immediate postpartum intrauterine dr michelle cooper mbchb ... · • cs - manual placement via...

Immediatepostpartumintrauterine

contraceptionprovisionwithinapublicmaternity

setting

Dr MichelleCooperMBChBMRCOGMFSRHClinicalResearchFellowinObstetrics&GynaecologyEdinburgh,UK

Disclosure• Noconflictsofinterest

Background• Postpartumperiodhighriskforunintendedpregnancy• Shortinter-pregnancyintervals– riskofobstetriccomplications• Womenshouldbeableaccessall contraceptivemethodsafterchildbirth• Immediate(<48hrs)postpartuminsertionofintrauterinecontraception(PPIUC)safeandeffective• Notroutinelyavailableinmanycountries

ResearchQuestions

IsitfeasibletoprovidePPIUCwithinapublicmaternityservice?

WhataretheoutcomesofPPIUCinsertioninthissetting?

Methods• Healthserviceevaluation• Phasedintroductionofservice(2hospitals;~9000births/yr)• StafftrainedinPPIUCinsertion• Womenreceiveinformationduringantenatalperiod• DevicesfittedattimeofCSorwithin48hoursvaginalbirth

• Insertiontechniques• CS- manualplacementviauterineincision• Vaginal– longplacentalforceps• LNG-IUSorCu-IUD

Methods• Follow-up• Threadcheck+/- USS4-6wks• Telephonereview3/6/12months

• Outcomes• Complicationse.g.infection,perforation• Deviceexpulsion• Methodcontinuation• Patientsatisfaction

Results:PPIUCatCS

• N=300women,12monthfollow-up• Uptake=13.8%(elective)• Suspectedendometritis=3.8%• Uterineperforation=0• Expulsionrate=8.0%

Ø 79.1%insituat12months

Results:VaginalPPIUC• N=224,3monthfollow-up

• Uptake=9.7%;Successfulinsertion=214(95.5%)• Complications

• Suspectedendometritis=2.8%• Uterineperforation=0

• Deviceexpulsion• Priorto1st visit=66(30.8%)• Removedat1st visit=60(28.0%)• Reinsertion=77.0%

Ø 86.2%insituat3months(follow-uprate87.5%)

PatientFeedback

“Alldoneatsametimesoyoudon’t

needtoworryaboutit…Iprobably

wouldn’thavegoneotherwise”

“Soeasytogetdonewhileyou’rethereandinthatframeofmind”

“Goodthatyoucangetitdonestraightawaybecause

you’resoreanywayandhavepainreliefonboard…didn’tfeelathing!”

“Wouldhavebeengreatifithadstayedin!”

“NotsureIwouldhavecomebacktogetcoilfittedotherwise”

“Veryquickandeasyandyou’re

inhospitalanyway”

“WasbitsoreatthetimebutI’mgladnowI

gotit”

Conclusions• FeasibletoprovidePPIUCwithinapublicmaternityservice• Complicationrateslow,long-termcontinuationhigh• ExpulsionhigherwithvaginalPPIUC– numberofinserters,improveswithtime• Womenhappywiththeservice,‘convenience’important• SimilarmethodcouldbeusedinotherregionstoincreasePPIUCavailability

Acknowledgments• Researchteam

• SharonCameron(PI),AnneArmstrong,Shiona Coutts,ShonaCowan,AnnaGlasier,RebeccaHeller,AnneJohnstone,KarenMcCabe,LindsayMcCracken,FrancesMcGuire

• Funding• ChiefScientistOffice/WellbeingofWomengrant

• PPIUCtrainingresources• RCOGLeadingSafeChoices