Training Outline:
The Uterine Evacuation Procedure
All staff involved in providing any degree of outpatient miscarriage management care will benefit from
basic knowledge of the process and procedure if the patient chooses outpatient aspiration
management. Staff are often surprised to learn that this procedure is fairly quick and that patients have
a very short recovery time before being discharged. Medically accurate information will replace myths
and misconceptions widely held.
Goal
To provide an overview of the uterine evacuation procedure
Objectives
It is important to clearly state the goals of this exercise and to encourage hands-on
participation. At the end of the training, participants will be able to:
1) Identify instruments used for uterine evacuation
2) Discuss the benefits and risks associated with using the MVA
3) Describe the uterine evacuation procedure in non-medical terms
Time
Approximately 60 minutes
Materials
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Drexel University Manual Vacuum Aspiration of the Uterus (8 minutes)
o http://www.youtube.com/watch?v=iHfRe7q7WEY
Papaya Workshop: Individual teaching demonstration (11 minutes)
o http://www.ryanprogram.org/papaya-workshop-individualteaching-demonstration
Pelvic model or diagram of female reproductive system
MVA, cannula, dilators, and other associated instruments
Materials for managing POCs including a light box, strainer and glass plan
o Gauze and basin used for strainer in the Drexel film
Handouts:
o Steps for performing manual vacuum aspiration
o Manual Vacuum Aspiration (MVA) for Uterine Evacuation: Pain
Management
o Processing the Ipas MVA
o Ipas U.S. Start-up Kit for Integrating Manual Vacuum Aspiration
(MVA) for Early Pregnancy Loss
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TEAMM, January 2014
Johnson May, VanDerhei, Wallace, Cardinal
Trainer Tip
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You do not need to be a licensed medical staff to facilitate this training;
however, you should be familiar with the instruments and procedure. The
goal is to familiarize staff to the procedure and the instruments.
The procedure videos provide an excellent overview. They are designed as
instructional videos and shows the procedure on a papaya and a patient as
well as managing the products of conception.
Some staff may be more sensitive to viewing and talking about the
aspiration procedure. It is important to acknowledge this at the beginning
of the training and give permission not to watch the videos.
Follow the video with a ‘show and tell’ of instruments used for uterine
aspiration and encourage staff to handle instruments.
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Prep
Preview procedure video(s)
Set up pelvic model and instruments
Time & Task
Trainer Notes
Introduction
5 minutes
Introduce training by reviewing the goals and objectives
 Remind staff that the video(s) provide a visual example of a uterine
evacuation procedure
 Invite staff to note the role of the support person
 Acknowledge that the video leaves nothing to the imagination and that
some staff who do not work as part of the clinical procedure team and
may elect not to view the video
View Video
10 minutes
After showing the video(s) check in with participants for any initial reactions.
Possible questions for debriefing include:
 What did you notice about the role of the support staff?
 What did you notice about the procedure?
 What questions do you have about the MVA?
Instruments
15 minutes
1)
2)
3)
4)
Identify and model use of the MVA
Encourage staff to handle MVA and practice charging the MVA
Identify and model use of items used to process POCs
Display and make available Ipas MVA handouts
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TEAMM, January 2014
Johnson May, VanDerhei, Wallace, Cardinal
Explaining the
Procedure
15 minutes
Sample introduction to role play:
I am going to role-play talking with a patient about what to expect during a
uterine evacuation procedure.
General guidelines:
 Provide a general overview of the MVA procedure and check in for
patient understanding
 Be client-centered and provide information appropriate to the needs of
the patient. Some women will only want a general overview of the
procedure and some women will want very specific details
 Answer questions that are within you scope of practice and refer to more
experienced or knowledgeable staff for questions that you are not able to
answer
Sample script for role-play:
Prior to beginning the procedure you will receive medication that may include
ibuprofen, an anti-anxiety to help you relax and a narcotic to help you manage
any cramping during and after the procedure.
For the procedure, we will take you into the procedure room. Our provider will
do a pelvic exam that will help them feel the position and size of your uterus.
They will then insert a speculum, cleanse the vaginal area and numb your
cervix. The next step is dilating the cervix to gently stretch the opening into
the uterus. The uterus is a muscle and you may feel some cramping while this
is being done. Talking with your support person and staff may help because if
you are talking you are breathing, and if you are breathing, your body will be
more relaxed.
The provider will then insert a small straw-like tube into the uterus and uses a
hand-held instrument to create suction that removes the lining and contents
of the uterus. Again, you may feel some cramping. If the cramping gets
intense, it usually doesn’t last long and it helps to apply heat, pressure or
massage.
Once the procedure is finished, you will be in a recovery area for about 30
minutes before you are discharged home.
Do you have any questions or can I offer further explanation?
Debrief by asking:
 What did you notice about this interaction?
 What questions do you have about the procedure?
 What do you think might be helpful to the patient when explaining the
procedure?
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TEAMM, January 2014
Johnson May, VanDerhei, Wallace, Cardinal
Participant Roleplay
15 minutes
Participants can now be paired up and each practice being the patient and the
provider in order to familiarize them with the process, procedure, and patient
needs.
Instructions:
Staff person asks: What questions do you have?
Patient responds: Can you explain what I can expect?
Staff person provides an overview of the procedure and answers any questions.
Debrief
5 minutes
After the role play encourage the group:
 What went well?
 What was most challenging for you? Any patient questions you had
trouble responding to?
 Share how you successfully responded to a difficult question?
*If you are unable to answer any questions, ask participants to email you,
research the question or obtain guidance from someone who has the answer and
email the entire group.
Evaluation and
Closure
Invite the group to reflect on what they learned during this training by answering
the following questions:
“I was surprised to learn that …”
“I am glad I came to this training because …”
“I would like to learn more about …”
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TEAMM, January 2014
Johnson May, VanDerhei, Wallace, Cardinal