- Email: [email protected]
A comparison of early complication rates in three IUDs — LNG-IUS, copper T and frameless copper
312
Abstracts / Contraception 90 (2014) 298–351
significant. Further studies are also needed to determine longer-term effects on minors’ access to abortion. http://dx.doi.org/10.1016/j.contraception.2014.05.067
P47
and one removal. The frameless Cu group had 5 perforations (0.9%), 1 infection (0.3%), 11 expulsions (2.0%) and 10 removals (1.8%). Conclusions: Complications rates are so low after IUD insertion that more than 2000 subjects in each group would be required to compare rates of expulsion with a power of .80 and α of .05. This study gives us some reassurance that frameless copper IUDs can be a good choice for some women. http://dx.doi.org/10.1016/j.contraception.2014.05.069
SEROSAL-ANCHOR MEASUREMENTS IMMEDIATELY AND 6–8 WEEKS POSTINSERTION OF FRAMELESS COPPER INTRAUTERINE DEVICES: ARE THESE RELATED TO EARLY COMPLICATIONS?
P49
E Wiebe University of British Columbia, Vancouver BC, Canada
FAMILY PLANNING PROVIDERS’ EXPERIENCES AND PERCEPTIONS OF LONG-ACTING REVERSIBLE CONTRACEPTION IN LILONGWE, MALAWI
Objectives: The purpose of this study was to determine if the position of the anchor of the frameless IUD on ultrasound postinsertion was related to early complications including perforation and expulsion. Methods: This was a prospective observational study of serosal-anchor measurements done by endovaginal ultrasound immediately and 6–8 weeks after insertion. At follow-up, ultrasound and pelvic examinations were performed. Women who did not come in for the follow-up visit were contacted by phone or email. We recorded demographic data and the rates of expulsion, infection, perforation, pregnancy and removal. Results: There were follow-up data available on 550 of 651 women (84.5%); one clinic had data for 93.6% of women, and the other had data for 62.0%. There were 27 early complications including 11 expulsions (2.0%), 5 perforations (0.9%), 10 removals (1.8%), 1 minor infection (0.2%) and 1 partial perforation (failed insertion). The mean serosal-anchor measurement postinsertion was 6.2(±2.5) mm and 6–8 weeks later was 5.9(±2.8 mm). The women who had perforations had measurements of 2.0 to 7.5 mm and 4/5 were within 1 standard deviation of the mean measurement for the whole group. The women who had expulsions had serosal-anchor measurements between 3.6 and 8.7 mm and 9/10 were within 1 standard deviation of the mean measurement. The mean difference between serosal-anchor measurements immediately and 6–8 weeks after insertion was 0.1 mm with a median and mode of 0. Conclusions: Measuring the serosal-anchor distance with ultrasound was feasible with the frameless IUD but was not predictive of expulsion and perforation.
O’Shea M UNC Project-Malawi, Lilongwe, Malawi Mwafulirwa T, Hamela G, Samuel E, Phiri R, Chingondole C, Chipangula V, Mwale M, Hosseinipour M, Tang J
A COMPARISON OF EARLY COMPLICATION RATES IN THREE IUDS — LNG-IUS, COPPER T AND FRAMELESS COPPER
Objectives: Despite high unintended pregnancy rates, less than 2% of Malawian women use intrauterine contraception (IUC) or the subdermal implant. Our objective was to describe Malawian family planning providers’ experiences and perceptions, with a focus on long-acting reversible contraception (LARC). Methods: We conducted a mixed-methods study using interviewer-administered surveys and focus group discussions with family planning providers at 12 government health centers in Lilongwe, Malawi. The quantitative and qualitative data were analyzed separately and then triangulated. Quantitative data were analyzed using descriptive statistics. Qualitative data were coded and focused on three domains: practice environment, perceptions of community family planning attitudes and strategies to improve LARC provision. Results: We administered 37 surveys and conducted three focus group discussions with 25 of the same providers. Most (58%) participants saw more than 30 patients daily and were most likely to have counseled clients about injectables (87%), condoms (84%), the pill (78%) and implants (73%) in the past month. Only 19% had ever inserted IUC, even though 30% had attended a training on IUC insertion. Focus group data were complementary; participants noted that while LARC provision was important, it was hindered by the lack of experienced LARC providers, their heavy work burden and low demand both during and after training because of LARC misperceptions in the community. Improved counseling, LARC training and mentoring, efficient scheduling of trained providers and performance-based incentives may improve LARC provision. Conclusions: Providers in Lilongwe face both supply-side and demand-side barriers to LARC provision. Future efforts to improve LARC access need to address both sides simultaneously.
