O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 10 performing ultrasound. A standardized protocol for follow-up may give more reliable results. Continuation rates improved with the experience of the inserters in our study. is highlights the importance of training and adequate supervision of junior doctors. Previous uterine surgery, cervical dilatation and HIV status did not signi cantly a ect continuation and should not be a contraindication to insertion. Limitations of the study is is a retrospective study relying on information from notes made in hospital folders, therefore information is not standardized and is dependent on the nature of the clinical note keeping. Some folders were excluded due to poor note keeping as it could not be established whether the patients ultimately received the IUD or not. Lost folders may also have contributed to the poor F/U rate. e number of patients who attended follow-up were exceptionally low, which make ndings from the population who followed up less reliable due to the small group. Findings between the two hospitals were similar though, which is reassuring. We could not assess patient satisfaction since this was rarely documented in the notes. is important outcome will best be measured in a prospective study. Conclusion e immediate postpartum period may be the only opportunity we have to provide LARC in some women. In our patient population follow-up rates are poor, and therefore the side-e ects, expulsion rate, malpositioning, patient satisfaction and IUD programme success cannot be accurately gauged. Measures must be taken to improve this. A prospective study with a di erent location or method of follow-up may give more information regarding these factors. Where the IUD is considered at the time of emergency C/S, patients must be informed about the possible lower continuation rate. However, it should still be o ered as many patients may default follow-up, and the IUD is safe, e ective and long-acting. Recommendations 1. Revision and standardization of follow-up protocols. Follow-up at Primary Health Care Clinics where the patient will attend for her and her baby’s 6 weeks visit may improve attendance rates. 2. Adequate training of Primary Health Care sta to ensure that they are familiar with the follow-up care. 3. Ultrasound access at the follow-up facility to e ciently manage patients with symptoms or lost strings. Where ultrasound is readily available, routine scanning at the rst visit should be considered. E ective referral pathways must be ensured. 4. Adequate counselling before hospital discharge including: - possible side-e ects (speci cally leucorrhoea, spotting, pain and protruding strings) - the small risk of unnoticed expulsion and unwanted pregnancy - the importance of follow-up and what it entails - an open-door policy for the trimming of strings and management of side-e ects. 5. Information lea ets with contact numbers and appointment slips. 6. Note keeping about insertion of IUDs and counselling before and a er IUD insertion are medicolegal pitfalls and should receive more attention. 7. Adequate training of junior doctors in the correct insertion techniques. IUD placement techniques should be standardised – particularly strings should be fed into the cervical canal and not trimmed based on the high rate of missing strings. 8. More data is needed regarding the decreased continuation rate a er insertion at the time of emergency C/S. Patients should be informed about this risk. 9. 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Family Planning Worldwide 2019 Data Sheet. Published online www.prb.org/fpdata. (accessed August 2020). 22. Credé S, Hoke T, Constant D, Green MS, Moodley J, Harries J. Factors impacting knowledge and use of long acting and permanent contraceptive methods by postpartum HIV positive and negative women in Cape Town, South Africa: A cross-sectional study. BMC Public Health. 2012;12(1): 197. 23. Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, et al. E ectiveness of Long-Acting Reversible Contraception. N Engl J Med. 2012;366(21):1998-2007. 24. Gutin SA, Mlobeli R, Moss M, Buga G, Morroni C. Survey of knowledge, attitudes and practices surrounding the intrauterine device in South Africa. Contraception. 2011;83(2):145–50. O&G Forum 2021; 31: 06 - 10 ORIGINAL RESEARCH