Complete Expulsion Research Articles

A novel remote controlled capsule for site-specific drug delivery in human GI tract

Remote controlled capsule (RCC) has been extensively used in the field of site-specific drug delivery. It is a potent tool to study the regional drug absorption of the gastrointestinal (GI) tract that provides pharmaceutical scientists with significant pharmacokinetics data for oral drug formulation development. In present investigations, a patented novel RCC has been devised based on micro-electronic mechanical system (MEMS) technology. Micro-thrusters were for the first time exploited as drug release actuators of RCCs. As the micro-thruster is ignited by a radio frequency (RF) signal, the thrust force generated by the propellants pushes the piston forward and leads to a rapid and complete expulsion of therapeutic agents from the capsule. The micro-thruster merely consumes 120 mW for ignition and the duration time of drug release is decreased to less than 1 s. The feasibility of the novel RCC was evaluated through animal experiments in beagles using aminophylline as the model drug. The novel RCC developed is a promising alternative for site-specific drug delivery in human GI tract.

Evolución de la litiasis residual post-LEOC en función del tipo de cálculo y de la composición de la orina

Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures for removal of renal calculi from the upper urinary tract, but complete expulsion of the fragments generated is not always achieved. This can lead to new lithiasic episodes, and it is considered that 10-26% of fragmented calculi can undergo regrowth. This in vitro study investigated the influence of fragment and urinary composition on post-ESWL growth of fragments, with the aims of establishing the effect and importance of these parameters, and identifying effective prophylactic measures. Fragments collected from patients immediately following expulsion after ESWL treatment were selected for regrowth experiments. The particles included 24 calcium oxalate monohydrate (COM) fragments, 48 calcium oxalate dihydrate (COD), 24 hydroxyapatite (HAP), and 16 uric acid. In all treatments, calculi fragments showed a considerable capacity to induce growth of calcium oxalate and calcium phosphate. Under normocalciuria conditions, new COM crystals formed; both COM and COD crystals developed under hypercalciuria conditions at a urinary pH < 6.0; and in hypercalciuric conditions and urinary pH > 6.0 both HAP and brushite (BRU) crystals were formed. The highest growth rates were observed for COD calculi fragments under hypercalciuria conditions and at a urinary pH of 6.5, followed by growth on COM and HAP fragments under the same conditions; growth rates under other conditions tested were similar but 10-fold lower. With regard to the role of crystallization inhibitors, phytate exhibited inhibitory effects under all assay conditions. However, citrate had little effect, even at the highest concentration tested (1,000 mg/L). This study demonstrates the importance of avoiding heterogeneous nucleant retention (pre-existing solid microparticles) in renal cavities, as these can act as very efficient inducers of the formation of new calculi, the composition of which is mainly dependant on the urine composition.

Hormone Analytical and Carrier Protein Alternations Following Administration of Mifepristone (RU 486) for Termination of Early Pregnancy

Outpatient terminations were performed on 50 biochemically confirmed pregnancies of 33 to 43 days amenorrhea with a single oral dose of 600 mg of mifepristone (RU 486). 37 women were randomly assigned to an additional endocrine investigation, comprising serum levels of beta hCG, progesterone (P), estradiol (E2), cortisol (C), sexual hormone binding globulin (SHBG), and cortisol binding globulin (CBG) on days 0 and 7 prior to and following the drug administration. Of these 37 patients, 30 experienced a complete expulsion of the uterine contents, 28 until day 7, 2 subjects on day 9 and 10, respectively. The remaining 7 women either showed an unaffected pregnancy or the symptoms of incomplete abortion, which made a surgical intervention necessary. In the successfully treated cases the levels of beta hCG, P and E2 decreased significantly, the nonresponders showed unchanged or even increasing hormone values. No significant changes of cortisol concentrations were found in the group of nonresponders, while the successful cases exhibited a slight elevation probably due to the abortion-associated processes. No considerable therapy-dependent differences were observed in the levels of SHBG. A small but significant decrease in the mean CBG value could be calculated in the group of responders.