Wiebe E University of British Columbia, Vancouver BC, Canada
http://dx.doi.org/10.1016/j.contraception.2014.05.070
http://dx.doi.org/10.1016/j.contraception.2014.05.068
P48
Objectives: To compare the early expulsion rates and other complications in frameless copper IUDs (Cu frameless) with those of LNG-IUS and T-shaped copper IUDS (Cu T). Methods: This was a retrospective chart review. The women having the frameless IUDs inserted were part of a clinical trial. At a follow-up visit 6–8 weeks postinsertion, ultrasound and pelvic examinations were performed. We compared rates of expulsion, infection, perforation, pregnancy and removal. Results: Follow-up data were available on 937 of 1062 women (88.3%). The three groups were similar with respect to mean age (31.3, 29.5 and 28.6) and uterus size (sounding length 7.6, 7.4 and 7.7 cm). The women receiving LNG-IUS and copper Ts were more likely to have had vaginal births than women receiving the frameless Cu (34.3% and 33.9% vs. 17.9%). There were no significant differences with respect to expulsion rates or other complications. The LNG-IUS group (n=215) had one perforation (0.5%), one infection (0.5%), four expulsions (1.9%) and six removals (2.8%). The copper T group (n=172) had three expulsions (1.7%) one pregnancy (0.6%)
P50 A QUALITATIVE EXPLORATION OF CONTRACEPTIVE DECISION-MAKING AMONG COUPLES IN NORTH-CENTRAL NIGERIA Giwa A University of Sheffield, Sheffield, UK Objectives: Despite the well-known benefits of contraception in improving the reproductive lives of women, the uptake in Nigeria, especially in the Northern regions, is still remarkably low. This paper departs from many quantitative studies on contraceptive decision-making and uses qualitative methods to explore how couples negotiate the use of contraceptive technology. Methods: Twenty semistructured interviews and five focus group discussions were conducted in households with wives within their reproductive age group
Abstracts / Contraception 90 (2014) 298–351
significant. Further studies are also needed to determine longer-term effects on minors’ access to abortion. http://dx.doi.org/10.1016/j.contraception.2014.05.067
P47
and one removal. The frameless Cu group had 5 perforations (0.9%), 1 infection (0.3%), 11 expulsions (2.0%) and 10 removals (1.8%). Conclusions: Complications rates are so low after IUD insertion that more than 2000 subjects in each group would be required to compare rates of expulsion with a power of .80 and α of .05. This study gives us some reassurance that frameless copper IUDs can be a good choice for some women. http://dx.doi.org/10.1016/j.contraception.2014.05.069
SEROSAL-ANCHOR MEASUREMENTS IMMEDIATELY AND 6–8 WEEKS POSTINSERTION OF FRAMELESS COPPER INTRAUTERINE DEVICES: ARE THESE RELATED TO EARLY COMPLICATIONS?
P49
E Wiebe University of British Columbia, Vancouver BC, Canada
FAMILY PLANNING PROVIDERS’ EXPERIENCES AND PERCEPTIONS OF LONG-ACTING REVERSIBLE CONTRACEPTION IN LILONGWE, MALAWI
Objectives: The purpose of this study was to determine if the position of the anchor of the frameless IUD on ultrasound postinsertion was related to early complications including perforation and expulsion. Methods: This was a prospective observational study of serosal-anchor measurements done by endovaginal ultrasound immediately and 6–8 weeks after insertion. At follow-up, ultrasound and pelvic examinations were performed. Women who did not come in for the follow-up visit were contacted by phone or email. We recorded demographic data and the rates of expulsion, infection, perforation, pregnancy and removal. Results: There were follow-up data available on 550 of 651 women (84.5%); one clinic had data for 93.6% of women, and the other had data for 62.0%. There were 27 early complications including 11 expulsions (2.0%), 5 perforations (0.9%), 10 removals (1.8%), 1 minor infection (0.2%) and 1 partial perforation (failed insertion). The mean serosal-anchor measurement postinsertion was 6.2(±2.5) mm and 6–8 weeks later was 5.9(±2.8 mm). The women who had perforations had measurements of 2.0 to 7.5 mm and 4/5 were within 1 standard deviation of the mean measurement for the whole group. The women who had expulsions had serosal-anchor measurements between 3.6 and 8.7 mm and 9/10 were within 1 standard deviation of the mean measurement. The mean difference between serosal-anchor measurements immediately and 6–8 weeks after insertion was 0.1 mm with a median and mode of 0. Conclusions: Measuring the serosal-anchor distance with ultrasound was feasible with the frameless IUD but was not predictive of expulsion and perforation.
