Counselling of complications of termination of pregnancy within a single Trust setting.

BACKGROUND: National guidelines on the care of women requesting induced abortion recommend that counselling prior to termination of pregnancy (TOP) includes information about potential complications and sequelae. Case notes of women requesting TOP in a single hospital Trust were audited for documentation of counselling about complications. As a result of this audit the integrated care pathway (ICP) was altered to include a list of the potential complications and sequelae. We repeated the audit to evaluate the effect of this intervention on counselling. OBJECTIVE: To re-audit the counselling of women undergoing TOP with regard to the potential complications and sequelae of TOP and to compare counselling in consultant-led and nurse-led clinics. METHODS: The study population comprised women requesting TOP within south Glasgow, UK who were seen in a consultant-led gynaecology clinic or nurse-led clinic. A retrospective audit was carried out in 2004 and a prospective audit in 2005. Case notes and correspondence to primary care referrers were reviewed for documented evidence of counselling. RESULTS: We reviewed 98% of case notes in the first audit and 85% in the second audit. Results from both nurse-led and consultant-led clinics indicated that evidence of adequate counselling had improved, with an increase from 98% to 100% in the nurse-led clinics and from 43% to 64% in the consultant-led clinics. CONCLUSIONS: Comparison of results from 2004 and 2005 suggests improvement in counselling since introduction of an ICP listing complications and sequelae of TOP.

Surgical management of stress urinary incontinence in Scotland and Wales: a questionnaire study.

Urodynamic stress incontinence is a common complaint. There have been over two hundred procedures described for treatment. In 2003, the Royal College of Obstetricians and Gynaecologists in London published a guideline highlighting the evidence for different surgical approaches. These guidelines are intended to guide practice in the United Kingdom, including the two countries that were surveyed. It was our impression however that more sub-urethral tape type procedures were taking place than was recommended. We therefore undertook a postal survey of the consultant gynaecologists in Scotland and Wales, to compare current practice with the evidence base, and also to assess practice from a clinical and manpower perspective. Two hundred and forty consultants were identified in Scotland (161) and Wales (79). About two-thirds of those who saw patients with stress incontinence would always arrange pre-operative physiotherapy, and the majority of consultants would always organise urodynamics preoperatively. There were several different choices of primary procedure, with Tension Free Vaginal Tape (TVT Gynecare- Johnson & Johnson) the most common option. More than half of the respondents in both countries would refer a patient with recurrent stress incontinence to a specialist. TVT was also the most common choice of procedure for recurrent stress incontinence. The procedures that have a grade A recommendation in the RCOG guideline are Burch colposuspension and TVT, and 72% in Scotland and 63% in Wales would perform one of these procedures as first choice. Clinical practice moves on and there are several new sub-urethral tape procedures available on the market. It is important to balance the available evidence base with new developments in order to optimise the management of this common condition.