Intrauterine Device Placement Research Articles

Access to single-visit IUD insertion at obstetrician-gynecology practices in Ohio: An audit study

ObjectiveSingle-visit intrauterine device (IUD) insertion protocols are recommended. We assessed the availability of single-visit IUD insertions, and whether access to these services varies by age, race or parity. Study designUsing audit study methodology, we called a random sample of 396 obstetrician-gynecology practices in Ohio while posing as a potential client seeking an IUD insertion appointment. Callers used eight standardized scripts and noted justifications for protocols offered by clinic staff. Practices were randomized to follow a balanced 3×2 factorial design, whereby practices were assigned to one of two conditions: (1) age (18 vs. 30 years of age); (2) race (white vs. black); and (3) parity. Multivariable logistic regression was used to control for clinics rural vs. urban location while considering the effects of these variables on service provision. ResultsAlmost all (95%) of the practices called offered IUD placement, of which 92% required multiple appointments for IUD insertion. Although access to single-visit IUD services did not vary by age or race, we found that parity was associated with clinics’ willingness to schedule a single-visit insertion visit (OR = 3.84, 95% CI = 1.23, 12.04). The most frequent justification provided by clinic staff for their multiple-appointment protocol was the need to verify insurance coverage or order the device directly through the patient’s insurance company. ConclusionOhio patients seeking IUD placement must typically make more than one clinic visit. ImplicationsEfforts are needed to reassure Ohio clinics that IUDs are routinely covered by insurers and to increase access to same-day IUD placement for women in Ohio, as the requirement to attend multiple clinics appointments to obtain a desired contraceptive may pose an insurmountable barrier to care for those with the fewest resources.

Efficacy of oral celecoxib and hyoscine butyl-bromide versus placebo during copper intrauterine device placement in women delivered only by elective cesarean section

<strong>Objective: </strong>To compare the efficacy and tolerability of celecoxib to hyoscine butyl bromide (HBB) and placebo in reducing pain scores during placement of copper intrauterine devices (IUD) in parous women who have undergone elective cesarean section and who have had no previous vaginal deliveries. <strong></strong> <strong>Methods: </strong>We conducted a randomized, double-blind, placebo-controlled trial at a tertiary University hospital from April 2018 to September 2018. The study included women who had never delivered vaginally and who desired copper IUD insertion. We randomized the study participants in a 1:1:1 ratio to celecoxib, HBB or placebo groups. They took the tablets orally two hours before IUD insertion. The study outcomes were the self-reported pain measurements, using a 10-cm Visual Analogue Scale (VAS), taken during tenaculum placement, sound insertion, IUD insertion and five minutes post-insertion, as well as an ease of insertion score. <strong></strong> <strong>Results: </strong>The study included 105 women (n=35 in each group). The baseline characteristics were similar among all groups. The mean pain score in the celecoxib group was lower during IUD insertion than placebo (1.97 vs 4.34, p<0.001). Moreover, the ease of insertion score was significantly better with celecoxib [1.56 vs. 3.03, p< 0.001] than with placebo. Similarly, Women in the HBB group were more likely to report lower pain scores during IUD insertion (2.91 vs 4.34, p<0.001) and lower ease of insertion score [1.43 vs. 3.03, p< 0.001].<strong></strong> <strong>Conclusions: </strong>The use of celecoxib and HBB may both reduce the pain associated with copper IUD insertion among women with no previous vaginal delivery. However, celecoxib is better tolerated with fewer side effects

Double-Blinded, Randomized, Placebo-Controlled Trial of Multimodal Analgesia at Intrauterine Device Insertion [15I

INTRODUCTION: The utilization of long acting reversible contraception has remained low. Pain and anxiety associated with intrauterine device (IUD) placement are barriers. The purpose of this study was to investigate the effects of cervical lidocaine injections and oral diazepam on pain and anxiety during office IUD insertion. METHODS: Following Institutional Review Board approval, subjects desiring IUD placement were randomized to diazepam 5 mg orally with cervical injections of 2.5 ml of 2% lidocaine or placebo pill with saline injections. Both groups received 800 mg oral Ibuprofen. Providers and subjects were blinded to their assigned group. Primary outcome was pain on a visual analog scale at various steps of IUD insertion. Power analysis set enrollment at 58, which is ongoing. RESULTS: At interim analysis, a total of 41 women have been enrolled. Of these, 39 (20 in the study arm, 19 in the placebo arm) underwent IUD insertion. Median anxiety was significantly decreased when placing the speculum in the study arm compared to placebo (5.5 mm vs. 31 mm; P=.004) respectively. Additionally, subjects in the intervention group reported lower pain scores during insertion of the IUD (24 mm vs. 71 mm, P=.030). CONCLUSION: At interim analysis, oral diazepam and cervical lidocaine injections compared to placebo show clinically significant decreases in anxiety and pain during IUD placement. If these early results are confirmed, the use of cervical lidocaine injections and oral diazepam may provide additional tools to help increase utilization of IUDs by decreasing pain and anxiety associated with insertion.

