J Fam Plann Reprod Health Care
· 2017 Oct · PMID 28823998
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AIM: To design and evaluate a pilot service for primary care endometrial sampling (PCES). DESIGN: Retrospective analysis of data from two service evaluations. SETTING: General practices and the gynaecology department in...AIM: To design and evaluate a pilot service for primary care endometrial sampling (PCES). DESIGN: Retrospective analysis of data from two service evaluations. SETTING: General practices and the gynaecology department in a large city in the UK. METHODS: These were two-fold: (1) To design the new service we identified all the endometrial samples taken in the city's gynaecology department in 2012/2013 and estimated the proportion of these with abnormal uterine bleeding (AUB) that would be suitable for PCES. (2) To evaluate the new PCES service we analysed data from the first year of activity. RESULTS: (1) A total of 1894 endometrial samples were taken in hospital in 2012/2013. An estimated 424 (22.4%) of these were from patients with AUB who fitted the criteria for PCES. (2) In the first year of the PCES service 108 samples were taken by general practitioners (GPs). Initial management of these patients was exclusively in primary care in 97.2% (104/108) of cases; most patients were treated with the Mirena intrauterine system (79/109; 73.1%) and there were no cases of hyperplasia or cancer. CONCLUSIONS: Most premenopausal patients with AUB could potentially be managed in primary care without referral to hospital if endometrial sampling (ES) was made available to appropriately trained and supported GPs. However, this study was limited by its retrospective, non-interventional design, and more research is required to demonstrate safety and cost-effectiveness.
J Fam Plann Reprod Health Care
· 2017 Oct · PMID 28739631
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INTRODUCTION: One of the major concerns with the insertion of intrauterine devices is uterine perforation. Though uncommon, it can be debilitating and result in failure of the device. In this article we review uterine pe...INTRODUCTION: One of the major concerns with the insertion of intrauterine devices is uterine perforation. Though uncommon, it can be debilitating and result in failure of the device. In this article we review uterine perforation with intrauterine contraception (IUC) in a community clinic in the UK over a 16-year period. METHODS: We prospectively collected data on uterine perforations for the years 2000-2015, reviewed associated factors and calculated the annual rate of perforation, estimating if this lay within the expected range of normal variation using statistical process control (SPC) analysis. We analysed the rates of perforation in relation to the time from delivery and to breastfeeding. RESULTS: We identified 30 uterine perforations in 22 795 IUC insertions over the 16 years of observation, with an annual rate ranging from 0 to 4.3 per 1000 insertions, and a mean annual rate of 1.3 per 1000 insertions (95% CI 0.9 to 1.9), which remain within the SPC limits. Twenty-eight of the perforations were in parous women, 87% of whom were within 18 weeks of delivery, peaking at 13 weeks postpartum. Twenty of these were in breastfeeding women. In 3/28 cases for which we have outcome data the device was adherent to or had perforated either the bladder or bowel. CONCLUSION: Our perforation rate is consistent with other studies. Most of our perforations were within 18 weeks of childbirth, earlier than in a recent major study. We cannot tell from our data if there is a true peak in perforations 3 months postpartum as that may be a time when a high proportion of insertions are done.
J Fam Plann Reprod Health Care
· 2017 Oct · PMID 28698244
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BACKGROUND: Controversy exists as to whether 'abortion or 'termination of pregnancy' should be used by health professionals during interactions with women and in published works. METHODS: Self-administered anonymous ques...BACKGROUND: Controversy exists as to whether 'abortion or 'termination of pregnancy' should be used by health professionals during interactions with women and in published works. METHODS: Self-administered anonymous questionnaires were distributed to women attending 54 abortion clinics in Scotland, England and Wales during a 4-month period in 2015. Responses were coded and analysed using SPSS. Descriptive statistics were generated and responses compared by demographic characteristics. The main outcome measures were the proportion of respondents reporting that they found the terms 'abortion' and 'termination of pregnancy' to be distressing, and women's preferred terminology for referring to induced abortion. RESULTS: Surveys were completed by 2259 women. The mean age of the respondents was 27(range 13-51) years; 82% identified as white, 51% had children and 36% had previously undergone abortion. Thirty-five percent indicated that they found the word 'abortion' distressing compared with 18% who reported that 'termination of pregnancy' was distressing (< 0.001). Forty-five percent of respondents expressed a preference for 'termination of pregnancy' and 12% for 'abortion'. Sixteen percent would choose either term. This pattern of results did not vary statistically by age, reproductive history, country of residence, ethnicity or level of deprivation. CONCLUSIONS: Most women seeking abortion did not find the terms 'abortion' or termination of pregnancy' distressing. When given a choice of terms, more women who expressed a preference chose 'termination of pregnancy'. Healthcare professionals should be sensitive to preferences for terminology when communicating with women seeking abortion.
Sherman S, Harden J, Cattanach D
… +1 more, Cameron ST
J Fam Plann Reprod Health Care
· 2017 Oct · PMID 28689176
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BACKGROUND: An animated film has been created to provide information to women requesting early medical abortion (EMA). The 9 min film, , was created using one woman's personal account of her experience. This study evalua...BACKGROUND: An animated film has been created to provide information to women requesting early medical abortion (EMA). The 9 min film, , was created using one woman's personal account of her experience. This study evaluated the views of women who had recently undergone EMA on the film and its potential usefulness in providing experiential information to women requesting EMA. METHOD: Women who had undergone EMA within the past month were recruited. They were shown the film and interviewed in a semi-structured style. Interviews were recorded and transcribed verbatim. They were analysed using cross-sectional indexing and thematic analysis with an inductive approach. RESULTS: 13 women were interviewed. All reported that the film gave a realistic account of EMA and most agreed that they would have wanted to watch it before EMA had it been available. Some said that it might help women who were struggling with decision-making with regard to EMA and all said that there should be unrestricted access to the film from the website of the abortion service. The women commented that the animated style of the film allowed all groups of women to relate to the story. Some commented that Lara's experience of pain, bleeding and side effects such as nausea differed from their own and therefore felt that it would be useful to make more than one woman's account available. CONCLUSION: The availability of animated audiovisual films recounting women's experiences of EMA might be a valuable adjunct to clinical information for women seeking EMA.