Masters Degrees (Obstetrics and Gynaecology)

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Browsing Masters Degrees (Obstetrics and Gynaecology) by Subject "Birth control devices"

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    A retrospective audit on the introduction of post placental copper-T 380A intra uterine contraceptive device insertion at Tygerberg hospital
    (Stellenbosch : Stellenbosch University, 2017-12) Bryan-Mc Innes, Michelle; Kluge, Judith; Stellenbosch University. Faculty of Health Sciences. Dept. of Obstetrics and Gynaecology.
    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.