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O062 SOCIO-CULTURAL DETERMINANTS OF FAMILY PLANNING UTILISATION IN GA WEST MUNICIPALITY OF GREATER ACCRA REGION, GHANA
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O062 SOCIO-CULTURAL DETERMINANTS OF FAMILY PLANNING UTILISATION IN GA WEST MUNICIPALITY OF GREATER ACCRA REGION, GHANA M.A. Antwi1 , R. Adanu2 . 1 Ghana College of Physicians and Surgeons, Accra, Ghana; 2 University of Ghana School of Public Health, Accra, Ghana Objectives: To determine the influence of ethnicity, educational status, family support systems and religion on the use of family planning in a rural district. Materials: Three hundred and twenty randomly selected antenatal and postnatal women attending clinics in five public health facilities in the Ga West Municipality of Greater Accra region were interviewed. Two focus group discussions, each constituted by eight purposefully selected antenatal women,were also held in two randomly selected communities in the municipality. Methods: A cross-sectional mixed study using a pre-tested structured questionnaire to interview 320 respondents and a focus group discussuion guide for the two focus group discussions. Quantitative data were captured in Epi Info statistical software version 3.5.1. and analysis was conducted using descriptive statistics. Further analysis of the data was done to explore the associations between the variables using odds ratios. The qualitative data were listed, categorised in relation to the objectives and coded. Content analysis of each category was then conducted to recognise the relationships under the various themes. Results: Ethnicity, educational status and religion were not found to be significantly related to both past use and intention for future use of family planning. We found that women who belonged to religious groups that prohibited family planning did not base their family planning decisions on religious prescriptions. The odds of a woman using a family planning method was doubled when spousal support was obtained. When support for family planning was from an extended family member the odds of future family planning use was 1.4. Conclusions: Spousal and extended family support systems are important for the uptake and sustained use of family planning services by women in rural communities. Social marketing of family planning services in rural communities must court and strengthen family support for services provided. O063 SUBGROUP ANALYSES OF A RANDOMIZED, PHASE II STUDY COMPARING TWO LOW DOSE LEVONORGESTREL IUSS WITH MIRENA D. Apter1 , M. Metsa-Heikkil ¨ a¨ 2 , A.-K. Poranen3 . 1 Sexual Health Clinic, V¨ aest¨ oliitto (Family Federation of Finland), Helsinki, Finland; 2 Femeda Oy, Helsinki, Finland; 3 Fertility Clinics, V¨ aest¨ oliitto (Family Federation of Finland), Turku, Finland Objectives: Previously reported randomized phase II data demonstrated that two experimental, low-dose LNG-IUSs, LNG IUS12 (early in vitro levonorgestrel [LNG] release 12 mg/day) and LNG IUS16 (16 mg/day), provided effective contraception with acceptable bleeding patterns and were easier and less painful to insert than Mirena (20 mg/day). The purpose of these subgroup analyses was to compare the new systems with Mirena regarding LNG pharmacokinetics (PK), and ovarian and cervical function. Materials: In this multicentre, phase II study, healthy parous or nulliparous women aged 21–40 years (n = 738) were randomized to treatment with LNG IUS12 (28 mm×28 mm), LNG IUS16 (28 mm×28 mm) or Mirena (32 mm×32 mm) for up to 3 years. Methods: Parameters for LNG PK (Cmax, tmax and C3years) were assessed in 37 women based on sampling at baseline, days 1, 3, 7 and 14, month 1, 6, 12, 18, 24, 30 and 36, and before LNGIUS removal. Ovarian function (serum progesterone and oestradiol concentrations) and cervical function (cervical mucus amount, spinbarkeit, ferning and degree of opening, evaluated on a scale
S283
