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