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. Setting 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 MVAwas chosen by 305/1681 potentially eligible women. Forty percent had the procedure on the day they attended for assessment. Seventynine 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 MVAwas 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 MVAwas associated with a very high uptake.