Manual Vacuum Aspiration protocol

This protocolprovides basic requirements for implementing MVA services at a family medicine teaching site. This interactive version allows you to click or tap tooltip text for citations and practice tips. A print-ready/PDF version of the protocol is also available.

MVA protocol


Patients requesting appointments for abortion should be scheduled as soon as possible but preferably no later than 7 days after appointment request.

Patient eligibility

This protocol is designed for those wanting to provide MVA in an outpatient setting such as a family medicine office. You may want to consider an alternative location or special preparations if:

  • The gestational age isover 10 weeks
  • The patient hasa bleeding disorderor is taking an anticoagulant medication
  • Moderate or deep sedation is more appropriate based on patient needs or preferences
  • The patient has BP>180/110 and/or is symptomatic

Staffing/clinic coverage

A clinician who is credentialed to perform MVA must be present during the procedure.

In addition to the clinician performing the MVA, an additional person, such as a medical support person (LPN, PCT, MA, etc.) must be available in the room during the procedure. A patient support person may be present but does not replace the need for a medical support person.

The medical support person can have the role(s) of:

  • Retrieving instruments or supplies as needed during the procedure
  • Helping to keep the patient stable during a vasovagal or vomiting episode
  • Providing additional emotional support for the patient
  • Offering comfort items such as stress balls, ice packs, or heating pads

A learner (resident, student, or other learner) may be in the room and/or involved in the procedure only after the patient agrees to their participation. Recommended roles for learners include:

  • Providing additional emotional support for the patient
  • Offering comfort items such as stress balls, ice packs, or heating pads
  • Medical students/NP students: observation, bimanual exam and speculum placement, paracervical block, final withdrawal of MVA to appreciate gritty texture
  • Medical residents: observation or all parts of hands-on training

Storage space

An instrument cart can serve for storage of instruments as well as a stable, sterile surface for instruments during the procedure. The cart must remain locked when not in use.

No-touch technique

Preventing infection is an important goal during a uterine aspiration. During the procedure, the provider and staff will use a no-touch technique to handle the instruments. This means having supplies on a sterile tray, keeping sterile and non-sterile instruments separate, and handling instruments in a way that avoids contact with any portion that will enter the uterus.

List of supplies

Single-use items

Vaginal antiseptic and applicator 

Sterile drape for tray

Syringes (10cc x 2) and Needle (21 or 22 gauge, 1.5 inch)

Sterile cannulas (plastic, flexible and/or rigid) up to 12 weeks size

Sterile gauze 4×4


Lubricating gel


GC/CT, pap if needed

Sealed specimen cup with formalin

Kidney basin (disposable or metal)

Reusable items

Sterile metal specula in multiple sizes

Serrated ring forceps

Single-tooth tenaculum

Sterile Pratt dilators (sizes 13/15, 17/19, 21/23, 25/27, 29/31, 33/35)

Several lubricated MVA syringes (put together and tested before each use)

Strainer and glass dish (to evaluate POCs)

Light box such as artist’s tracing box


Local anesthetic such as lidocaine 1% or bupivacaine 0.25%, or equivalent items available in your facility


Misoprostol prn

Antibiotic prophylaxis; often doxycycline, azithromycin, or metronidazole

Methergine prn

Sample tray setup for MVA


Ring forceps






Useful documents

On the day of the abortion

  • Estimate gestational age (GA) 
  • Offer Rh status testing for all patients >12 weeks LMP with unknown status
    • If the LMP is >12 weeks and the patient declines testing, document with an informed waiver
    • If the LMP is >12 weeks, and the Rh is negative, offer anti-D immune globulin. If the patient declines, document with an informed waiver
    • Follow NAF Clinical Policy Guidelines for Abortion Care
  • Offer testing for gonorrhea and chlamydia. Some clinics will also offer pap if due.
  • Perform hemoglobin testing if indicated by patient history or symptoms
  • Determineif ultrasound is needed
    • If ultrasound is available at your site, it is necessary to have staff trained to use and interpret the ultrasound.
  • Have patient sign consent form 
  • Offerpain medications(e.g., ibuprofen 800mg)
  • Administer antibioticmedication(often azithromycin 500mg, doxycycline 200mg or metronidazole 500 mg, PRIOR to abortion procedure) 
  • Review Information for Patients after an MVA
  • Confirm that patient knows how to reach the medical team if needed
  • Discussfollow-up planwith the patient
  • Offer opportunity to discusscontraception 
  • Complete mandated reporting if required per city or state protocol

"Time out" protocol

Consult with your institution to determine whether a “time out” is required by Joint Commission regulations prior to the procedure. Obtaining the consent in the presence of the involved staff may serve as an appropriate substitute. Otherwise, “time out” may include verifying the patient’s name and DOB prior to the procedure.

Document the patient encounter per clinic protocol. 

Evaluation of Products of Conception (POCs)

Even if sending to pathology, inspection of POCs is integral to the procedure. Determine who will be evaluating the POCs and where this will be done.

Allow patient to see POCs upon request. 

Before the patient leaves

  • Post-procedural vital signs should be taken
  • Ensure they have a way to contact the clinic
  • Ensure they have received the post-procedure instructions
  • Confirm any additional testing was ordered/completed and reviewed with the patient

Clean up per clinic protocol

Management of reusable MVA instruments

All institutions have different policies and procedures for sterilization of instruments. A trained staff member will soak used instruments in enzymatic cleaner, scrub any soiled areas, and then rinse the instruments, and let them air-dry. All used medical instruments must be kept in a “used instruments” area of a room. Once dry, the instruments need to autoclaved on-site or sent out for autoclaving.

Autoclaving on-site:
• Document training and certification in sterilization/infection control procedures.
• Maintain a log for machine runs, cleaning schedule, weekly spore test/biologic indicator results.

Sterile instruments may be kept in the instrument cart.