Audrey Brown

conférence:

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    Continuation rate of contraceptive implant fitted
    on the day of a termination of pregnancy
    Brown, A; Nixon, H
    NHS Greater Glasgow and Clyde, UK
    Sandyford is an integrated sexual health service with over 100 000
    visits annually. Our termination of pregnancy (TOP) service sees
    over 1500 women annually. Around 30% of TOPs are in women
    who have previously had at least one TOP. As a strategy to reduce
    repeat TOP, we encourage uptake of long-acting reversible
    contraception on the day of a TOP. Anecdotally, clinic staff were
    reporting that many women having a contraceptive implant on

    the day of abortion were returning in a short time to have it
    removed.
    Aim: To assess: uptake of contraceptive implant on the day of the
    TOP; and continuation rate at one year after the TOP.
    Methods: Records of women attending from May to October
    2010 were accessed to record: method of contraception provided
    on day of the TOP; rate of removal at one year after the TOP;
    and reason for removal.
    Results: During the 6 month period, 707 women had a TOP.
    One hundred and fifty-two women (21%) had a contraceptive
    implant fitted on the day of the TOP.
    During the first year, 27 women had the implant removed for
    reasons including bleeding (20), mood problems (2), weight gain
    (2), planned pregnancy (2) and not sexually active (1).
    One hundred and twenty-five women (82%) continued with
    the implant for at least 1 year after insertion.
    Discussion: Published series demonstrate implant continuation
    rates of around 75% at 1 year. Implants are cost-effective at one
    year of use. In our audit, women having an implant fitted on the
    day of the TOP do not have a higher removal rate than standard
    implant users.

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    Improving the Provision of Contraception of the Day of Medical Abortion

    Helen Nixon and Audrey Brown, NHS Greater Glasgow and Clyde, UK

    Introduction:

    Annually over 13000 women undergo therapeutic abortion in Scotland. Over 25% of these abortions are carried out in women who have previously undergone abortion. One strategy to reduce the number of abortions is to ensure the provision of reliable contraception on the day of abortion.

    Objectives:

    To describe national campaigns to increase uptake of long-acting reversible contraception, and to improve contraceptive provision at the time of medical abortion,

    to describe a local training programme to achieve the national standards

    to compare the provision of reliable contraception at the time of medical abortion before and after the introduction of the above

    Methods: Case notes of women requesting medical abortion and accessing our abortion assessment clinic were reviewed for a 3 month period in 2007 (n=180) and 2010 (n= 157). Method of contraception chosen at the time of abortion assessment was recorded, as was method of contraception provided on the day of abortion.

    Results:

     

     

    % requesting method in 2007

    % supplied with method in 2007

    % requesting method in 2010

    % supplied with method in 2010

    COCP

    33

    39

    31

    38

    POP

    13

    16

    7

    6

    Implant

    19

    1

    32

    26

    IUD/IUS

    11

    0

    10

    0

    DMPA

    14

    18

    11

    11

    Barrier

    1

    4

    3

    3

    Nil/undecided

    9

    22

    6

    16

    TOTAL

    100

    100

    100

    100

     

    Discussion: Women who choose the oral or injectable contraception are usually provided with the method on the day of medical abortion in both 2007 and 2010. Although 19% of women chose a contraceptive implant in 2007, only 1% of women were fitted with an implant on the day of medical abortion. Several national campaigns, and local projects to enable medical abortion unit staff to fit contraceptive implants, took place during 2008 and 2009. Between 2007 and 2010, there was an increase in number of women choosing a contraceptive implant, from 19% to 32%. In addition, a contraceptive implant was fitted on the day of medical abortion in 26% of women, compared to 1% three years previously. Intra-uterine contraceptive methods are not fitted on the day of medical abortion in our unit. Despite around 1 in 10 women choosing this method, they cannot be provided with their chosen method at the time of abortion. Most women fail to return for interval IUD/IUS insertion, potentially leaving them at risk of further pregnancy. Consideration should now be given  to improving timely provision of intra-uterine methods.

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    Uptake of independent counselling in addition to
    termination of pregnancy consultation
    Nixon, H; Brown, A
    Sandyford, NHS Greater Glasgow and Clyde, UK
    Sandyford is an integrated sexual health service with over 100 000
    visits annually. Our termination of pregnancy and referral
    (TOPAR) service sees over 1500 women annually and offers
    information, assessment and admission for medical and surgical
    termination of pregnancy (TOP). There is access to a trained
    counsellor if wished.
    Recently in the UK, there have been demands to make
    additional counselling or a ‘cooling off’ period compulsory.
    Aim: To assess: uptake of counselling in addition to the TOPAR
    consultation; and relationship between time to TOP and eventual
    decision.
    Methods: Records of women attending from September to
    November 2011 were accessed to record:
    (i) certainty of decision at first visit.
    (ii) uptake of additional counselling.
    (iii) waiting time to TOP date and final outcome to proceed to
    TOP or continue the pregnancy.
    Results: Of 384 women with confirmed pregnancies at
    consultation:
    (i) Twenty-six decided to continue the pregnancy.
    (ii) Three hundred and forty-one wanted a TOP and this was
    arranged.
    (iii) Twenty-eight subsequently did not attend for a TOP and
    continued the pregnancy.
    (iv) Seventeen women wished more time to consider their
    decision and were offered an appointment with a trained
    counsellor – two women accepted.
    (v) Sixof the undecided women continued thepregnancy,
    including the two women who attended for counselling and 11 had
    aTOP.
    (vi) Neither time to the TOP or gestation influenced the
    decision to abort or continue the pregnancy.
    Our results suggest that the vast majority of women do not
    wish or need additional counselling and that introducing a
    ‘cooling off’ period or delay would not alter the decision.

    Post Abortion Family Planning (PAFP) is a key part of any
    comprehensive TOP service as this is a vital opportunity in which
    to provide family planning, to avoid future unwanted pregnancies.
    In order to understand the factors that may impact on the
    uptake of PAFP, MSI undertook a baseline survey of all clients
    accessing services in four of the MSI country programmes. The
    data was collected for 1 month, September 2011.
    In total 4081 clients availed themselves of TOP services across
    MSI centres in Ethiopia (1974), Nepal (1160), Vietnam (888), and
    Zambia (59).
    The average age of clients was 27–29 years. Ethiopia was the
    only programme with a lower than average age of 22 years.
    Eighty-three percent of TOP were performed at under 9 weeks
    of gestation. Medical TOP was chosen by an average of 61% of
    women: Zambia (90%), Vietnam (76%), Ethiopia (62%), Nepal
    (16%).
    Sixty-eight percent of women had not been using any
    contraception when they became pregnant. Thirteen percent were
    using male condom, 9% the oral contraceptive pill, 4% injection,
    1% emergency contraception, and 1% traditional methods. No
    one had been using implants, IUDs, male or female sterilisation as
    a method of contraception when they became pregnant.
    This review reflects the baseline factors of MSI clients,
    including the low use of contraception in women seeking TOP,
    and highlights variables to consider when providing PAFP and
    informing the ongoing MSI PAFP project that focuses on
    increasing levels of PAFP uptake.