Mifepristone and Misoprostol for the management of placenta accreta – a new alternative approach

The incidence of morbidly adherent placentas has increased ten-fold in the past 50 years, currently occurring at a frequency of 1 per 1000–2500 deliveries1,2. It is contributing to a large proportion of postpartum hemorrhages (PPH) and has led to some maternal mortalities and several surgical interventions. Current management of morbidly adherent placentas – accreta, increta and especially percreta – reportedly result in a maternal mortality rate of up to 7%, and extensive morbidity due to massive hemorrhage, blood transfusions, infection, ureteral damage and fistula formation3–5. In developing countries, adherent placenta contributed to 13% of maternal deaths6. Traditionally there was a tendency to ensure complete removal of the placental tissue after the delivery to avoid the risk of PPH. This led to a high risk of intervention that sometimes was associated with higher morbidity. In reality, management of adherent placenta should be altered according to the cause of failed delivery of placenta and whether it is associated with PPH. Several options have been developed over recent years for the management of placenta accreta with limited success rates7–16. Recently, the combination of mifepristone/misoprostol was introduced for the treatment of placenta accreta. Both drugs were used over several years for the management of termination of pregnancy with a high success rate to reach complete expulsion of products of conception.

Complete Mesh Expulsion as a Complication of Vaginally Assisted Laparoscopic Cervicosacropexy with Subtotal Hysterectomy: A Case Report

We report the first case of complete mesh expulsion after laparoscopic subtotal hysterectomy associated with sacral suspension of the cervix for pelvic organ prolapse.

Study on a novel copper-containing composite for contraception

Background The copper-containing intrauterine devices (Cu-IUDs) are being increasingly used worldwide as an effective contraception for family planning. To avoid abnormal bleeding, pain, partial and complete expulsion, which are associated with the burst release of cupric ions during the first few days, a novel cross-linked composite based on polyvinyl alcohol (PVA) that contained cupric ions, but not metallic copper, was developed by our research team. Study Design As a logical extension of our previous work, the corrosion products and release behavior of this composite after immersing in simulated body fluid (SBF) for 1 year were studied by X-ray fluorescence spectroscopy (XRF), X-ray diffraction (XRD) and atomic absorption spectrophotometry (AAS). Results No other new elements, such as P, Cl and Ca, appeared on the surface of the composite, and no Cu 2O was formed after immersing in SBF for 1 year, indicating that the effectiveness of copper can be greatly improved. Furthermore, no significant change on time dependence was found for the release rates of cupric ions in the composite compared with that of metallic copper, suggesting the absent burst release of cupric ions in the composite. Conclusion The present in vitro long-term data suggest that this novel copper-containing composite has potential as a substitute for conventional materials used in the manufacture of IUDs.

Active management of the third stage of labour without controlled cord traction: a randomized non-inferiority controlled trial.

BackgroundThe third stage of labour refers to the period between birth of the baby and complete expulsion of the placenta. Some degree of blood loss occurs after the birth of the baby due to separation of the placenta. This period is a risky period because uterus may not contract well after birth and heavy blood loss can endanger the life of the mother. Active management of the third stage of labour (AMTSL) reduces the occurrence of severe postpartum haemorrhage by approximately 60–70%. Active management consists of several interventions packaged together and the relative contribution of each of the components is unknown. Controlled cord traction is one of those components that require training in manual skill for it to be performed appropriately. If it is possible to dispense with controlled cord traction without losing efficacy it would have major implications for effective management of the third stage of labour at peripheral levels of health care.ObjectiveThe primary objective is to determine whether the simplified package of oxytocin 10 IU IM/IV is not less effective than the full AMTSL package.MethodsA hospital-based, multicentre, individually randomized controlled trial is proposed. The hypothesis tested will be a non-inferiority hypothesis. The aim will be to determine whether the simplified package without CCT, with the advantage of not requiring training to acquire the manual skill to perform this task, is not less effective than the full AMTSL package with regard to reducing blood loss in the third stage of labour.The simplified package will include uterotonic (oxytocin 10 IU IM) injection after delivery of the baby and cord clamping and cutting at approximately 3 minutes after birth. The full package will include the uterotonic injection (oxytocin 10 IU IM), controlled cord traction following observation of uterine contraction and cord clamping and cutting at approximately 3 minutes after birth. The primary outcome measure is blood loss of 1000 ml or more at one hour and up to two hours for women who continue to bleed after one hour. The secondary outcomes are blood transfusion, the use of additional uterotonics and measure of severe morbidity and maternal death.We aim to recruit 25,000 women delivering vaginally in health facilities in eight countries within a 12 month recruitment period.ManagementOverall trial management will be from HRP/RHR in Geneva. There will be eight centres located in Argentina, Egypt, India, Kenya, Philippines, South Africa, Thailand and Uganda. There will be an online data entry system managed from HRP/RHR. The trial protocol was developed following a technical consultation with international organizations and leading researchers in the field.Expected outcomesThe main objective of this trial is to investigate whether a simplified package of third stage management can be recommended without increasing the risk of PPH. By avoiding the need for a manual procedure that requires training, the third stage management can be implemented in a more widespread and cost-effective way around the world even at the most peripheral levels of the health care system. This trial forms part of the programme of work to reduce maternal deaths due to postpartum haemorrhage within the RHR department in collaboration with other research groups and organizations active in the field.Trial RegistrationACTRN12608000434392

