Copper Intrauterine Contraceptive Device Research Articles

Comparison between intrapartum and post puerperium insertion of copper intrauterine contraceptive device in women undergoing elective caesarean section.

Comparison between intrapartum and post puerperium insertion of copper intrauterine contraceptive device in women undergoing elective caesarean section.

Frequency of contraceptive use among Female Specialists and Consultants of Multan, Pakistan

Objective: To describe frequency of contraceptive use among female specialists and consultant doctors of Multan City. Study Design: Cross-sectional study. Place and Duration: It is a multicenter study on female doctors of Multan City from 01 April 2022 to 31 Dec 2022, conducted by Department of Obstetrics & Gynaecology Nishtar Hospital Multan. Methodology: An anonymous, predesigned questionnaire survey was performed on specialists and consultant female doctors, gynecologists and non-gynaecologists, during their reproductive age, practicing in the city of Multan. Total 100 female doctors (N) were included. Results: Overall prevalence of contraception was 84%. Amongst them 48% are from gynecology. In the gynecologist group, 91.7% used contraception, 50 % of them are from age 31 -38 years and 75% had parity ≤ 3. 50% of use the barrier methods, 16.7 % copper intrauterine contraceptive device, 16% calendar method, 4.2 % each for mirena and tubal ligation. No one used oral contraceptive pill. From the non-gynecologist group, prevalence was 76.9%. 53.8% were of age > 38 years, 80.8% had parity ≤ 3. Among choice of contraception, 42.3% used Barrier method, 23.1 % oral contraceptive pills, 3.8% copper intrauterine contraceptive device. None used calendar method, mirena and tubal ligation. Conclusion: Even amongst the most qualified doctors of Multan city, half of them used Barrier methods. 16% of the gynecologists used Calendar method. These results enable us to change the thinking and contraceptive practices of the most literate persons of an urban city of an underdeveloped country. Keywords: Contraception, Gynaecologists, Specialists, Consultants, Multan. How to Cite This: Ali S, Yasmeen S, Parveen R, Akhter S. Frequency of contraceptive use among Female Specialists and Consultants of Multan, Pakistan. Isra Med J. 2023; 15(2): 65-69. DOI: https://doi.org/10.55282/imj.oa1365

The Effect of Use of Copper Intrauterine Device for Contraception on Pain and Female Sexual Functions

The Effect of Use of Copper Intrauterine Device for Contraception on Pain and Female Sexual Functions

Transvaginal ultrasonography and color Doppler in female patients complaining of menorrhagia and using copper intrauterine contraceptive device

Transvaginal ultrasonography and color Doppler in female patients complaining of menorrhagia and using copper intrauterine contraceptive device

Knowledge, beliefs and practices of nurses with long-acting reversible contraception, Cape Town.

Implanon and copper intrauterine contraceptive device (IUCD) are long-acting reversible contraceptives (LARC) available in public primary health care (PHC) South Africa. These methods are the most effective forms of contraception. To evaluate the knowledge, beliefs and practices on provision of LARC. Primary health care facilities within the Khayelitsha Eastern Substructure, Cape Town. A descriptive survey of all permanent nurses who provided contraception. Data were collected from 72/90 (80% response rate) via a validated questionnaire and evaluated using Statistical Package for Social Sciences (SPSS). Knowledge of eligibility for LARC was tested. The mean knowledge scores for Implanon were 8.56/11 (s.d. 1.42) for the trained and 7.16/11 (s.d. 2.83) for the untrained (p = 0.007). The mean knowledge scores for IUCD were 10.42/12 (s.d. 1.80) for the trained and 8.03/12 (s.d. 3.70) for the untrained (p = 0.019). Participants believed that inaccessibility to training courses (29%), no skilled person available (24%) and staff shortages (35%) were barriers. Less than 50% of women were routinely counselled for LARC. Forty-one percent of nurses were trained and performed IUCD insertion, and 64% were trained and performed Implanon insertion, while 61% and 45% required further training. Confidence was low, with 32% trained and confident in IUCD and 56% trained and confident in Implanon insertion. Lack of training, poor confidence and deficient counselling skills were barriers to effective LARC provision. The identified system-specific barriers must be addressed to improve uptake.Contribution: The first study to evaluate knowledge, beliefs and practices on LARC in providers in the Western Cape.

