Rapid, minimally invasive adult voluntary male circumcision : a randomised trial of Unicirc, a novel disposable device

CITATION: Millard, P. S., Wilson, H. R., Goldstuck, N. D. & Anaso, C. 2014. Rapid, minimally invasive adult voluntary male circumcision: a randomised trial of Unicirc, a novel disposable device. South African Medical Journal, 104(1):52-57, doi:10.7196/SAMJ.7357.The original publication is available at http://www.samj.org.zaBackground. Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate VMMC scale-up, the World Health Organization is seeking circumcision techniques that are faster, easier, and safer than open surgical methods. Objective. To compare open surgical circumcision with suturing v. the Unicirc disposable instrument plus tissue adhesive. Methods. We conducted a non-blinded randomised controlled trial at an outpatient primary healthcare clinic in Cape Town, South Africa, with 2:1 allocation ratio of 150 male volunteers who were at least 18 years of age. Our primary outcome was intraoperative time and secondary outcomes were ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result. Results. The intraoperative time was less with the Unicirc/adhesive technique (median 13 v. 22.6 min, respectively; p<0.001). The intraoperative suturing rate was 17% using the Unicirc device. Other adverse events and wound healing outcomes were similar in both groups, but the cosmetic result was superior in the Unicirc group. Doctors found the Unicirc procedure easier to perform and preferred it to the open surgical technique. Conclusions. This study has important implications for the scale-up of VMMC services. Excising the foreskin with the Unicirc instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, easier to learn, and is potentially safer than open surgical VMMC. Further studies should be conducted with the optimised device. This new instrument has the potential to facilitate more rapid scale-up and save costs.http://www.samj.org.za/index.php/samj/article/view/7357Publisher's versio

Postpartum Contraception

The provision of effective and safe contraception during the postnatal period is an important aspect of maternal care. There is still a high unmet need for modern contraception postpartum. The postnatal ward is not the most appropriate setting to discuss future contraception for the first time; however it should be discussed at the latest in the first week postpartum and a future contraceptive plan needs to be established by week four as women may be fertile before the return of their menstrual cycle. Breastfeeding can prevent pregnancy based on natural postpartum infertility due to the suppression of ovulation and guidelines to improve the efficacy of breastfeeding as a contraceptive method were developed. The World health Organization provides evidence-based recommendations (World Health Organisation (WHO) Medical Eligibility Criteria (MEC) to ensure that patients with medical conditions are fit to use a particular method and can safely select the most appropriate method of contraception. Breastfeeding, modern contraceptive methods, sterilisation and emergency contraception should be considered in all cases.There are concerns about the possible hormonal effects of combined hormonal contraceptives on the suppression of quality and quantity of milk production as well as possible absorption by the infant. The increased risk of thromboembolism postpartum is also of concern when using COCs and it is recommended that the earliest date to commence is 21 days postpartum if there are no other risk factors for the development of VTE.Women should receive written information on contraceptives, provided with detailed advice about possible side-effects, including the availability of emergency contraception if needed and a follow-up appointment should be arranged.Keywords: Postpartum Contraceptio