of 0–3) were analysed twice weekly over 6-week periods in the second half of years 1, 2 and 3 in 53 women. Results: After insertion of LNG-IUS12, a geometric mean Cmax of 137 ng/l (coefficient of variation [CV] 28.6%, n = 12) was reached after a median of 14 days. For LNG-IUS16 and Mirena, the corresponding values were 186 ng/l (CV 46.9%, n = 12) and 360 ng/l (CV 45.9, n = 13) after 11 and 7 days, respectively. Thereafter, serum levels of LNG declined slowly to mean C3years values of 69 ng/l (LNG-IUS12, n = 8), 85 ng/l (LNG-IUS16, n = 7) and 165 ng/l (Mirena, n = 12). With LNG-IUS12 (n = 21), ovulation was observed in all women at all examinations where an assessment was possible. With LNG-IUS16 (n = 15) ovulation was observed in most women at all examinations, although in two women ovulation was not demonstrated in year 1. With Mirena (n = 17), more women failed to demonstrate ovulation during the time periods observed (four in year 1, two in year 2, one in year 3). Progestogenic effects on cervical mucus were similar across the treatment groups; cervical scores remained low over 3 years (mean 2.7–3.7), indicating mucus that is less penetrable by sperm. Conclusions: Compared with Mirena, LNG IUS12 and LNG IUS16 result in lower systemic exposure to LNG, a reduced tendency for anovulation, and similar thickening effects on cervical mucus. O064 CLINICS AND BIOMECHANICS OF BIDIRECTIONAL BARBED SUTURE IN GYNAECOLOGY M. Ardovino2 , I. Ardovino2 , M.A. Castaldi1 , M. Adamo1 , G. Fatigati1 , N. Colacurci1 , L. Cobellis1 . 1 Department of Gynaecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy; 2 A. O. R. N. S. Giuseppe Moscati, Avellino, Italy Objectives: to compare the feasibility, safety and shortest suture by using bidirectional knotless barbed vs. standard suture, either with extracorporeal or intracorporeal knots, for uterine wall defect repair after myomectomy and vaginal cuff closure following hysterectomy, and to evaluate the biomechanical stability of barbed sutures vs. conventional sutures. Materials: 117 women, 42 who underwent total laparoscopic hysterectomy (TLH) and 75 laparoscopic myomectomy (LM), were enrolled. Methods: In accord with randomization vaginal cuff (TLH) and uterine wall defect (LM) were closed either with extracorporeal or intracorporeal knots (1-Monocryl), and a bidirectional knotless barbed suture (0-Quill). Biomechanical stability of bidirectional barbed 0-Quill sutures vs. 2–0 Monocryl sutures were evaluated on biological specimen.
Figure 1.
O062 SOCIO-CULTURAL DETERMINANTS OF FAMILY PLANNING UTILISATION IN GA WEST MUNICIPALITY OF GREATER ACCRA REGION, GHANA M.A. Antwi1 , R. Adanu2 . 1 Ghana College of Physicians and Surgeons, Accra, Ghana; 2 University of Ghana School of Public Health, Accra, Ghana Objectives: To determine the influence of ethnicity, educational status, family support systems and religion on the use of family planning in a rural district. Materials: Three hundred and twenty randomly selected antenatal and postnatal women attending clinics in five public health facilities in the Ga West Municipality of Greater Accra region were interviewed. Two focus group discussions, each constituted by eight purposefully selected antenatal women,were also held in two randomly selected communities in the municipality. Methods: A cross-sectional mixed study using a pre-tested structured questionnaire to interview 320 respondents and a focus group discussuion guide for the two focus group discussions. Quantitative data were captured in Epi Info statistical software version 3.5.1. and analysis was conducted using descriptive statistics. Further analysis of the data was done to explore the associations between the variables using odds ratios. The qualitative data were listed, categorised in relation to the objectives and coded. Content analysis of each category was then conducted to recognise the relationships under the various themes. Results: Ethnicity, educational status and religion were not found to be significantly related to both past use and intention for future use of family planning. We found that women who belonged to religious groups that prohibited family planning did not base their family planning decisions on religious prescriptions. The odds of a woman using a family planning method was doubled when spousal support was obtained. When support for family planning was from an extended family member the odds of future family planning use was 1.4. Conclusions: Spousal and extended family support systems are important for the uptake and sustained use of family planning services by women in rural communities. Social marketing of family planning services in rural communities must court and strengthen family support for services provided. O063 SUBGROUP ANALYSES OF A RANDOMIZED, PHASE II STUDY COMPARING TWO LOW DOSE LEVONORGESTREL IUSS WITH MIRENA D. Apter1 , M. Metsa-Heikkil ¨ a¨ 2 , A.