Evaluation of Immediate Post-placental Insertion of the Copper Intrauterine Contraceptive Device during Caesarean Delivery

Evaluation of Immediate Post-placental Insertion of the Copper Intrauterine Contraceptive Device during Caesarean Delivery

Uterine Artery and Arcuate Vessels Doppler in Patients with Abnormal Uterine Bleeding Using Copper Intrauterine Contraceptive Device (IUCDs) and Combined Oral Contraceptive Pills (COCPs)

Uterine Artery and Arcuate Vessels Doppler in Patients with Abnormal Uterine Bleeding Using Copper Intrauterine Contraceptive Device (IUCDs) and Combined Oral Contraceptive Pills (COCPs)

Uterine Artery Doppler Indices: Pulsatility Index and Resistance Index as Predictive Tools to Menstrual Changes Related to Levonorgestrel Intrauterine System versus Copper Intrauterine Contraceptive Device Among Egyptian Women: A Cohort Study

Uterine Artery Doppler Indices: Pulsatility Index and Resistance Index as Predictive Tools to Menstrual Changes Related to Levonorgestrel Intrauterine System versus Copper Intrauterine Contraceptive Device Among Egyptian Women: A Cohort Study

Ectopic Pregnancy in A 28-year-old Woman with CuT IUCD in Situ – A Case Report

Background: There is a 3–4 percent chance of all pregnancies being ectopic in location. The risk of ectopic pregnancy to a woman using an Intrauterine Contraceptive Device (IUCD) is lower than that in a woman using no form of birth control. However if awoman gets pregnant whiles using the IUCD, the chances of having ectopic is more than 4 percent. Data on the occurrence of ectopic gestation with IUCD in situ is scanty, with no report of any such case in Ghana or West Africa. The objective of this report is therefore to contribute to knowledge on the subject with the view to bring it to attention among clinicians.Case: A 28year old woman (G3P1A+1) who has had copper IUCD in situ for over two years, reported to a health facility in Accra after missing her period for two weeks. She had performed a home-based urine pregnancy test on three separate occasions, and theywere all positive. A trans-vaginal ultrasound scan showed a small cystic lesion in the right adnexa with moderate fluid in the pouch of Douglas. A right tubal abortion was found at laparotomy.Conclusion: Ectopic pregnancy in women with an IUCD is an important major potential complication that can be life-threatening.Adequate counselling by clinicians would create awareness among clients for early reporting of amenorhoea and prompt intervention for desirable outcome.

Can pre-insertion uterine artery Doppler indices predict intrauterine contraceptive device-related heavy menstrual bleeding?

Background: The intrauterine contraceptive device (IUCD) is a frequently used method of contraception all-over the world. The most common side effect of IUCD is menorrhagia which is accountable for increased removal rate in the first year of its use. Objective: To test the hypothesis that initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of Tcu 380A IUCD could predict IUCD-related heavy menstrual bleeding or not. Methodology: A cohort study was performed on 300 women who demanded copper IUCD insertion as a method of contraception. Full history, detailed examination and investigations were done. Hemoglobin (Hb) concentration and PI and RI of uterine artery were measured using voluson B6 equipment before IUCD insertion and 3 and 6 months after insertion. Results: 162 participants who suffered from heavy menstrual bleeding (group II) had significantly lower uterine artery PI and RI than 138 participants who did not suffer from heavy menstrual bleeding (group I) before IUCD insertion and 3 and 6 months after insertion (p-value 0.05). 64 participants in group II with severe heavy menstrual bleeding required removal of the IUCD at the 3 months follow up visit. A cut-off levels for Doppler indices of uterine artery were PI ≤1.52 and RI ≤0.66. Conclusion: PI and RI of uterine artery are lower in patients with IUCD-induced heavy menstrual bleeding before IUCD insertion. Initial measurement of Doppler indices of uterine artery could predict IUCD-related heavy bleeding.

Uterine artery Doppler indices: pulsatility index and resistance index as predictive tools for the incidence of heavy menstrual bleeding related to copper intrauterine contraceptive device.