High-Dose Misoprostol as An Alternative Therapy After Failed Medical Abortion

The aim of this study was to determine the complete abortion rate for the vaginal administration of high-dose misoprostol after a failed medical abortion. When their medical abortions failed after the conventional oral administration of mifepristone and misoprostol, participants then received 1,000 microg of misoprostol vaginally. The efficacy and side effects of this treatment were evaluated. Twenty-seven women who failed to abort after the conventional administration of mifepristone and misoprostol were enrolled in this trial. Fourteen days after the vaginal administration of 1,000 microg misoprostol, the overall complete expulsion rate had reached 88.8% (24/27). Most adverse effects were mild to moderate and did not require treatment. The vaginal administration of 1,000 microg misoprostol as a salvage therapy after a failed medical abortion appears to be a safe and highly effective alternative to surgical intervention.

Vaginal Misoprostol in the Management of First Trimester Non-viable Pregnancy

To study the effectiveness of a regimen of repeated doses of vaginal misoprostol in the management of first trimester missed abortion, one hundred andfour pregnant women with first trimester non-viable pregnancies were treated with an initial dose of800 g of vaginal misoprostol followed after four hours by further doses of400 ! g fourhourly for a maximum of three doses. The complete expulsion rate was 85.6%. Fifty of the 104 (48.1%) women underwent surgical evacuation. In 14 (135%) women, gestational products were obtained and confirmed by histopathological examination. In 36 (34.6%) there were minimal or no products obtained and these were considered to be complete miscarriages. The cervical os was found open in all (135%) the incomplete miscarriages. Severe abdominal pain was experienced by 10.6% of the patients and excessive vaginal bleeding occurred in 135% of them. A fall in hemoglobin of more than one gramldl occurred in 5.8% of the women and another 5.8% of them had fever &gt; 38°C. The stay in hospital was two days for 87 (83.7%) women and three days for 15 (14.4%) women. One (1%) woman stayed four days and another stayed less than one day. None of the women had any complications. This study demonstrated the efficacy and safety of vaginal misoprostol as a medical treatment for first trimester non-viable pregnancies using an initial dose of 800 g, followed after four hours by further doses of 400 ! g four-hourly for a maximum of three doses. This management also provided adequate cervical dilatation for surgical evacuation when complete expulsion did not occur.

Fetus presentation and time taken for parturition in Antarctic fur seal, Arctocephalus gazella, at Cape Shirreff, Antarctica

We document the influence of fetus orientation in the time invested in the birthing process of Antarctic fur seals at Cape Shirreff, Antarctica. Our results show that breeching was significantly higher than cephalic orientation on the order of 1.5:1. The average duration of the birthing process was 37.26 min, and the average duration considering the fetus orientation was 27.22 and 49.39 min for the cephalic and breech, respectively. The average time was significantly different only in the phase from the appearance of the amniotic-allantoids sac to the complete expulsion of the pup. Possible explanations for this difference are: the friction between the opposite hair direction with the uterus-vaginal wall after the rupture of amnio-allantoid sac during the transit of the fetus in breech position, and/or the fact one or both front flippers would increase the scapular diameter and make the final step of fetus delivery more difficult.