Clinical Outcomes of Intrauterine Devices Inserted After Peripartum Intrauterine Infection [06J

INTRODUCTION: Postpartum intrauterine device (IUD) insertion is contraindicated after intrauterine infection such as chorioamnionitis or endometritis, as this theoretically increases risk of pelvic inflammatory disease (PID). We conducted a retrospective study to evaluate PID risk associated with IUD placement after delivery complicated by intrauterine infection. METHODS: A retrospective cohort receiving an IUD off-label within 3 months of a delivery complicated by intrauterine infection (INF+IUD) was identified and propensity matched to two control cohorts: patients with intrauterine infection but no IUD (INF Only), and patients without infection but receiving an IUD (IUD Only). PID and other complications within 9 months post-delivery were assessed by chart review. IRB approval was obtained. RESULTS: Eighty patients in each cohort had similar demographics with the exceptions of higher age, gravidity, and parity in the IUD Only group. Documented follow up occurred for 79 (99%), 44 (55%), and 77 (96%) in the INF+IUD, INF Only, and IUD Only groups, respectively (P&lt;.0001). PID developed in one patient each in the INF+IUD and IUD Only cohorts, which was not statistically significant (P=1). The INF+IUD cohort experienced more abnormal bleeding (12.1% vs 0% vs 3.9% in INF+IUD, INF Only, and IUD Only groups, respectively, P=.048), which was not significant after controlling for IUD type. Three patients in the INF Only cohort were pregnant within 9 months, compared to 0 in both IUD groups (P=.024). CONCLUSION: This retrospective review does not show an increased risk of PID in patients receiving an IUD after peripartum intrauterine infection. Larger studies are needed to confirm these findings.

Uptake of Postpartum Long-Acting Reversible Contraception: The Impact of Timing and Practice Patterns [29J

INTRODUCTION: Uptake of long-acting reversible contraception (LARC) postpartum is impacted by differences in clinical practices, contraceptive counseling, postpartum follow-up and temporary Medicaid coverage. We sought to determine whether differences in inpatient provision influence uptake of preferred LARC by 8-weeks postpartum. METHODS: We performed an IRB approved, retrospective cohort study of all deliveries after 24 weeks gestation in two distinct practice groups at a single academic center in 2016: Practice A routinely offers initiation of intrauterine devices (IUDs) and contraceptive implants prior to hospital discharge; Practice B only routinely offers implants. We collected demographic information, documented postpartum contraception preference and LARC uptake by 8-weeks postpartum. RESULTS: We included all deliveries from Practice A (n=878) and Practice B (n=739). Patients from B were younger, Hispanic, publicly insured multiparas with a term, vaginal delivery. At discharge, more from B desired LARC (A: 27.2%, B: 39.2%; P&lt;.001), but more from A desiring LARC initiated prior to discharge (A: 64.9%, B: 39.4%; P&lt;.001). Postpartum follow-up was higher for B (A: 74.5%, B: 83.9%; P&lt;.001), but by 8 weeks, uptake of desired IUD was higher for A (A: 72.9%, B: 51.6%, P&lt;.001), with the majority placed inpatient for A (86.1% vs 10.6%; P&lt;.001). Implant uptake by 8 weeks was similar (A: 86.3%, B: 90.4%; P=.41), with the majority placed inpatient (A: 72.5%, B: 69.2%; P&lt;.001). CONCLUSION: Routine access to immediate postpartum IUD placement results in significantly increased uptake of desired IUD by 8-weeks postpartum, supporting provision of immediate postpartum LARC. Future efforts should focus on understanding if the option of immediate postpartum IUD placement influences contraceptive counseling, patient preferences and uptake.