ObjectivesTo assess the predictive value of the initial uterine artery Doppler indices, the pulsatility index (PI), and resistance index (RI) in the prediction of heavy menstrual bleeding before and after copper intrauterine contraceptive device (IUCD) insertion.MethodsThe current prospective clinical study included 100 women who intended to use a copper IUCD (Cu T-380A) and met the inclusion criteria. Uterine artery Doppler PI and RI indices were calculated before IUCD insertion and at three and six months after insertion. Based on the presence or absence of menorrhagia, all women were classified into two groups: non-bleeding (n=52) and extreme menstrual bleeding (n=48). Receiver operating curve analysis was used to determine the predictive value of uterine artery PI and RI in patients with menorrhagia relevant to IUCD.ResultsThe PI and RI indices displayed a highly significant difference between the IUCD groups at three and six months after insertion (P<0.001). Uterine artery PI ≤2.02 (sensitivity of 95.8%, specificity of 100%, and area below the curve [AUC] of 0.97 at P-value<0.001) and RI ≤0.83 (sensitivity of 93.8%, specificity of 100%, and AUC of 0.949 at P-value<0.001) were correlated with significant menstrual bleeding following insertion of IUCD.ConclusionThe presented results confirmed our assumption that the initial studies of uterine artery Doppler can predict heavy-menstrual bleeding associated with IUCD and therefore, should be conducted in women pursuing reversible long-acting contraception.

Ileal Perforation after Intrauterine Device Insertion

The intrauterine contraceptive device is the second most popular form of contraception worldwide. Uterine perforations may rarely complicate intrauterine contraceptive device use and are believed to occur mostly at the time of insertion. In the majority of cases, perforations are not recognized by the operator and remain asymptomatic. In rare instances however, severe delayed complications involving adjacent organs may ensue. We report an unusual case of uterine perforation with bowel injury diagnosed two years after the insertion of a copper intrauterine contraceptive device. We aim to address the use of transvaginal sonography to confirm proper intrauterine contraceptive device placement following a technically challenging insertion, clinical surveillance, and prompt removal of an intraperitoneal intrauterine contraceptive deviceto prevent potential serious complications, such as bowel embedment. Keywords: Bleeding; Bowel injury; Contraception; Intrauterine contraceptive device; Uterine perforations. Abbreviations IUD: intrauterine contraceptive device; G2P2: Gravidity 2 Parity 2

A study to assess the knowledge and awareness among young doctors about emergency contraception.

Background:Emergency contraception (EC) is the contraception on demand which can prevent millions of unintended pregnancies. The knowledge and awareness of young doctors towards EC who may be the first contact physician of the society has not been well studied. This study aims to assess the knowledge and awareness of young doctors in a teaching institute in northeast India.Methodology:This study was carried out among 200 young doctors and included 100 interns and 100 postgraduate trainees (PGT) and senior resident doctors (SRD) from January 2020 to March 2020 to compare their knowledge and awareness about EC. A predesigned self-administered 22 items questionnaire was used to collect data.Observation:In our study, majority of the doctors in both groups were aware of levonorgestrel 1.5 mg tablet as EC (93% and 95%) and more interns than PG SRD were aware of its easy availability (86%, 35%, P value < 0.0001), government supply (77%, 30%, P value < 0.0001), and that copper intrauterine contraceptive device (IUCD) can be used as EC up to 120 h (89%, 60%, P value < 0.0001). Most doctors were unaware of ulipristal acetate. Most PGT SRDs believe that EC promotes irresponsible behavior, sexually transmitted diseases, and promiscuity but most intern did not agree to it (P value < 0.0001 for each). More than 65% doctors in both groups were aware of the mechanism of action of EC. PGT SRD were more aware of the effectiveness of EC (62%, 80%, P value 0.0078). More interns were aware that EC affects the next period (53%, 25%, P value < 0.0001).Conclusion:Interns were more aware about contraception than PGT and SRD, especially about government supply of EC, about IUCD, and behavioral aspect like promoting irresponsible behavior, sexually transmitted disease, and promiscuity.

Interventions to improve the use of long-acting reversible contraceptive methods at primary health centers in Burkina Faso.

