Abstract
Family planning is a system for attaining the desired number of children and enabling a desired spacing between pregnancies. Family planning can be achieved through both the use of contraceptive methods and the treatment of infertility. A woman’s ability to limit her pregnancy has a significant effect on her health.While family planning reduces the rate of unintented pregnancies, it also reduces the number of unsafe abortions. Contraception is an important component of family planning and reproductive health. Among various contraceptive methods, intrauterine devices (IUDs) are very popular because of some of the features of IUDs including being affordable, simplicity of insertion, long duration of action and reversibility. Modern, frameless, copper IUDs contain more copper and their copper content is contained in the solid tubular sleeves rather than in the wire which increases efficacy and lifespan. Immediate postpartum intrauterine device insertion (IPPI) during cesarean section can be considered in women who desire long acting, reversible contraception. Fertility returns instantly after removal of the device and pregnancy rate is not affected. IPPI is a very attractive method, especially for women who have undergone cesarean and require an interval of contraception before getting pregnant again. However, IPPI needs more clinical attention due to many aspects. The advantages remain including the prevention of unintended short interval pregnancies and, by providing an optimal timeframe for post-cesarean uterine recover, can reduce the incidence of the next cesarean delivery. With the publication of international IPPI studies, it will take a place in the range of globally available contraceptive methods, which in this author’s opinion, it deserves.
Highlights
An article appeared in the journal Contraception titled: “Immediate postplacental intrauterine devices (IUD) insertion (IPPI): the expulsion problem” [2]
IPPI insertion satisfies the basic requirements of any contraceptive method: Ease of insertion, safety of insertion, and high contraceptive effectiveness, but more importantly allows family planning discussions and contraception choices at a time when patient awareness is highest
Numerous attempts have been made to solve the problem of expulsion and IUD displacement primarily focused on establishing a maximal insertion window of 10 minutes post-placenta expulsion. These efforts tended to result in more favorable expulsion rates, they remain significantly higher after IPPI than after interval insertion of the same IUD
Summary
Planning provides individuals and couples to get desired number of children and interval between pregnancies. A trial conducted by Family Health International in the US reported six-month expulsion rates of 22% and 12% for the Lippes Loop D and the TCu220C, respectively [4]. Numerous attempts have been made to solve the problem of expulsion and IUD displacement primarily focused on establishing a maximal insertion window of 10 minutes post-placenta expulsion. These efforts tended to result in more favorable expulsion rates, they remain significantly higher after IPPI than after interval insertion of the same IUD. The comparative study, with a follow-up period of three months, compared the frameless, anchored, copper GYN-CS® with the TCu380A IUD in 140 women; 70 in each arm of the study. The precise positioning of the anchor can be verified in the fundus of the uterus, as the anchor is provided with a tiny stainless-steel marker, highly visible on ultrasound examination
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