 

and ask them to help each other. Once some learners have reached competency, they can help those who have not. 

Ensure learners understand what their roles are, what the other learners’ roles are and how to assist other learners. 

❑ Limit the number of learners and observers for each procedure. 

❑ Obtain the client’s permission for learners to perform the procedure, ensuring she understands that the trainer will 

be present and that she has the right to refuse without being denied care. 

❑ Always respect the woman’s right to confidentiality and privacy, not only in direct care but also when discussing 

her care with learners. 

❑ Only give corrective feedback to learners in the presence of a client when the mistake could endanger her or 

cause her discomfort, in order to limit the anxiety of the client as well as the learner. 

❑ Carefully monitor the practicum to ensure that other trainers are following agreed-upon protocols and using the 

checklists; to problem-solve issues that arise; to ensure that practice groups are working well; and to make certain 

that every learner is getting opportunities to participate. 

❑ In addition to leading a debrief discussion, consider seeking feedback from learners after each session. 

❑ Use the Clinical Skills Evaluation form in this module for evaluating learners to determine if they can be 

considered competent in abortion-care skills. 

After the Practicum 

❑ Provide the evaluation for learners to complete 

❑ Debrief with site staff and other trainers about what worked well and how the clinical practicum could be 

improved, and thank everyone for their participation. 

❑ Provide each learner with specific recommendations for implementing and improving their skills when they 

return to their sites. 

❑ Provide feedback on each learner’s skills to their site supervisor, if appropriate. 

❑ Provide opportunities for refresher courses and site-visit exchanges between learners. 

❑ Ask the learners what they see as their most important next steps and how you might assist them. 


Tool C-6: MVA Procedure Checklist: Incomplete/Missed Abortion 

INSTRUCTIONS: Provide a copy to each participant for use during training on pelvic models. Only one version 

of this tool is printed below, but the CD-ROM contains both versions. 

MVA Procedure Checklist: Incomplete/Missed Abortion 

Skills Yes No Comments 

Creates pain management plan 

Tailors pain management plan with woman according to her needs 

Discusses sources of pain, options, potential side effects 

Includes combination of support and pharmacological measures 

Takes into account woman’s medical and psychological status, dilatation 

necessary, staff skill, nature of procedure and availability of supplies 

Prepares the instruments 

Checks vacuum retention of aspirator 

Has more than one instrument available 

Prepares the woman 

Administers pain medication in timely fashion 

Asks woman to empty her bladder 

Asks what supportive measures she would like and provides them 

Asks for permission to start 

Puts on barriers and washes hands 

Performs pelvic exam to confirm assessment findings 

Warms and inserts speculum gently 

Removes foreign bodies in os; refers if bowel present 

Performs cervical antiseptic prep 

Follows No-Touch Technique 

Uses antiseptic sponges to clean os and, if desired, vagina 

Administers paracervical block 

Uses less than 200mg lidocaine 

Aspirates before injecting 1–2mL at tenaculum site 

Places tenaculum 

Applies slight traction to expose tissue transition 

Slowly injects 2–5mL lidocaine to 1–1.5 inches at 3,5,7 and 9 o’clock 

Dilates cervix if needed 

Inserts cannula 

Applies gentle traction to cervix 

Rotates cannula while gently applying pressure 

Inserts cannula to just past internal os OR to fundus and pulls back 

Suctions uterine contents 


Holds tenaculum and end of cannula in one hand 

Attaches charged aspirator 

Releases buttons to start vacuum 

Rotates cannula 180 degrees each direction 

Uses an ―in and out‖ motion 

Does not withdraw aperture beyond os 

Uses gentle operative technique 

Uses positive, respectful, supportive reassurance 

Stops when pink foam without tissue passes, gritty sensation is felt, uterus 

contracts around cannula and uterine cramping increases 

Removes the instrument 

Is ready to evacuate again after inspecting tissue if needed 

Inspects tissue 

Empties aspirator into container 

Looks for products of conception (POC) 

Evaluates amount based on estimated gestation 

Determines all POC have been removed 

Completes remaining steps: 

Wipes cervix to assess bleeding 

Considers if pelvic exam is advisable 

Reassures woman that procedure is finished 

Performs post-procedure care 

Processes instruments 

Removes barriers and washes hands 

Ensures woman is escorted to recovery area 

Resolves technical problems that arise 


Tool C-7: 

MVA 301 Sample Learning Assessment Tools 

(Contexts: incomplete/missed abortion; multiple use for cannulae) 

INSTRUCTIONS: There are two parts of Learning Assessments for MVA 301: (1) Clinical Skills Evaluation, and 

(2) Learning Assessment for Managing Complications and Monitoring. 

