Audit of laparoscopic sterilisation in Merthyr Tydfil, South Wales, UK
ESC Congress Library. Vanderpump C. May 10, 2018; 208095; ESC87
Dr. Chloe Vanderpump
Dr. Chloe Vanderpump
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Abstract
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Introduction Merthyr Tydfil is one of the most deprived counties in South Wales, UK with very high concentration of obese women of childbearing age. In view of this, we have decided to conduct an audit to review if laparoscopic sterilisation practice in this area differed from the standards recommended by Faculty of Sexual and Reproductive healthcare (FSRH). Objectives To identify number of laparoscopic sterilisations To identify complications related to the procedure To assess adherence to the FSRH guidelines year September 2014 To recommend areas for improvement Methods Obtained a list of patients undergoing laparoscopic sterilisation from online theatre database from December 2015 onwards. Reviewed online records on: Welsh clinical portal (clinic letters, investigation results), Myrddin (appointments, for A&E attendances), Pre-Assessment, Theatre and enquired about complaints regarding failed procedure. Results 80 laparoscopic sterilisations were performed during the period of December 2015 to April 2017 in Prince Charles Hospital, Merthyr Tydfil. 80 patients' records were reviewed. Age ranged from 25 to 44 years with average age of 34. Body mass index (BMI) ranged from 20 to 45 with average of 28.5. Mean parity was 2.8 with range of 0 - 7, not documented in 20 cases. Five women had documented history TOP. Most commonly used contraception at the time of sterilisation was Depo injection. Filshie clips were used in 100% of women. Topical analgesia was used four times. 19 women were 30 years old or younger. One was nulliparous. Thromboprophylaxis was documented in 13 women. Intraoperatively, 12 cases had a complication such as omental adhesions, failed Veress needle entry, application of two clips, bleeding from port site, oophorectomy, bleeding salpinx and small bowel perforation. Five patients had overnight admission. Five patients attended accident and emergency or neighbouring hospital with chest pain, bleeding wound, granulation tissue in umbilicus, abdominal and shoulder-tip pain and admission to ward 5 days later with uncertain reason. One woman had a TOP 16 months following the sterilisation. Conclusions Local clinicians need to be made aware that: Almost 25% of women of the age of 30 or younger when regret risk is high have undergone the procedure. Use of topical analgesia as improves post-op pain score. Possibly more than 13 patients had thoromboprophylaxis which was not well documented online. Calculating failure rate of 1:80 based on this audit might be inaccurate. Limitations We reviewed online data only therefore women returning with post op complications to GP, gynaecology clinic appointments due to regret, requesting TOP or with miscarriage following the procedure were difficult to trace.
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