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Assessment of a ‘fast-track’ referral service for intrauterine contraception following early medical abortion
  1. Sharon T Cameron1,
  2. Nayani Berugoda2,
  3. Anne Johnstone3,
  4. Anna Glasier4
  1. 1Consultant Gynaecologist, Chalmers Sexual and Reproductive Health Service, NHS Lothian, Edinburgh; Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh; and Department of Reproductive and Developmental Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Specialist Trainee in Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3Clinical Research Nurse, Department of Reproductive and Developmental Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
  4. 4Consultant Gynaecologist, Department of Reproductive and Developmental Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Sharon T Cameron, Chalmers Sexual and Reproductive Health Service, NHS Lothian, 2a Chalmers Street, Edinburgh EH3 9ES, UK; sharon.cameron{at}ed.ac.uk

Abstract

Background A ‘fast-track’ referral system for intrauterine contraception was established in 2007 between the medical abortion service at the Royal Infirmary of Edinburgh and the principal family planning clinic (FPC) in Edinburgh.

Methods Case note review of women fast-tracked for intrauterine contraception after medical abortion between January 2007 and June 2009. Main outcome measures were numbers of women referred, attendance rates, interval to insertion, devices chosen and known complication rates.

Results Of the 237 women referred, 126 (53%) attended for intrauterine contraception insertion. Attenders were slightly but significantly older than non-attenders (mean ages of 30 and 27 years, respectively; p=0.003), less likely to live in an area of deprivation (p=0.045) and were significantly more likely to have attended the FPC in the past (p<0.0001). Most attenders (90%; n=113) proceeded to have an intrauterine method inserted; 57% (n=64) chose the levonorgestrel intrauterine system and 43% (n=49) chose a copper intrauterine device. The median interval to insertion was 21 (range 0–54) days. Of those women (n=55) who attended for routine follow-up 6 weeks later (49%), there were four (7.2%) cases of expulsion, two (3.6%) requests for removal and four (7.2%) cases of suspected infection.

Conclusions Only half the women fast-tracked for intrauterine contraception actually attended and these tended to be women who were pre-existing clients of the FPC. Consideration should therefore be given to provision of immediate insertion where possible.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.