title: Introduction of a manual vacuum aspiration service: a model of service within a NHS Sexual Health Service.
abstract: BACKGROUND
  We assessed the applicability, acceptability and cost implications of introducing the manual vacuum aspiration (MVA) technique with local anaesthesia for fully conscious first-trimester termination of pregnancy within our service and for our population.
  
  
  METHODS
  The outpatient setting of a Pregnancy Advisory Service within a NHS Sexual Health Service.
  
  
  METHODS
  Self-administered misoprostol and diclofenac, extra-amniotic local anaesthetic gel and paracervical mepivicaine prior to MVA. Routinely collected data were used to provide information on uptake, demographic details, timing, pain score, complications, contraceptive uptake, and economic implications for our service.
  
  
  RESULTS
  MVA was chosen by 305/1681 potentially eligible women. Forty percent had the procedure on the day they attended for assessment. Seventy-nine percent gave a pain score of 3 or less out of 10. Complications occurred in six cases (2%); these included cervical rigidity, a false passage, retained products of conception, bleeding (more than 200 ml) and one allergic reaction. Eighty percent of women chose to commence a long-acting reversible contraception (LARC) method at the time of MVA. Operating theatre utilisation was reduced by one termination list per week and cost savings of around £60,000 per annum were realised.
  
  
  CONCLUSIONS
  The technique for fully conscious MVA was very suitable for our outpatient setting. It was associated with very low levels of pain and bleeding. The uptake of LARC was high, and particularly the ability to provide intrauterine contraception at MVA was associated with a very high uptake.
authors.affiliation: Consultant in Community Gynaecology and Obstetrics, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Pillai
authors.affiliation: Lead Nurse in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK.
authors.forename: Val
authors.initials: V
authors.lastname: Welsh
authors.affiliation: Nurse in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Sedgeman
authors.affiliation: Associate Specialist in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK.
authors.forename: A Caroline
authors.initials: AC
authors.lastname: Gazet
authors.affiliation: Associate Specialist and General Practitioner, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: Staddon
authors.affiliation: Nurse in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Carter
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000028:Abortion, Induced / Q000379:methods*; D003362:Cost-Benefit Analysis; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D016595:Misoprostol / Q000627:therapeutic use; D010045:Outpatients; D017060:Patient Satisfaction; D011247:Pregnancy; D060728:Reproductive Health; D012449:Safety; D012646:Self Administration; D013222:State Medicine; D014619:Vacuum Curettage / Q000379:methods*
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D004008:Diclofenac
keywords: Abortion; Health Economics; Service Delivery