N. Mullin

Ponencia:

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    Do women attending a termination of pregnancy
    clinic wish to see the ultrasound scan image of
    their fetus?
    Mullin, N; Prabakar, I
    Countess of Chester Hospital NHS Foundation Trust, UK
    Objective: In our National Health Service termination of
    pregnancy (TOP) clinic we have noticed an increasing number of
    women and their partners asking to look at the ultrasound screen
    during their gestational dating scan and some women have also
    asked for a photograph.
    Method: A prospective pilot study was carried out to discover
    more about our patients’ wishes and their experience of
    ultrasound during their pre-abortion consultation.
    Results: Over 3 months, 53 questionnaires were returned,
    response rate 47% (53/112). All women who completed a
    questionaire had a first trimester TOP, mean age 25 years, range
    15–44 (women with a miscarriage were excluded). The majority of
    respondants, 94% (50/53) were expecting a scan; 32 women
    (60%) did not want to view the ultrasound image or have a

    photograph. The remaining 20 women (one did not respond) said
    they wished to view the image but only seven women actually did
    look at the ultrasound screen, and nine women wanted a
    photograph (median age 19 years, range 16–23). All the women
    were satisfied with the way the scan was carried out and with
    their care.
    Conclusions: Generally women do not want to see an image of
    their fetus when they attend a TOP service. However, a minority
    of younger women would like the opportunity to look at the
    image and this should be allowed as it may be helpful to some
    women. We now inform clients that they may look at the
    ultrasound screen if they wish; a partner may view the screen only
    with the woman’s permission. We do not provide a photograph
    due to cost.

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    What are the contraceptive issues for women conceiving too soon after a live birth, miscarriage or abortion?

    Nicola Mullin, Suzanne Kirkwood, Andrea Brockmeyer Countess of Chester Hospital NHS Foundation Trust, Chester, Cheshire, UK - nicola.mullin@btinternet.com

    Background: Timely access to contraceptive advice and supplies is important for couples following a live birth (LB), miscarriage (M) or abortion (A) to prevent another pregancy too soon. There is national guidance on postnatal care. Method: Women who had an unplanned and unwanted pregnancy within 12 months of their last pregnancy received standard abortion care but were asked 5 questions about the quality/timing of contraceptive advice given previously and any problems accessing or using their chosen method of contraception. Results: Of 40 women identified, 28 previously had a live birth, 6 a miscarriage, 6 had an abortion. Overall, all women who had had an abortion and all but one women who gave birth remembered receiving contraception advice, but only 50% (3/6) women who had had a miscarriage received advice. LB group: 16 women conceived within 6 months and 12 conceived 6-12 months later. Thematic analysis revealed only 50% recalled advice being helpful. Issues: health professionals assuming parous women knew about contraception or were going back to a previously used method or the advice given was too early to be useful. Several women had difficulty obtaining pills or getting an appointment to have an implant or IUD/IUS fitted. Miscarriage group: 3 women conceived within 3 months and one commented ‘that she didn't know it was possible to conceive so quickly'. Two women found the miscarriage particularly traumatic and stated that both they and the staff found it difficult to talk about contraception. Women having a repeat abortion conceived later than the other groups (after 8-12 months). They reported difficulties using contraception and several stopped the long-acting reversible (LARC) method provided at the earlier abortion. Conclusion: The quality of postnatal contraception provision needs to be improved for women who give birth or have a miscarriage. There is a high uptake of LARC in our abortion service but women need more support managing side effects to improve continuation rates.

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    What is the best way to provide women with postnatal contraception?

    Nicola Mullin, Rebekah Hughes Countess of Chester Hospital NHS Foundation Trust, Chester, Cheshire, UK - nicola.mullin@btinternet.com

    Background: Many women attending our National Health Service abortion service reported difficulties with using contraception, particularly the women who had had an unplanned pregnancy within 12 months of giving birth. Aims: To discover if women know how soon they should resume contraception postnatally. To understand when and how women prefer to receive information about contraception and contraceptive supplies. Method: A prospective questionnaire was offered to pregnant women accessing an English hospital-based antenatal clinic. The questionnaire was also completed by postnatal women and included a contraceptive ‘pack' of information and condoms. Results: There were 106 completed questionnaires in the antenatal (AN) group (1 refusal). In the postnatal (PN) group 50 women completed questionnaires (no refusals). Most women were aged 21-30 and over 50% in both groups had other children. Very few women could recall having received any kind of information about postnatal contraception: 16% (17/106) AN and 18% (9/50) PN. The majority of women thought contraception should be started as soon as sex was resumed after delivery; however, the knowledge of the effects of breast feeding and when there was a risk of conception if not breast feeding was low. Many women had already decided on their preferred contraception, 38% (40/106) AN and 52% (26/50) PN, including 3 women who wished to be sterilised (2 were currently pregnant). Most women chose contraceptive pills or condoms, few were interested in long-acting reversible contraception. The AN group preferred to receive contraception from their midwives at the one week postnatal home visit or at the routine postnatal check up at 6-8 weeks. In contrast, most postnatal women wanted to leave hospital with their contraception supplies. Conclusions: This work has informed the maternity department of our patients’ wishes regarding receiving information about contraception and how and when they would like to be given supplies of contraception.

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    Who refuses chlamydia screening in a termination
    of pregnancy clinic?
    Mullin, N; Robinson, K; Carter, J
    Countess of Chester Hospital NHS Foundation Trust, UK
    Background: National United Kingdom guidelines recommend all
    women requesting a termination of pregnancy (TOP) are screened
    for Chlamydia Trachomatis (CT) infection beforehand. Two years
    ago in our hospital we had a gravely ill woman with a post-TOP
    pelvic infection, and after a significant event analysis the staff were
    trained to become more effective in offering screening to all
    women.
    Objectives: To audit the documented offer, uptake and refusal of
    CT screening pre-TOP.
    Method: Retrospective case notes review.
    Results: In 12 months, 471 women attended the pre-assessment
    (pre-TOP) clinic, age range 14–48 years, 250 (53%) were under
    24 years. All clients had a documented offer of CT screening,
    including women whose pregnancy was found to be non-viable or
    who decided to continue with their pregnancy. There were 143
    women who declined a test in clinic and in 68 (50%) cases there
    was a documented CT test taken prior to attending the TOP
    service. Of the remaining 75/471 (16%) clients (mean age
    25 years, range 16–43) these women mostly (94%) declined
    screening because they were in a long term relationship or had
    recently been tested in a new relationship.
    Conclusion: Despite staff strongly recommending CT screening to
    all women attending our TOP service, one in six women decline.
    However, this appears to be a self selected low risk group of
    women. No severe post-TOP infections have occured in our
    service recently (universal antibiotic prophlaxis is given as well as
    screening). Further work is needed to encourage referring agencies
    to offer CT screening at the first discussion of pregnancy options
    to ensure maximum uptake.