To assess the effects of strengthening family planning capacity on the uptake of long acting reversible contraceptive (LARC) methods at two primary health centers. Between April 2016 and March 2017, the Society of Gynecologists and Obstetricians of Burkina Faso (SOGOB) increased the capacity of two primary health centers in Ouagadougou, Burkina Faso, to offer LARC methods by training staff and providing family planning equipment and commodities. Uptake of LARC methods was compared between the year preceding the intervention and the year during the intervention. Within a year, the number of new users of family planning increased 2.8-fold from 2936 new users before the intervention to 8267 during it. The rate of new users of contraception increased 1.9-fold (14.9% vs 28.1%; P<0.001) for all LARC methods, 2.4-fold for intrauterine contraceptive devices (IUCDs), and 1.7-fold for subdermal contraceptive implants. The proportion of new users of the copper IUCD younger than 25years was higher during the intervention than before it (57.2% vs 46.9%; P=0.026). The SOGOB's family planning intervention resulted in an increase in the use of LARC methods at the two primary health centers.

Doppler Characteristics of Subendometrium and Uterine Hemodynamic Changes in Patients with Copper Intrauterine Device-induced Bleeding

Background: The intrauterine contraceptive device is one of the most frequently used method of contraception allover the world. The most important adverse effects related to copper intrauterine contraceptive device use are excessive uterine bleeding and menstrual pain which are responsible for 5-15% removal rate of IUD during the first year of its insertion. Objectives: The aim of the present study is to evaluate subendometrial blood flow in cases of menorrhagia after copper IUCD insertion in comparison to cases using IUCD and not complaining of abnormal uterine bleeding. Patients and Methods: This study included 200 women; divided into two groups. Group I; included 100 women using copper intrauterine device and complaining of menorrhagia, Group II; included 100 women using copper IUD and not complaining of abnormal uterine bleeding. Results: As regard to Doppler findings, it was noted that PI, RI of uterine arteries were significantly lower in group I in comparison to group II (p value <0.001), and by power Doppler energy women in group I with menorrhagia had a significant increase in subendometrial blood flow according to the subendometrial signal area percentage in comparison with women in group II using copper IUD and not complaining of abnormal uterine bleeding (control group). Conclusion: The results of our study revealed that uterine artery and subendometrial blood flow were increased in women with copper IUD induced menorrhagia in comparison to women with copper IUD and not complaining of abnormal uterine bleeding

Missing Intrauterine Device Copper-T: Case Series

An intrauterine contraceptive device (IUD) is a long acting, highly effective, economic and reversible method of contraception used worldwide. The most used devices are copper IUD (Copper-T) or Progesterone IUD. Common complications include failed insertion, pain, vasovagal reactions, infection, menstrual abnormalities, expulsion and rarely uterine embedment and perforation. In this case series we will discuss three cases of missing Copper-T. In one case Copper T was inserted at our hospital and in the other cases it was inserted in the periphery and all the cases was managed surgically with different modality. Keywords: Copper-T; Intrauterine device; laparoscopy; laparotomy; perforation.

Missing Intrauterine Device Copper-T: Case Series

An intrauterine contraceptive device (IUD) is a long acting, highly effective, economic and reversible method of contraception used worldwide. The most used devices are copper IUD (Copper-T) or Progesterone IUD. Common complications include failed insertion, pain, vasovagal reactions, infection, menstrual abnormalities, expulsion and rarely uterine embedment and perforation. In this case series we will discuss three cases of missing Copper-T. In one case Copper T was inserted at our hospital and in the other cases it was inserted in the periphery and all the cases was managed surgically with different modality.Keywords: Copper-T; Intrauterine device; laparoscopy; laparotomy; perforation.

Oral micronised flavonoids versus tranexamic acid for treatment of heavy menstrual bleeding secondary to copper IUD use: a randomised double-blind clinical trial

Objective: The aim of the study was to compare the efficacy of micronised flavonoids versus tranexamic acid in reducing menstrual blood loss (MBL) associated with the use of the TCu 380A intrauterine contraceptive device (IUD) in women with heavy menstrual bleeding (HMB). Methods: We conducted a randomised double-blind clinical trial between October 2016 and August 2017 in 100 women with HMB (defined as a pictorial blood assessment chart [PBAC] score >100) secondary to IUD use. After assessment of MBL using PBAC score in a baseline cycle, participants were randomised to receive either oral tranexamic acid 500 mg or oral micronised flavonoids 500 mg every 6 h for the first three days of menstruation. PBAC scores were collected in the three subsequent treatment cycles. The primary outcome was the difference in PBAC scores between the groups. Two-way repeated measures ANOVA was used to assess the primary outcome of the change in PBAC scores. Results: Mean PBAC scores were significantly improved in the tranexamic acid group compared with the micronised flavonoids group (236 ± 48, 105 ± 26, 97 ± 16 and 93 ± 15 at the baseline, first, second and third study cycle, respectively, versus 227 ± 52, 139 ± 29, 128 ± 25 and 125 ± 24 in the micronised flavonoids group; p = .01). Moreover, the number of bleeding days and number of pads used were significantly reduced in the tranexamic acid group compared with the micronised flavonoids group (p = .009 and p = .03, respectively). Side effects were comparable between the two groups. Conclusion: Oral tranexamic acid compared with oral micronised flavonoids is more effective in reducing HMB associated with copper IUD use. Treating IUD-induced HMB using tranexamic acid was more effective compared with micronised flavonoids in decreasing MBL volume and the number of bleeding days.