O’Shea M UNC Project-Malawi, Lilongwe, Malawi Mwafulirwa T, Hamela G, Samuel E, Phiri R, Chingondole C, Chipangula V, Mwale M, Hosseinipour M, Tang J
A COMPARISON OF EARLY COMPLICATION RATES IN THREE IUDS — LNG-IUS, COPPER T AND FRAMELESS COPPER
Objectives: Despite high unintended pregnancy rates, less than 2% of Malawian women use intrauterine contraception (IUC) or the subdermal implant. Our objective was to describe Malawian family planning providers’ experiences and perceptions, with a focus on long-acting reversible contraception (LARC). Methods: We conducted a mixed-methods study using interviewer-administered surveys and focus group discussions with family planning providers at 12 government health centers in Lilongwe, Malawi. The quantitative and qualitative data were analyzed separately and then triangulated. Quantitative data were analyzed using descriptive statistics. Qualitative data were coded and focused on three domains: practice environment, perceptions of community family planning attitudes and strategies to improve LARC provision. Results: We administered 37 surveys and conducted three focus group discussions with 25 of the same providers. Most (58%) participants saw more than 30 patients daily and were most likely to have counseled clients about injectables (87%), condoms (84%), the pill (78%) and implants (73%) in the past month. Only 19% had ever inserted IUC, even though 30% had attended a training on IUC insertion. Focus group data were complementary; participants noted that while LARC provision was important, it was hindered by the lack of experienced LARC providers, their heavy work burden and low demand both during and after training because of LARC misperceptions in the community. Improved counseling, LARC training and mentoring, efficient scheduling of trained providers and performance-based incentives may improve LARC provision. Conclusions: Providers in Lilongwe face both supply-side and demand-side barriers to LARC provision. Future efforts to improve LARC access need to address both sides simultaneously.
Wiebe E University of British Columbia, Vancouver BC, Canada
http://dx.doi.org/10.1016/j.contraception.2014.05.070
http://dx.doi.org/10.1016/j.contraception.2014.05.068
P48
Objectives: To compare the early expulsion rates and other complications in frameless copper IUDs (Cu frameless) with those of LNG-IUS and T-shaped copper IUDS (Cu T). Methods: This was a retrospective chart review. The women having the frameless IUDs inserted were part of a clinical trial. At a follow-up visit 6–8 weeks postinsertion, ultrasound and pelvic examinations were performed. We compared rates of expulsion, infection, perforation, pregnancy and removal. Results: Follow-up data were available on 937 of 1062 women (88.3%). The three groups were similar with respect to mean age (31.3, 29.5 and 28.6) and uterus size (sounding length 7.6, 7.4 and 7.7 cm). The women receiving LNG-IUS and copper Ts were more likely to have had vaginal births than women receiving the frameless Cu (34.3% and 33.9% vs. 17.9%). There were no significant differences with respect to expulsion rates or other complications. The LNG-IUS group (n=215) had one perforation (0.5%), one infection (0.5%), four expulsions (1.9%) and six removals (2.8%). The copper T group (n=172) had three expulsions (1.7%) one pregnancy (0.6%)
P50 A QUALITATIVE EXPLORATION OF CONTRACEPTIVE DECISION-MAKING AMONG COUPLES IN NORTH-CENTRAL NIGERIA Giwa A University of Sheffield, Sheffield, UK Objectives: Despite the well-known benefits of contraception in improving the reproductive lives of women, the uptake in Nigeria, especially in the Northern regions, is still remarkably low. This paper departs from many quantitative studies on contraceptive decision-making and uses qualitative methods to explore how couples negotiate the use of contraceptive technology. Methods: Twenty semistructured interviews and five focus group discussions were conducted in households with wives within their reproductive age group