For Clinical Skills Evaluation: Provide one copy per participant for the Clinical Trainer who is conducting the 

Clinical Practicum portion of this course. The Clinical Trainer will complete an evaluation for each participant and 

review it with personally with the participant, either immediately after the practicum (if time allows) or during the 

Learning Assessment module of the course. 

For the Learning Assessment for Managing Complications and Monitoring, keep one copy of test with highlighted 

answers for presenter/trainer. Select the participant version from the CD-ROM (correct answers not noted) make 

one copy for each participant and administer at end of course to all participants. Review answers with all 

participants after they have completed test. 


Clinical Skills Evaluation 

UTERINE EVACUATION FOR INCOMPLETE/MISSED ABORTION: 

Instructions: The trainer should use one form to evaluate the ability of each learner based on direct observation of 

the learner’s management of an incomplete abortion case, including performance of manual vacuum aspiration 

(MVA). Proficiency in MVA service delivery requires demonstrating competency on all items in Part I. If a learner 

does not demonstrate competency or cannot be observed, refer to Part II where recommendations can be made as to 

how performance might be improved to achieve competency. After completing the form, the trainer should discuss 

the results with the learner. 

Mark an X in the box next to each step that is competently demonstrated by the learner. 

I. Clinical Skills 

❑ 1. Establishes rapport with the woman, helping her feel comfortable 

❑ 2. Assesses the woman’s status: medical history, presenting conditions, date of LMP, emotional state 

❑ 3. Provides or confirms that the woman received counseling: privately explores her decisions 

❑ 4. Discusses the procedure with the woman and obtains consent 

❑ 5. Evaluates need for and administers pain management based on the woman’s condition and her desires 

❑ 6. Uses infection-prevention practices: handwashing, gloves 

❑ 7. Assesses uterus: size, position, trauma 

❑ 8. Identifies cervical laceration or trauma 

❑ 9. Identifies possible reproductive tract infection 

❑ 10. Ensures that the cannulae are HLD or sterile and rinsed of caustic solutions 

❑ 11. Prepares aspirator and checks vacuum 

❑ 12. Selects cannula based on uterine size and dilatation; inspects cannula and aspirator for wear 

❑ 13. Swabs cervix, and vagina if desired, with antiseptic solution 

❑ 14. Administers paracervical block and any other medications; allows time for medications to take effect 

❑ 15. Dilates the cervix, if needed 

❑ 16. Inserts cannula and attaches aspirator 

❑ 17. Uses no-touch technique; does not contaminate the cannula 

❑ 18. Moves cannula effectively to empty the uterus 

❑ 19. Stops evacuation when signs of completion are present 

❑ 20. Examines the aspirate to assure it is consistent with the woman’s condition 

❑ 21. Assures post-procedure care is provided to monitor and discuss her recovery 

❑ 22. Assures contraceptive counseling and a method are provided if the woman desires 

❑ 23. Assures follow-up care is scheduled with referrals made where needed 

II. Recommendations. 

For skills that were not performed to competency or were not observed, suggest recommendations to be followed, 

for example: “needs to continue practice under supervision” or “repeat clinical training.” 

Item 

Recommendation 

____________________ __________________________________________________________ 

____________________ __________________________________________________________ 

____________________ __________________________________________________________ 

____________________ __________________________________________________________ 


III. Comments 

Please add any comments you may have about the learner’s ability to perform MVA. 

__________________________________________________________________________________ 

__________________________________________________________________________________ 

__________________________________________________________________________________ 

__________________________________________________________________________________ 

__________________________________________________________________________________ 

PLEASE PRINT 

Evaluator ____________________________ Learner ____________________________________ 

Name 

Name 


Sample Learning Assessment Tool for Managing Complications and 

Monitoring (test & answer key) (Trainer version) 

Circle the correct response 

1. MVA procedures result in immediate and long-term complications when performed by 

trained providers: 

a. Rarely, but complications can include infection and/or retained POC [correct] 

b. Quite often 

c. Such as breast cancer and infertility 

d. b & c 

2. Managing complications does not entail: 

a. Staff knowing how to recognize a complication 

b. Staff knowing how to treat a complication 

c. Referral for conditions that cannot be fully treated onsite [correct] 

d. Fully treating onsite all complications that occur 

3. Retained products of conception (POC): 

a. Is indicated by vaginal bleeding and pain 

b. Can lead to infection 

c. Is treatable by vacuum aspiration 

d. All of the above [correct] 