Effect of baseline menstrual bleeding pattern on copper intrauterine device continuation

Heavy menstrual bleeding is a leading cause of copper intrauterine device discontinuation. Thus, girls and women with heavy baseline menstrual bleeding may be at increased risk for early copper intrauterine device discontinuation. Our objective was to assess if there was an association between baseline menstrual bleeding pattern prior to intrauterine device insertion and discontinuation rate at 12 months among study participants who chose copper intrauterine device at baseline. We performed a secondary analysis of the Contraceptive CHOICE Project, a prospective observational cohort study of 9256 girls and women offered no-cost contraception for 2-3 years. Included in our study were participants who chose copper intrauterine device for contraception and for whom method continuation data at 12 months were available. Prior to contraception initiation, participants were asked to qualify their menstrual bleeding over the past year as: light, moderate, moderately heavy, or heavy. Light bleeding corresponded to using ≤10 pads/tampons per period. Moderate, moderately heavy, and heavy bleeding corresponded to 11-20 pads/tampons, 21-30 pads/tampons, and >30 pads/tampons per period, respectively. Subjects were then categorized into either a "heavy" baseline group (those reporting moderately heavy or heavy bleeding at baseline), or a "not heavy" group (those reporting light or moderate bleeding). The 12-month continuation rate for each group was then calculated using Kaplan-Meier survival function, and hazard ratio for risk of discontinuation was evaluated using a Cox proportional hazard model to determine if moderately heavy or heavy bleeding at baseline was associated with early discontinuation. Of the 918 girls and women meeting the inclusion criteria for this analysis, 165 were in the heavy baseline bleeding group, while 753 were in the not heavy bleeding group. The 12-month continuation rates for groups were similar: 80.2% (heavy) and 85.0% (not heavy; P= .24). Patients reporting either moderately heavy or heavy baseline bleeding were not at increased risk for early discontinuation of copper intrauterine device (hazard ratio, 1.21; 95% confidence interval, 0.88-1.66). Our sample size provided >90% power to detect a clinically important difference of 15% (assuming 20% discontinuation rate in not heavy bleeding group and a 35% discontinuation rate in the heavy bleeding group). We did not find that girls and women who reported baseline moderately heavy or heavy menstrual bleeding were at increased risk for early discontinuation. Thus, we do not believe that girls and womenwith heavy menstrual bleeding should be discouraged from using this safe and highly effective form of contraception.

Pre-insertion uterine artery Doppler indices may predict intrauterine contraceptive device-related heavy menstrual bleeding

Abstract Objective To test the hypothesis whether initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of copper-T 380 intrauterine contraceptive device (IUCD) could predict IUCD-related heavy menstrual bleeding or not. Methods This prospective observational study was conducted on 332 women who requested insertion of copper IUCD. Uterine artery PI and RI were measured before insertion and repeated at 3 and 6 months after IUCD insertion. Participants were divided into two groups according to their menstrual calendar and hemoglobin concentration; Normal bleeding group (n = 188) and heavy menstrual bleeding group (n = 144). Receiver-operating characteristic (ROC) curve analysis was used to evaluate the prognostic value of uterine artery PI and RI in prediction of IUCD-related heavy menstrual bleeding. Results Uterine artery Doppler indices does not show significant change 3 and 6 months after IUCD insertion in both groups (p > .05). Uterine artery PI Conclusion Initial uterine artery Doppler studies could be beneficial as a predictor of IUCD related heavy menstrual bleeding and should be implemented during counseling of women desiring long acting reversible contraception.