-K. Poranen3 . 1 Sexual Health Clinic, V¨ aest¨ oliitto (Family Federation of Finland), Helsinki, Finland; 2 Femeda Oy, Helsinki, Finland; 3 Fertility Clinics, V¨ aest¨ oliitto (Family Federation of Finland), Turku, Finland Objectives: Previously reported randomized phase II data demonstrated that two experimental, low-dose LNG-IUSs, LNG IUS12 (early in vitro levonorgestrel [LNG] release 12 mg/day) and LNG IUS16 (16 mg/day), provided effective contraception with acceptable bleeding patterns and were easier and less painful to insert than Mirena (20 mg/day). The purpose of these subgroup analyses was to compare the new systems with Mirena regarding LNG pharmacokinetics (PK), and ovarian and cervical function. Materials: In this multicentre, phase II study, healthy parous or nulliparous women aged 21–40 years (n = 738) were randomized to treatment with LNG IUS12 (28 mm×28 mm), LNG IUS16 (28 mm×28 mm) or Mirena (32 mm×32 mm) for up to 3 years. Methods: Parameters for LNG PK (Cmax, tmax and C3years) were assessed in 37 women based on sampling at baseline, days 1, 3, 7 and 14, month 1, 6, 12, 18, 24, 30 and 36, and before LNGIUS removal. Ovarian function (serum progesterone and oestradiol concentrations) and cervical function (cervical mucus amount, spinbarkeit, ferning and degree of opening, evaluated on a scale
S283
of 0–3) were analysed twice weekly over 6-week periods in the second half of years 1, 2 and 3 in 53 women. Results: After insertion of LNG-IUS12, a geometric mean Cmax of 137 ng/l (coefficient of variation [CV] 28.6%, n = 12) was reached after a median of 14 days. For LNG-IUS16 and Mirena, the corresponding values were 186 ng/l (CV 46.9%, n = 12) and 360 ng/l (CV 45.9, n = 13) after 11 and 7 days, respectively. Thereafter, serum levels of LNG declined slowly to mean C3years values of 69 ng/l (LNG-IUS12, n = 8), 85 ng/l (LNG-IUS16, n = 7) and 165 ng/l (Mirena, n = 12). With LNG-IUS12 (n = 21), ovulation was observed in all women at all examinations where an assessment was possible. With LNG-IUS16 (n = 15) ovulation was observed in most women at all examinations, although in two women ovulation was not demonstrated in year 1. With Mirena (n = 17), more women failed to demonstrate ovulation during the time periods observed (four in year 1, two in year 2, one in year 3). Progestogenic effects on cervical mucus were similar across the treatment groups; cervical scores remained low over 3 years (mean 2.7–3.7), indicating mucus that is less penetrable by sperm. Conclusions: Compared with Mirena, LNG IUS12 and LNG IUS16 result in lower systemic exposure to LNG, a reduced tendency for anovulation, and similar thickening effects on cervical mucus. O064 CLINICS AND BIOMECHANICS OF BIDIRECTIONAL BARBED SUTURE IN GYNAECOLOGY M. Ardovino2 , I. Ardovino2 , M.A. Castaldi1 , M. Adamo1 , G. Fatigati1 , N. Colacurci1 , L. Cobellis1 . 1 Department of Gynaecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy; 2 A. O. R. N. S. Giuseppe Moscati, Avellino, Italy Objectives: to compare the feasibility, safety and shortest suture by using bidirectional knotless barbed vs. standard suture, either with extracorporeal or intracorporeal knots, for uterine wall defect repair after myomectomy and vaginal cuff closure following hysterectomy, and to evaluate the biomechanical stability of barbed sutures vs. conventional sutures. Materials: 117 women, 42 who underwent total laparoscopic hysterectomy (TLH) and 75 laparoscopic myomectomy (LM), were enrolled. Methods: In accord with randomization vaginal cuff (TLH) and uterine wall defect (LM) were closed either with extracorporeal or intracorporeal knots (1-Monocryl), and a bidirectional knotless barbed suture (0-Quill). Biomechanical stability of bidirectional barbed 0-Quill sutures vs. 2–0 Monocryl sutures were evaluated on biological specimen.
Figure 1.