{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T10:11:15Z","timestamp":1774519875323,"version":"3.50.1"},"reference-count":11,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Fam Plann Reprod Health Care"],"accepted":{"date-parts":[[2014,1,7]]},"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>The outpatient setting of a Pregnancy Advisory Service within a NHS Sexual Health Service.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2005ml) 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 \u00a360\u2005000 per annum were realised.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jfprhc-2013-100700","type":"journal-article","created":{"date-parts":[[2014,2,22]],"date-time":"2014-02-22T01:49:32Z","timestamp":1393033772000},"page":"27-32","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Introduction of a manual vacuum aspiration service: a model of service within a NHS Sexual Health Service"],"prefix":"10.1136","volume":"41","author":[{"given":"Mary","family":"Pillai","sequence":"first","affiliation":[{"name":"Consultant in Community Gynaecology and Obstetrics, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val","family":"Welsh","sequence":"additional","affiliation":[{"name":"Lead Nurse in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsty","family":"Sedgeman","sequence":"additional","affiliation":[{"name":"Nurse in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A Caroline","family":"Gazet","sequence":"additional","affiliation":[{"name":"Associate Specialist in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliet","family":"Staddon","sequence":"additional","affiliation":[{"name":"Associate Specialist and General Practitioner, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Carter","sequence":"additional","affiliation":[{"name":"Nurse in Sexual and Reproductive Health, Gloucestershire Care Services NHS Trust, Sexual Health Service, Gloucestershire Royal Hospital, Gloucester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,2,21]]},"reference":[{"key":"2025090221461337000_41.1.27.1","unstructured":"Department of Health. Abortion Statistics England and Wales 2012. July 2012. https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/211790\/2012_Abortion_Statistics.pdf (accessed 12 December 2013)."},{"key":"2025090221461337000_41.1.27.2","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2011-100132"},{"key":"2025090221461337000_41.1.27.3","doi-asserted-by":"publisher","DOI":"10.1783\/1471189054484004"},{"key":"2025090221461337000_41.1.27.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02223.x"},{"key":"2025090221461337000_41.1.27.5","doi-asserted-by":"publisher","DOI":"10.3310\/hta13320"},{"key":"2025090221461337000_41.1.27.6","doi-asserted-by":"crossref","unstructured":"Say L Kulier R G\u00fclmezoglu M . Medical versus surgical methods for first trimester termination of pregnancy. Cochrane Database Syst Rev 2005;1:CD003037.","DOI":"10.1002\/14651858.CD002855.pub3"},{"key":"2025090221461337000_41.1.27.7","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.contraception.2008.09.003","article-title":"Barriers associated with the failure to return for intrauterine device insertion following first-trimester abortion","volume":"79","author":"Stanek","year":"2009","journal-title":"Contraception"},{"key":"2025090221461337000_41.1.27.8","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/01.AOG.0000194204.71925.4a","article-title":"Four percent intrauterine lidocaine infusion for pain management in first-trimester abortions","volume":"107","author":"Edelman","year":"2006","journal-title":"Obstet Gynecol"},{"key":"2025090221461337000_41.1.27.9","doi-asserted-by":"crossref","unstructured":"Renner RM Jensen JT Nichols MD . Pain control in first trimester surgical abortion. Cochrane Database Syst Rev 2009;2:CD006712.","DOI":"10.1002\/14651858.CD006712.pub2"},{"key":"2025090221461337000_41.1.27.10","doi-asserted-by":"crossref","unstructured":"Tangsiriwatthana T Sangkomkamhang US Lumbiganon P . Paracervical local anaesthesia for cervical dilatation and uterine intervention. Cochrane Database Syst Rev 2013;9:CD005056.","DOI":"10.1002\/14651858.CD005056.pub3"},{"key":"2025090221461337000_41.1.27.11","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1097\/AOG.0b013e3182639ab5","article-title":"Intrauterine anesthesia for gynecologic procedures: a systematic review","volume":"120","author":"Mercier","year":"2012","journal-title":"Obstet Gynecol"}],"updated-by":[{"DOI":"10.1136\/jfprhc-2013-100700corr1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2015,3,20]],"date-time":"2015-03-20T00:00:00Z","timestamp":1426809600000}}],"container-title":["Journal of Family Planning and Reproductive Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jfprhc-2013-100700","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T04:46:25Z","timestamp":1756874785000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/jfprhc-2013-100700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2,21]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2014,12,14]]},"published-print":{"date-parts":[[2015,1]]}},"alternative-id":["10.1136\/jfprhc-2013-100700"],"URL":"https:\/\/doi.org\/10.1136\/jfprhc-2013-100700","relation":{"correction":[{"id-type":"doi","id":"10.1136\/jfprhc-2013-100700corr1","asserted-by":"object"}]},"ISSN":["1471-1893","2045-2098"],"issn-type":[{"value":"1471-1893","type":"print"},{"value":"2045-2098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2,21]]}}}