Mid-gestation pregnancy termination in rabbits by the progesterone antagonist aglepristone

The efficacy of aglepristone treatment to induce abortion in does 15 and 16 days after mating was investigated. The pregnant does were randomly allocated into two groups: For group I, aglepristone was injected twice (10mg/kg, subcutaneously) on days 15 and 16 after mating (n=10); for group II the does got no treatment but the same volume of 0.9% sodium chloride solution was subcutaneously injected at the same days of pregnancy (n=5). group I, termination of pregnancy was successful in all does. The mean interval between the first administration of aglepristone and the beginning of vaginal discharge was 32.4+/-5.6h (range 19-72h). Complete expulsion of all fetuses was observed in four does with first occurrences of vaginal discharge on the same day. The duration between the first occurrence of vaginal discharge to expulsion of all fetuses ranged between 21 and 130h (mean 70.2+/-12.2h). As important side effects, decrease in food consumption during abortion time and irregular mating behaviour (52.3+/-2.0 days/range 46-63) were recorded. But after this time all does were mated again, 8/10 became pregnant and they whelped normal and live kittens. Group II, all does gave birth to live kittens after a mean pregnancy length of 31.2+/-0.37 days (range 30-32 days). The mean serum progesterone (P(4)) concentrations were significantly different between control and treated does after day 20 of pregnancy (P<0.05). The results indicate that aglepristone treatment is effective to induce abortion in does and causes no serious negative effects on further fertility except a short non-receptive period after abortion and short time decrease in food consumption.

Efficacy of simultaneous use of mifepristone and misoprostol for early abortion

For early medical abortion, the most widely accepted regimens involve oral mifepristone in either a 200or 600mg dose, followed 2 days later by misoprostol. A recent study has reported that the rate of complete expulsion with medical abortion remains unchanged even if the interval between administration of mifepristone and misoprostol decreased to between 6 and 8 hours [1]. Other research has revealed a high rate of complete abortion when the 2 drugs are used concurrently [2−4]. The aim of this study was to determine the complete abortion rate with concurrent use of mifepristone and vaginal misoprostol. The study received approval from the Institutional Review Board and written informed consent was obtained from all participants. Successful abortion was defined as complete medical abortion without surgical intervention. From November 2005 to October 2007, a total of 144 pregnant women underwent medical abortion. All eligible women had an intrauterine pregnancy at 49 days of gestation or less confirmed by vaginal ultrasound. The method used was oral administration of 200 mg mifepristone (Apano; Lotus Pharmaceutical Co., Taipei, Taiwan) and immediate intravaginal placement of 600 μg misoprostol (Cytotec; Pfizer, New York, NY, USA). Participants returned 3 days after administration of the combination. After being questioned regarding side effects, vaginal ultrasound was performed. All participants were scheduled for a second follow-up visit on day 14 after the

The Effect of Tamsulosin on Expulsion of Ureteral Stones after Extracorporeal Shock Wave Lithotripsy

Purpose: The aim of this study was to evaluate the effect of tamsulosin on expulsion of ureteral stones after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: Seventy-six patients (39 with upper ureteral stones and 37 with lower ureteral stones) treated with ESWL for stones <10mm were randomly divided into two groups. Tamsulosin (0.2mg orally once daily) was administered to group 1; group 2 received no medications. All patients were evaluated with respect to the number of episodes of ureteral colic, the expulsion rates of stones after ESWL, and the mean number of sessions of ESWL until complete expulsion of stones. Results: The complete expulsion rates of upper and lower ureteral stones did not differ significantly between groups 1 and 2 during each session of ESWL; however, the mean session of ESWL was lower in group 1 than in group 2. For upper ureteral stones, 1.8 sessions were necessary per patient in group 1, while 2.3 sessions were required for the patients in group 2 (p=0.039). For lower ureteral stones, 2.0 sessions were necessary per patient in group 1, while 2.9 sessions were required for the patients in group 2 (p=0.032). There were significant decreases in the number of episodes of pain in group 1 with lower ureteral stones (p=0.014). There were no side effects associated with tamsulosin. Conclusions: The use of tamsulosin in the treatment of upper and lower ureteral stones after ESWL can decrease the mean number of sessions of ESWL and the number of episodes of pain, but cannot improve the expulsion rate. Further research regarding the cost-effectiveness of tamsulosin after ESWL is needed. (Korean J Urol 2008;49:1100-1104) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Insights into a Mutation-Assisted Lateral Drug Escape Mechanism from the HIV-1 Protease Active Site

