O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 8 Results ere were 2310 and 1376 C/S performed atMMHandNSH respectively from January to June 2018. e IUD insertion rate was 17.4% (n=402) at MMH and 14.3% (n=197) at NSH. Of the patients who had an IUD inserted, 132 folders were either lost or excluded due to poor note keeping or exclusion criteria. We could therefore only assess 467 records ( gure 1). e median age at insertion was 27 years (p50=27; IQR=8), and the median parity 2 (p50=2; IQR=1). Most women were unemployed (63.2%; 295/467) and single (60.8%; 284/467) (table I). Almost two third of insertions were done at the time of emergency C/S (59.1%; 276/467). In 7 cases it was unclear if the C/S was an elective or emergency (table II). A family planning discussion was documented in the antenatal period with 84% (392/467) of patients, during labour in 2% (7/467) and at the time of C/S in 13% (61/467). e commonest indications for the emergency C/Ss were fetal distress (49.7%), one previous C/S (12.76%) and failure to progress (10.3%). Of patients choosing the IUD, 40% (187/467) had no previous C/S, 41.8% (195/467) had one previous C/S, and 18% (84/467) had more than one. e HIV positive rate amongst the study population was 27.8% (130/467), with 85.4% (111/467) of these women having a viral load of less than a thousand (table II). Immediate complications ( gure 2) were de ned as complications occurring whilst still in hospital and which could possibly have been attributed to the IUD. Most women experienced no immediate side-e ects (84.4%, 394/467). Complications included unexplained tachycardia (10.7%, 50/467), unexplained temperature (3%, 14/467), PPH (1.3%, 6/467), expulsion (1.1%, 5/467), minor wound sepsis (0.6%, 3/467), and endomyometritis (0.4%, 2/467). Four out of the ve immediate expulsions (expulsion whilst still in hospital) were a er emergency C/S – some directly post-operative in the theatre or recovery room and some during the hospital stay. One of the women with endomyometritis (0.2%) had a hysterectomy. She had an evacuation of her uterus 6 weeks post-delivery for secondary PPH. ree days later she had a hysterectomy and histology con rmed endomyometritis. e mean amount of days spent in hospital post-delivery were 3.27 (min 2, max 12, 95% CI 3.19-3.35). Only 16.5% (77/467) of women attended follow up of whom 68 (88.3%) attended at the designated appointment and 9 (11.6%) attended elsewhere ( g.1). e follow-up rate at NSH (18.4%, 25/136) was slightly better than at GSH (13%, 43/331). ere was no di erence in the mean age and parity between patients who attended follow up (27.4; 2.3) and those who did not attend (27.2; 2.3). e continuation rate at follow up was 71.6% (53/74), speci cally 60.5% (23/38) a er emergency C/S, and 82.8% (24/29) a er elective C/S (p=0.049) ( gure 3). Of the 49 MMH patients who followed up, 34 (69.4%) continued with their IUD, and of the 28 NSH patients who followed up, 19 continued (67.9%) (p=0.889). In 3 of the women attending follow up it was not clear from the case notes whether they continued with their IUD or not. e commonest symptoms at follow up ( g. 4) were vaginal discharge (26%; 20/77), pain (11.7%; 9/77), expulsion (11.7%; 9/77), abnormal bleeding (6.5%; 5/77), and protruding strings (6.5%; 5/77). ere were no perforations. Patients were asymptomatic in 51.9% (40/77) of cases. Inmost patients complaining of a discharge no antibiotic was prescribed and reassurance was adequate. One woman fell pregnant post-insertion. She was a 27-year old para 4 who defaulted follow-up a er IUD-insertion at emergency C/S. She returned three months later pregnant with twins. No IUD was seen on ultrasound. She had a negative laparoscopy for abdominal pain in the second trimester, and subsequently had a C/S and tubal ligation at term. e overall expulsion rate a er emergency C/S was 3.26% (9/276) and a er elective C/S 2.17% (4/184) (p=0.576). In one case it was unsure if it was an emergency or elective C/S). Strings were visible at follow up in 53.2 % (41/77) of patients. An ultrasound was performed in 67.5 % (52/77) of patients - 79.6% (39/49) of patients at GSH and 46.4% (13/28) at NSH. e IUD was normally placed in 63.5 % (33/52) of cases where ultrasound was performed. Malpositioning (IUD distance of more than 20 mm from fundus and/or abnormally positioned in the cavity) occurred in 23% (12/52) of cases, O&G Forum 2021; 31: 06 - 10 ORIGINAL RESEARCH Figure 2: Immediate complications that could possibly be attributed to the IUD N TEMPERATURE PPH 14 0 13 25 38 50 6 2 3 5 50 1 WOUND SEPSIS ENDOMETRITIS EXPULSION TACHYCARDIA HYSTERECTOMY Figure 3: Discontinuation rate vs CS type ELECTIVE 0 10 20 30 40 % DISCONTINUATION 17,2 39,5 EMERGENCY Figure 4: Side-effects at follow-up 1,3% PREGNANCY 11,7% EXPULSION 11,7% PAIN 6,5% PROTRUDING STRINGS 6,5% BLEEDING 51,9% NONE 1,3% INFECTION 26% DISCHARGE Figure 1: Data collection summary Caesarean sections performed IUDs inserted n=467 Follow up (n=77) Folders excluded: 132 MMH: 2310 MMH: 402 (17.4%) MMH: 331 GSH: 43 (13%) NSH: 1376 NSH: 197 (14.3%) NSH: 136 NSH: 25 (18.4%) Elsewhere: 9 (1.9%)