Rebecca Heller


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    Postpartum contraception: a missed opportunity for preventing termination of pregnancy and short inter-pregnancy intervals?

    Rebecca Heller1 ,2, Rosie Briggs2, Norma Forson1, Anna Glasier2, Sharon Cameron1 ,2 1NHS Lothian, Edinburgh, UK, 2University of Edinburgh, Edinburgh, UK -

    Background: There is a growing realization that women's need for effective contraception in the immediate postpartum period has been underestimated. Unintended pregnancies soon after childbirth may lead to termination of pregnancy (TOP), or short inter-pregnancy intervals that are associated with adverse maternal, perinatal and infant outcomes. Using local TOP and maternity databases in Edinburgh, Scotland, we examined (1) the proportion of women attending for TOP over a 6-month period (Sept 2013 - Feb 2014) who had given birth within the preceding 12 months, (2) the proportion of postpartum mothers over the same time period whose baby followed an earlier birth to pregnancy interval of 12 months or less. (3) We also conducted an anonymous self-administered survey of mothers (n=250) within the first week postpartum about contraceptive intentions. Results: Database analysis showed that (1) 75 women out of 1052 (7.1%) attending for TOP had given birth within the preceding 12 months and that (2) 311 out of 4713 postpartum mothers (6.6%) gave birth following a preceding birth to pregnancy interval of 12 months or less. The majority of postpartum women surveyed - 62/250 (76.6%) - had not decided on an ongoing method of contraception and most (174/247, 70.4%) had not discussed postpartum contraception during the pregnancy with a health care professional. Discussion: Almost 1 in 13 women in our population who present for TOP or who deliver a baby have conceived the pregnancy soon after childbirth. Given the consequences of an unintended pregnancy for women and the risks of short inter-pregnancy intervals, consideration needs to be given to interventions that might improve uptake of effective contraception in the immediate postpartum period.

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    An evaluation of postplacental insertion of intrauterine contraception (PPIUC) at elective caesarean section in the UK

    Rebecca Heller2, Anne Johnstone2, Sharon Cameron1 ,2
    1NHS Lothian, Edinburgh, UK, 2University of Edinburgh, Edinburgh, UK

    Objectives: Sexual health policy recognises that increased uptake of the most effective methods of contraception immediately postpartum could prevent unintended pregnancies and short interpregnancy intervals. Our objective was to evaluate uptake, complications and acceptability of postpartum intra-uterine contraception (PPIUC) inserted at elective caesarean section.
    Methods: All women scheduled for elective caesarean section in NHS Lothian, Scotland were given written information on postpartum contraceptive methods antenatally, indicating that intrauterine contraception could be inserted at caesarean section. This included the offer of a thread check at six weeks by a gynaecologist with an ultrasound scan if threads were not visible. At this visit women were asked about their satisfaction with PPIUC.
    Results: To date (July 2015 – March 2016) 787 women were scheduled for elective section and sent information about postpartum contraception. 142 of 787 women (18%) chose PPIUC, which was performed in 136 cases.  6 were unable to be inserted, 2 of these women returned for insertion subsequently. 120 women (88%) still have the device in situ. There have been 10 expulsions, in 6 cases women have had a second device inserted.  6 devices have been removed. There have been no cases of pelvic inflammatory disease. Of 88 women who have thus far attended for a 6 week check, threads were visible in 47% of cases (n=41). Ultrasound confirmed IUC in situ in all cases of missing threads apart from1, this woman awaits an abdominal x-ray to exclude perforation. Of women attending the 6 week check, 78 (89%) stated that they were happy or very happy with IUC insertion at caesarean section.
    Conclusion: PPIUC at elective caesarean section appears to be a popular option, for women, that is safe and highly acceptable.  This could be an important strategy to prevent short interpregnancy intervals and unintended pregnancies in the UK.