Feasibility and acceptability of providing immediate postpartum intrauterine contraception (PPIUC) in a public maternity service
ESC Congress Library. Cooper M. May 10, 2018; 208236; ESC105
Dr. Michelle Cooper
Dr. Michelle Cooper
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Abstract
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Objective: Improving access to effective contraceptive methods during the postpartum period can reduce the risk of subsequent unintended pregnancy and short inter-pregnancy intervals. Provision of immediate postpartum intrauterine contraception (PPIUC), i.e. copper intrauterine device (CU-IUD) or levonorgestrel intrauterine system (LNG-IUS), is an option that is not routinely practiced within the UK or other parts of Europe. Our aim was to introduce and evaluate an immediate PPIUC service within a large public maternity service (NHS Lothian) in Scotland. Design and methods: All obstetricians were trained in PPIUC techniques. In addition, a cohort of labour ward midwives were trained in PPIUC after vaginal birth. Pregnant women in the region were given information about PPIUC by community midwives as part of a routine antenatal contraception discussion. Women could choose to receive PPIUC at planned caesarean section (from July 2015) or after a vaginal birth (from January 2017) were invited to take part in the study. Those choosing PPIUC insertion received a clinical review at six weeks to confirm device placement, followed by a telephone consultation at three, six and 12 months. Data from the first 200 women to receive PPIUC at caesarean section and the first 50 women to receive PPIUC at vaginal birth were analysed in relation to complications, continuation rates and patient satisfaction. Results: The uptake rate of PPIUC at caesarean section was 13.3%.  There were 2 cases of clinically-confirmed infection (1.0%), no uterine perforations and a cumulative device expulsion rate of 6.1%. The 12-month follow-up rate was 87.2% with a 76.6% continuation rate of intrauterine contraception. Of those followed up, 93% reported they were ‘Happy/Very Happy' with the method.   Of the first 50 women having PPIUC at vaginal birth 26 (52.0%) had a partial or complete expulsion by six weeks. Most of these women (21; 80.7%) proceeded to have further IUC inserted. There were no cases of infection or uterine perforation. Conclusions: It is feasible and acceptable to introduce immediate PPIUC insertion within a public maternity setting. There is a low rate of adverse events and patient satisfaction is high. Early expulsion rates with insertion after vaginal birth are high but this may improve with increasing provider experience.
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