A retrospective audit on the introduction of post placental copper-T 380A intra uterine contraceptive device insertion at Tygerberg hospital

Bryan-Mc Innes, Michelle (2017-12)

Thesis (MMed)--Stellenbosch University, 2017.

Thesis

INTRODUCTION The Copper-T 380A intrauterine contraceptive device (Cu-IUCD) is a safe and effective long-acting reversible form of contraception (LARC) that is used by over 100 million women worldwide it is therefore of great concern that in South Africa the use of IUCD is < 2 %. AIM & METHOD In 2012 progestogen-only injectables and IUCDs were the only LARCs available in South Africa. A new protocol for post-placental insertion of the Cu-IUCD (PPIUD) was introduced at Tygerberg hospital, Cape Town to encourage the uptake of this method. The purpose of this study was to audit the implementation of this protocol and outcomes, which included the rate of return and complications. Only pregnancies that were >24 weeks of gestation or >500 g were included. RESULTS According to the IUCD register, 523 women had the IUCD inserted between June 2013 and February 2014. Forty-two records were excluded from the analysis due to insufficient information giving a total of 481 women of which only 437 had an IUCD inserted. Antenatally only 108 women opted for the Cu-IUCD and most (301) women only made the decision to have the IUCD inserted around the time of delivery. The majority were inserted at emergency caesarean section (312) compared to elective caesarean section (66) and vaginal deliveries (57). There were 39 (8.6%) cases identified with puerperal sepsis of which five were diagnosed with endometritis (1.1%). The PPH rate was 1.8% with and increased risk of expulsion during this period. Only 118 (24.5%) returned for follow-up at Tygerberg with three expulsions (2.5%) and five partial expulsions (4.2%), 22 devices (18%) were removed for various reasons and there were no identified perforations. CONCLUSION: Post placental insertion of the IUCD copper T380A is a safe, effective and affordable form of contraception that is ideal for women in a low-middle income country. There was significant risk of infection, bleeding and associated with insertion although one should be aware of exclusion criteria and should select the appropriate patients for the procedure. Although there is an increased risk of expulsion in immediate post placental insertion the risk of loss to follow up with consequent resulting pregnancies is higher.

BEKENDSTELLING Die Koper T (Copper T380A) intra-uteriene toestelling (IUT) is ‘n veilige langewerkende omkeerbare voorbehoedmiddel (LARC) wat deur meer as ‘n 100 miljoen vrouens wêreldwyd gebruik word. Dit is dus kommerwekend dat in Suid Afrika die gebruik van die IUT minder as 2% is. DOEL & METODE In 2012 was progestogeen inspuitings en IUT die enigste LARC beskikbaar in Suid Afrika. ‘n Nuwe protokol vir post partum inplasing van die koper IUT was bekend gestel in Tygerberg Hospital in 2012 om die implimentasie van die metode te bevorder. Die doel van die navorsing was om die implementasie van die prokotol en die gevolge te oudit. Dit sal aantal en tipe komplikasies, sowel as die terugkeer van pasiente inlsuit. RESULTATE Volgens die IUT register het 523 vrouens die IUT laat inplaas tussen Junie 2013 en Ferbruarie 2014. Twee en veertig notas was onvolledig wat beteken het dat 481 vrouens se mediese rekords ge-analiseer was waarvan net 437 ‘n IUT laat inplaas het. Voorgeboortheid het slegs 108 vrouens die IUT gekies en die meeste vrouens (301) het die besluit eers geneem rondom die tyd van geboorte. Meeste toestelle (312) was ingesit by nood Keisersnitte vergeleke met (66) elektiewe Keisersnitte en (57) Vaginale verlossings. Daar was 39 gevalle (8.6%) geïdentifiseer met puerperale sepsis waarvan vyf (1.1%) pasiente gediagnoseer was met endometritis . Slegs 118 (24.5%) van die pasiente het vir hul opvolg na Tygerberg gekom. Daar was 3 (2.5%) uitwerpings en 5 (4.2%) gedeeltelikke uitwerpings is noteer, 22 Apparate (18%) is verwyder vir verskeie redes en geen perforasies is geidentifiseer nie. GEVOLGTREKKING Post plasentale inplasing van IUT Copper T380A is ‘n effektiewe en bekostigbare vorm van kontrasepsie wat ideaal is vir vrouens in ‘n ontwikkelende land. Daar is geen beduidende risiko vir infeksie of bloeding wat geassosieer word met inplasing van die apparaat nie alhoewel mens bewus moet wees van die uitsluitsel kriteria en die korrekte aanvaarbare pasiente kies vir die prosedure. Alhoewel daar n verhoogte risiko vir uittwerping is met die onmiddellike post partum inplasing, is die kans van ‘n volgende swangeskap voor ‘n interval inplasing inplasing ‘n groter problem.

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