Use of Ultrasound within an integrated Contraception And Sexual Health Service.
ESC Congress Library. Valarche E. May 4, 2016; 126934; A-108
Dr. Elena Valarche
Dr. Elena Valarche
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Abstract
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Background Use of ultrasound is widely recommended to confirm correct placement of intra-uterine device and finding deep subdermal implants (SDI). It may give additional information to clinician if patient is symptomatic.

 

Aim To analyse use of ultrasound scan service in CASH (Contraceptive And Sexual Health) service, source of referrals and additional clinical information obtained during USS

 

Study We conducted a prospective study to review feedback and details of procedures for patients with intrauterine or Nexplanon procedures in a CASH clinic with USS facilities from 9/06/14 until 24/11/2014

 

Method All Intra-Uterine procedure patients were offered a choice of having pelvic USS before and after their procedure to confirm placement of device and to exclude additional pelvic pathology (verbal consent obtained)

 

Patients were given an anonymous feedback form before leaving the clinic

 

Details of procedures reviewed by Electronic Patients Records

 

Data was collected on Excel programme and analysed

 

Results

 

34% of referrals were from CASH staff or local GPs

 

Out of 85 female patients, 79 feedback forms 92% were returned

 

Patients - aged between 16 and 61

 

11.7% patients had Nexplanon related consultation

4/10 deep SDI were successfully removed with USS and 3/10-sent to specialist centre for removal SDI

 

75 patients (88%) were presented with issues related to intra-uterine contraceptives.

 

16 patients were presented with lost threads: 14 -position of IUD was correct and 2-referred for an abdominal X ray.

 

31% of patients had additional USS findings:

12 -fibroids, 5 -dermoid or simple ovarian cysts, 2- PCOS,2 -PID,1- endometrial hyperplasia (later confirmed endometrial cancer)

 

Conclusion.

 

This study demonstrated the significant benefit from additional USS facilities to patients, CASH clinicians and local GPs.

Patient’s written feedback post consultation was 100% positive with some additional comments.

 

Irrespective of age or ethnicity patients reported feeling reassured by the results of the scan, feeling more comfortable and supported with the procedure and recommending more patients have the opportunity to have a scan post intra-uterine device insertion.

 

 

 

Positive patient’s experience during LARC procedures may increase their uptake.

Almost third of patients had additional medical pathology (1 case of endometrial cancer) which was investigated and treated accordingly due to USS findings.

 

 

Referral clinic is beneficial in managing patients with complex contraception needs. It supports CASH staff and local GPs in complex cases, and offers complex and comprehensive care to our patients in primary care avoiding or reducing number of referrals for hospital level gynaecological investigations.

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