Abstract

Laparoscopic sterilisation is increasing the burden on theatre list, prolonging clinic and theatre waiting times, thus increasing performance pressure. The reason of this audit is to figure out whether women are being appropriately referred and adequately counselled for the sterilisation. A CEU guidance has been published by the Faculty of Sexual and Reproductive Healthcare (FSRH) on Male and Female sterilisation in 2014 and it should be followed closely by clinicians in the UK. Aims:

To determine the DNA rate at clinics.
To audit aspects of the counselling against standards set by CEU guidance published by Faculty of Sexual and Reproductive Health in agreement with Royal College of Obstetrics and Gynaecologists [1]
o LARC offered
o Vasectomy / partner
o Risks of procedure
o Regret if <30 years old, nulliparous or recently had baby

To determine the final decision of patients following consultation
Methods: The records of 47 women who were referred for sterilisation from July to October 2018 by their GP were reviewed. Data was recorded retrospectively by reviewing case notes from general gynaecology clinics and nurse led sterilisation clinics.
The age, BMI, relationship status, parity and mode of delivery (if any) were recorded. Data such as whether risks of sterilisation procedure (failure risk, ectopic pregnancy), risk of regret, alternatives such as LARC or vasectomy of partner were recorded.
Summary of results:
Only 13 out of 47 patients chose LARC over sterilisation during the consultation.
couples chose vasectomy as an alternative.
36 % of patients have had or are on the waiting list for a laparoscopic sterilisation.

Conclusions:
 DNA rates were x3 higher in nurse-led sterilisation clinics compared to general gynaecology clinics.
 Counselling about LARC as an alternative to sterilisation (94%) nearly reaching standards although ultimate goal should be 100%.
 LARC accepted in approximately 1/3 of cases and the aim is to encourage it further among women.