We provide insight into the first stages of a kinetic mechanism of lateral drug expulsion from the active site of HIV-1 protease, by conducting all atom molecular dynamics simulations with explicit solvent over a time scale of 24 ns for saquinavir bound to the wildtype, G48V, L90M and G48V/L90M mutant proteases. We find a consistent escape mechanism associated with the G48V mutation. First, increased hydrophilic and hydrophobic flap coupling and water mediated disruption of catalytic dyad hydrogen bonding induce drug motion away from the dyad and promote protease flap transition to the semi-open form. Conversely, flap-inhibitor motion is decoupled in the wildtype. Second, the decrease of total interactions causes unidirectional lateral inhibitor translation by up to 4 A toward the P3 subsite exit of the active site, increased P3 subsite exposure to solvent and a complete loss of hydrophobic interactions with the opposite end of the active site. The P1 subsite moves beyond the hydrophobic active site side pocket, the only remaining steric barrier to complete expulsion being the "breathable" residue, P81. Significant inhibitor deviation is reported over 24 ns, and subsequent complete expulsion, implemented using steered molecular dynamics simulations, is shown to occur most easily for the G48V-containing mutants. Our simulations thus provide compelling support for lateral drug escape from a protease in a semi-open flap conformation. It is likely that some mutations take advantage of this escape mechanism to increase the rate of inhibitor dissociation from the protease. Finally, unidirectional translation may be countered by designing inhibitors with terminal subsites that provide sufficient anchoring to the flaps, thus increasing the steric barrier for translation in either direction.

High-beta plasma effects in a low-pressure helicon plasma

In this work, high-beta plasma effects are investigated in a low-pressure helicon plasma source attached to a large volume diffusion chamber. When operating above an input power of 900W and a magnetic field of 30G a narrow column of bright blue light (due to Ar II radiation) is observed along the axis of the diffusion chamber. With this blue mode, the plasma density is axially very uniform in the diffusion chamber; however, the radial profiles are not, suggesting that a large diamagnetic current might be induced. The diamagnetic behavior of the plasma has been investigated by measuring the temporal evolution of the magnetic field (Bz) and the plasma kinetic pressure when operating in a pulsed discharge mode. It is found that although the electron pressure can exceed the magnetic field pressure by a factor of 2, a complete expulsion of the magnetic field from the plasma interior is not observed. In fact, under our operating conditions with magnetized ions, the maximum diamagnetism observed is ∼2%. It is observed that the magnetic field displays the strongest change at the plasma centre, which corresponds to the maximum in the plasma kinetic pressure. These results suggest that the magnetic field diffuses into the plasma sufficiently quickly that on a long time scale only a slight perturbation of the magnetic field is ever observed.

Comparison of the release behaviors of cupric ions from metallic copper and a novel composite in simulated body fluid

The copper-containing intrauterine devices (Cu-IUDs) are being increasingly used worldwide as an effective contraceptive for family planning. To avoid abnormal bleeding, pain, and partial and complete expulsion which are associated with the burst release of copper during the first few days, a novel crosslinked composite based on poly(vinyl alcohol) that contained cupric ions, but not metallic copper, was synthesized. It is hypothesized that the burst release of cupric ions could be avoided and the utility of the cupric ions could be improved by this novel composite. To evaluate these effects of the composite, the corrosion products and the release rate of cupric ions after soaking in simulated body fluid (SBF) for different time spans were studied by environmental scanning electron microscopy, X-ray energy dispersive spectroscopy, X-ray diffraction, and atomic absorption spectrophotometer. In the first week, the release amount of cupric ions in the composite was 0.486 microg/mm(2). In the fifth week, it decreased to 0.0278 microg/mm(2). But for metallic copper, these were 5.93 microg/mm(2) and 0.041 microg/mm(2), respectively. No significant change on time-dependence was found for the release rates of cupric ions in the composite compared with that of metallic copper. Moreover, no other new elements, such as P, Cl, and Ca, appeared on the surface of the composite, and no Cu2O was formed after immersing in SBF for 90 days. All of these results suggested that burst release of cupric ions could be avoided and the effective utility of copper could be improved in this composite. In view of the earlier results, this novel copper-containing composite might serve as a potential substitute for conventional materials of IUDs in the future.