4. Continuing pregnancy: 

a. Is the same as failed abortion 

b. Requires uterine evacuation 

c. Both a & b [correct] 

d. Is caused by dilatation and curettage (D&C) 

5. A condition that occurs when the uterus cannot contract to stop bleeding is: 

a. Disseminated intravascular coagulopathy (DIC) 

b. Ashermans Syndrome 

c. Uterine atony [correct] 

d. Hematometra 

6. The causes of medication-related complications can include: 

a. Overdosage 

b. Incorrect injection into a vessel 

c. Hypersensitivity 


7. Medical-abortion complications include: 

a. Severe and prolonged bleeding, continuing pregnancy [correct] 

b. Severe headaches, dizziness 

c. Brief fainting spells 

d. a & c 

8. A vasovagal reaction: 

a. Is the same as physiological shock 

b. Usually resolves itself and is not life-threatening [correct] 

c. Indicates uterine perforation 

d. Must be treated surgically 


9. Sites should refer women with complications to another facility if: 

a. They cannot fully treat her onsite [correct] 

b. She cannot pay at the current site 

c. She has a high fever 

d. She has injury to the uterus, vagina or bowel 

10. After-care for women with complications includes providing: 

a. Close monitoring 

b. Information about follow-up 

c. Counseling on medical and emotional consequences 


11. Circle True or False: 

1. True or False Monitoring is a random tracking of services conducted once in a while. [false] 

2. True or False Monitoring does not need to be expensive or complex.[true] 

3. True or False It is possible to use existing sources of information for monitoring.[true] 

4. True or False To measure changes in one type of service, different information should be 

collected each time. [false] 

5. True or False An example of an indicator is the number and type of complications. [true] 

12. Put the steps of monitoring in correct order: [b,a,d,c] 

___ a. Information gathering 

___ b. Planning 

___ c. Developing an action plan 

___ d. Analysis 


Tool C-8: 


INSTRUCTIONS: Insert date and location of course at top of evaluation. Provide Course Evaluation for each 

participant at the end of the course and ask them to complete and turn in before leaving. Study the responses after 

the course, with the goal of using responses to improve and adapt the course for future offerings. 


DATE:_________________________ LOCATION:_______________________ 

Course Objectives: 

Perform a supervised MVA procedure in a local clinical facility 

Be familiar with key tools for monitoring services with a goal toward quality improvement 

Be able to manage potential complications 


Rating 

1. The course fulfilled its goal and objectives (see above). ______ 

Comments: 


Comments: 

3. Because of this course, I have a better understanding of how to use MVA. _______ 

Comments: 


4. Now that I have completed this course, I feel 

a. Ready to offer care to women with MVA 

b. That I need more training before offering care with MVA to women 

c. That this procedure is not one I would choose to provide 

d. Prepared to promote (but not provide) MVA services 

e. Other [please describe] 


6. I came to this course with 

a) No experience providing transvaginal procedures 

b) Less than three years clinical experience including transvaginal procedures 

c) Between three and five years of clinical experience including transvaginal procedures 

d) More than five years of clinical experience including transvaginal procedures 

7. My clinical background is as: 

a) Professional midwife or nurse-midwife 

b) Other advance practice or midlevel clinician (physician’s assistant, clinical officer, professional 

nurse, etc) 

c) Medical doctor (non specialist) 

d) Ob-Gyn specialists 

e) Public Health (non practicing clinician) 

f) Other (please describe) 


Tool C-9: 



INSTRUCTIONS: Print one copy of Certificate Template for each participant, customized with each individual 

participant name, and distribute at the close of course. 


sponsor/host 

organization 

SUPERVISED CLINICAL PRACTICE WITH 


Course 301 

Add Logo of 

sponsoring 

Organization 


Awarded to 

____________________________________ 

NAME 

________________________________ 

PLACE 

_________________________ 

DATE 




Tool C-10: Information on Instruments and Availability 

INSTRUCTIONS: Insert specific contact information of local MVA instruments supplier in template, 

delete instructions and print one copy for each participant in course. 

Contact information for MVA instruments supplier(s): 




E-09-MVA-008 

Rev. 0 12/2009 

MVASRTC-E09

Uterine evacuation with manual vacuum aspiration ... - CommonHealth

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