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Why was change needed?
In 2015 over 185 000 women in England and Wales underwent a termination of pregnancy (TOP)1 and 80% of these were performed at 3–9 weeks of pregnancy.1 The majority of early procedures (63%) were performed using medical methods.1 Manual vacuum aspiration (MVA) under local anaesthetic was initially designed to be used in resource-poor settings for uterine evacuation following incomplete miscarriage.2 Use of the procedure was then broadened to include TOP. A systematic review comparing MVA with electric vacuum aspiration (EVA) found that MVA was associated with comparable rates of complete uterine evacuation, but less pain and blood loss.3 Women found the two procedures equally acceptable.3 As a result, MVA is now routinely used in many developed countries for the management of both miscarriage and TOP. More recent UK data has highlighted the cost effectiveness and acceptability of MVA using local anaesthetic.4 However, despite the evidence regarding the effectiveness and acceptability of MVA, the procedure has not been widely adopted in the UK. As a result of this evidence we decided to introduce a MVA service to increase women’s choice when accessing an abortion.
How did we go about implementing change?
The MVA TOP service at Newcastle upon Tyne NHS Foundation Trust was set up by SR who had extensive experience of performing EVA under general anaesthesia up to 15 weeks' gestation. A business case for the service was approved by the Trust. Patient information about MVA was developed and added to the Trust’s TOP web page.5 Nurse practitioners, who conduct all TOP assessment clinics, were educated about the procedure and which patient groups would be appropriate.
The service was introduced in the Women’s Health Unit in 2009 with a maximum of two procedures per week. …
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