Release behavior of copper ion in a novel contraceptive composite

Purpose The universally used contraceptive method, the Cu-IUD, an effective contraceptive, is being increasingly used worldwide for family planning. To avoid abnormal bleeding, pain, partial and complete expulsion associated with the burst release of copper during the first few days, a novel cross-linked composite based on poly vinyl alcohol (PVA) that contains copper ions, but not metallic copper, was synthesized. Material and Methods PVA, well known for its good processability, high strength, long-term temperature and pH stability and biocompatibility, was used as the matrix material. The corrosion products and the release rate of copper ions after soaking in simulated body fluid (SBF) for different time spans were studied by environmental scanning electron microscopy, X-ray energy dispersive spectroscopy, X-ray diffraction and atomic absorption spectrophotometer. Results No significant change on time dependence for the release rate of copper ions in the composite compared with that of metallic copper was found. Moreover, no other new elements, such as P, Cl and Ca, appeared on the surface of the composite and no Cu 2O formed after immersing in SBF for 90 days. Conclusion Burst release of copper ions can be avoided by loading copper ions in this polymer material. Release channels would not be obstructed by the deposition of corrosion products and nearly all of the copper loaded in the composites could be an effective contraceptive.

Risk factors for unsuccessful medical abortion with mifepristone and misoprostol

The aim of this study was to determine the effectiveness of medical abortions with mifepristone and misoprostol following the approval of medical abortion in Israel. A retrospective review of 377 consecutive medical records at an ambulatory care unit of a university medical centre was performed, screening all women undergoing medical abortion with mifepristone and misoprostol. Transvaginal ultrasonographic study and serum beta hCG measurement were performed 14-20 days after the procedure. The clinical outcome was defined as complete expulsion of intrauterine contents with (failed group) or without (successful group) surgical intervention. Surgical intervention was performed in 7.4% of patients. Residual products of conception were confirmed in 89%. Older age, previous spontaneous abortions, multigravidity, and earlier follow-up visit were independently associated with unsuccessful medical abortion. Significant differences were found in mean serum beta hCG and mean endometrial thickness in the successful versus failed procedure groups. Medical termination of pregnancy with mifepristone and misoprostol is >90% effective. High risk group for failure of the procedure can be characterised. An algorithm of follow up using follow-up visit date, serum beta hCG and sonographic endometrial stripe is suggested to define high risk patients for failed medical abortion.

Partial and complete expulsion of the Multiload 375 IUD and the levonorgestrel-releasing IUD after correct insertion

Objective The contraceptive efficacy of intrauterine devices (IUD) is thought to relate to the position of the IUD in the uterine cavity. Several trials examined the number of copper IUD expulsions, but none evaluated the partial and complete expulsion rate of the levonorgestrel-releasing device (LNG-IUD). Study design This retrospective cohort study compares the dislocation rate of the Multiload 375 IUD (ML 375) and the LNG-IUD in 214 women (107 subjects with each IUD). Transvaginal ultrasound was used to monitor the IUD position immediately after insertion, after 6 weeks, and later on at intervals of 6 months. The observation period included 3631 cycles. Results We detected a significantly lower number of dislocations in LNG-IUD users. Previous expulsion was associated with a significantly higher risk for a re-expulsion in both IUD groups. Hypermenorrhea was not associated with an increased dislocation rate in LNG-IUD users. Conclusion Expulsions are less likely to occur with the LNG-IUD, which might contribute to its contraceptive efficacy.

Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up

Objective This study aimed to compare immediate postplacental (IPP) and early postpartum (EP) intrauterine device (IUD) insertions with interval (INT) IUD insertions with respect to efficacy and complications. Methods The study group consisted of 268 women in whom the following TCu 380A IUD insertions were performed: 84 IPP (less than 10 min), 46 EP (10 min to 72 h) and 138 INT (more than 6 weeks). The women were followed up 8 weeks, 6 months and 12 months after insertion. Complications and pregnancies encountered at the end of 1 year following IPP, EP and INT insertions were compared. The chi-square test and Fisher's Exact Test were used for the evaluation of the data. Results Complications developed in 40.4% of the women in the IPP group, in 74.4% of the women in the EP group and in 19.2% of the women in the INT group (p<.001). Although no statistically significant difference was found between the groups for uterine perforation and infection (p>.001), there was a statistically significant difference between the groups in the incidence of complete and partial expulsion according to the time of IUD insertion. The overall cumulative pregnancy rate and frequency of pregnancy were found to be higher (p>.05 for both), which are both insignificant for the EP group (2 of 43 women), as compared with the INT (4 of 130 women) and IPP groups (2 of 84 women), and pregnancy rates at 1 year for all groups was 3.1% (8 of 257 women). Conclusion IPP and EP insertion of the TCu 380A IUD is an effective and convenient procedure, and expulsion rates in these groups are higher than in the INT group. Further studies are necessary to determine the cause of the higher expulsion rates and to find ways to reduce such rates.