VIA (Visual Inspection with Acetic Acid Aplication) Preparation of Steps
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VIA (Visual Inspection with Acetic Acid Aplication)
Preparation of Steps
Dwiana Ocviyanti• Department of Obstetrics and Gynecology Faculty of
Medicine University of Indonesia• National Clinical Training Network of Reproductive
Health/NCTN-RH
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VIA can be considered for use in low-resource settings because it:
• Can effectively identify most precancerous lesions
• Is noninvasive, easy to perform and inexpensive
• Can be performed by all levels of healthcare workers in almost any setting
• Provides immediate results that can be used to inform decisions and actions regarding treatment
• Requires supplies and equipment that are readily available locally
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Who Should Be Tested
• Testing for cervical cancer or its precursors is recommended for any woman between the ages of 30 and 45.
• Cervical cancer rates peak among women between the ages of 40 and 50, so testing should take place during the ages in which detecting a precancerous lesion is most likely, normally 10 to 20 years earlier
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When To Perform Via
• VIA can be performed at any time in the menstrual cycle, including during menses, during pregnancy and at a postpartum or postabortion checkup
• It can be performed in a woman suspected or known to have an STI or HIV/AIDS.
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REPRODUCTIVE HISTORY
Age Parity o Currently pregnant (weeks) Example of Cervical Map
Current contraceptive Age of first intercourse
Menstrual Bleeding Pattern
o Regular (23–35 day interval)
o Irregular
o Postcoital spotting or bleeding
STI History
Number of sexual partners: o Had an STI
Patient Patient
Spouse Spouse
Risk Factors
o Smoker o Previous abnormal Pap smear
o HIV/AIDS o Mother or sister(s) with cervical cancer
o Chronic corticosteriod use
EXAMINATION
Bimanual examination
Vulva Uterus
Vagina Adnexa
Cervix Rectovaginal examination
(if indicated)Outline of squamocolumnar junction (SCJ)
White epithelium
Actual cervical os
xxxx
xxxx
xxxx
Cancer
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Instruments And Supplies
• Examining table• Light source• Bivalved speculum (Cusco or Graves)• Instrument tray or container
o Cotton swabso New examination gloves or high-level disinfected surgical
gloveso New wooden spatula and/or condomo Dilute (3–5%) acetic acid solution (white vinegar is
acceptable) o 0.5% chlorine solution for decontaminating instruments
and gloveso A record form for recording the findings
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Client Assessment and Getting Ready
• Before performing the VIA test, discuss the procedure with the woman
• Explain why the test is recommended and exactly what will take place during the examinatio
• Discuss with her the nature of the most likely findings and the followup or treatment that might be required.
• Make sure that all necessary instruments and supplies are available
• Bring the woman into the examination area
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The VIA Test
• Inspect the external genitalia • Insert the speculum fully so that the entire cervix
can be seen• Look at the cervix and check for evidence of
cancer or infection (cervicitis)• Soak a clean swab in dilute acetic acid solution
and apply it to the cervix• Once the cervix has been washed with the acetic
acid solution, wait at least 1 minute for it to be absorbed and any acetowhite reaction to appear
• Inspect the SCJ carefully
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Normal Cervix and Cervical Cancer
Normal Cervix Cervical Cancer
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VIA CLASSIFICATION CLINICAL FINDINGS
Test-positive Raised and thickened white plaques oracetowhite epithelium, usually near the SCJ
Test-negative Smooth, pink, uniform and featureless;ectropion, polyp, cervicitis, inflammation,Nabothian cysts
Cancer Cauliflower-like growth or ulcer; fungatingmass
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Normal Cervix and Cervix with VIA Test positive after Acetic Acid Aplication
Normal Cervix VIA Test Positive
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Adapted from: International Agency for Research on Cancer (IARC).
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Clinical Significance and Location of Acetowhite Lesions:
Insignificant Lesions
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Far away from SCJ
Faint acetowhite areas without sharp outline
Streak-like acetowhitening
Line-like acetowhitening at brim of endocervix
Dot-like pale areas in endocervix
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Clinical Significance and Location of
Acetowhite Lesions:
Significant Lesions
15
Thick, well-defined acetowhite areas, like leukoplakia, appearing very close to SCJ, jutting into ectocervix or endocervix or both
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Discussion after VIA test
• If the VIA test is positive or cancer is suspected, tell the woman what the recommended next steps are
• If the VIA test is negative, tell the women that she can return for VIA the next five years and than every 5 years