Immediate Post Placental IUDs: Are Removal Complications Increased? [13J

INTRODUCTION: Post-placental intrauterine device (IUD) insertion is associated with increased risk for expulsion and missing strings at follow up. We evaluated the proportion of non-visualized strings and complicated IUD removals in patients who had post-placental IUDs placed at the time of vaginal delivery or cesarean section. METHODS: We performed a single site retrospective cohort study of women who had an IUD placed at either the time of cesarean section or vaginal delivery from January 2016-January 2019. The primary outcome was identification of the IUD strings at a postpartum or emergency department visit. IRB approval was obtained. Demographic, obstetric and clinical characteristics were summarized through descriptive statistics, and 95% confidence intervals summarized variability. Fisher’s exact test was utilized to provide unadjusted comparisons between groups. RESULTS: A total of 253 women had a post-placental IUD. Fifty-four percent had IUD insertion after vaginal delivery and 46% after cesarean section. Of these 253 women, 66% (n=167) had documented follow up visits. Of the 167 women with follow up, strings were visualized in 52% (95% CI 44, 59%). Strings were not visible in 31% (n=52) or were not assessed or previously expulsed in 17% (n=29). The proportion of women with non-visible strings was not different between vaginal (45%) versus cesarean (53%) deliveries (Fisher’s exact p-value: 0.28). Among those with non-visualized IUD strings, 11.5% (n=6) required complicated removal. CONCLUSION: Post-placental IUD insertion was associated with a substantial proportion of non-visible strings in the post-partum setting, leading to a higher potential for complicated IUD removals and need for improved patient counseling.

Immediate versus delayed insertion of the IUD following medical abortion at 17–20 weeks’ gestation: Preliminary results from a randomized controlled trial

Introduction The risk-benefit ratio of immediate compared with delayed insertion of an intrauterine device (IUD) following medical abortion (MA) at 17-20 weeks gestation is largely unknown. We report preliminary findings from a randomized controlled trial on IUD use at 6 weeks after immediate compared to delayed insertion, following medical abortion at this gestation. Method This 2-arm randomized controlled trial was conducted in Cape Town, South Africa. Between August 2018 and June 2019, we consented and randomized 114 women admitted for MA. The immediate arm had an IUD inserted prior to discharge; the delayed arm was referred for insertion 3 weeks later at a primary healthcare facility. Follow-up involved in-person clinical examination and ultrasound 6 weeks after MA. Non-attendees were contacted by phone. Follow-up at 6 months is ongoing. Our main outcome was use of the original IUD at 6 weeks, defined as adequate placement without indication for removal, according to intention-to-treat (ITT). Secondary outcomes include 1) use of any IUD after the 6-week follow-up period (ITT) and 2) expulsion, intracervical and symptomatic malposition at 6 weeks after MA (per protocol [PP]). Results There were 55 women in the immediate arm and 57 in the delayed arm (ITT). At 6 weeks we followed up 98/112 women (88% in each study arm). There was adequate placement of the original IUD in 53% of women in the immediate arm versus 23% in the delayed arm. At the end of the 6-week follow-up period 73% in the immediate arm versus 40% in the delayed arm had either the original IUD, a replacement IUD, or an IUD placed for the first time at follow up. Of those who had an IUD placed, 36% (immediate) versus 14% (delayed) had complete expulsion, or removal of the IUD due to malposition (PP). Conclusions Insertion of an IUD immediately after late second trimester MA results in increased use after 6 weeks compared to delayed insertion. Expulsion rates are higher than interval insertion and higher than for immediate insertion after MA at earlier gestational ages.

Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond

Author(s): Raymond, Elizabeth; Grossman, Daniel; Mark, Alice; Upadhyay, Ushma; Dean, Gillian; Creinin, Mitchell; Coplon, Leah; Perritt, Jamila; Atrio, Jessica; Taylor, DeShawn; Gold, Marji | Abstract: No abstract

Adherence to Guideline-Based Antibiotic Prophylaxis in Gynecology among Alabama Providers.

Surgical site infection (SSI) is a preventable cause of postoperative morbidity. The appropriate use of perioperative antibiotics for prevention of SSIs is a well-established quality metric. Little is known about the adherence to guidelines-based antibiotic prophylaxis among Alabama obstetricians and gynecologists. Our aims were to determine their adherence to guidelines-based antibiotic prophylaxis and identify the factors that are predictive of nonadherence. Online, self-administered survey of Alabama obstetricians and gynecologists. Providers reported not providing the indicated antibiotics and/or giving nonindicated antibiotics in almost all surgical scenarios. The exceptions included hysterectomies, in which almost all (96%) providers routinely gave indicated antibiotics. No providers reported giving antibiotics during intrauterine device placement or endometrial biopsies, which is appropriate. The only factor predictive of inappropriate antibiotic use was the absence of a standing antibiotic protocol. Alabama gynecologic surgeons can and should improve their compliance with guidelines-based antibiotic prophylaxis. More research is needed to determine which interventions would improve adherence in this provider population; our study suggests that the implementation of a standing antibiotic protocol may be a reasonable first step.

39. Possible Association between Urogenital Sinus and Exposure to Levonorgestrel Intrauterine Device Placement in Proximity to Fertilization

39. Possible Association between Urogenital Sinus and Exposure to Levonorgestrel Intrauterine Device Placement in Proximity to Fertilization

Efficacy, Safety, and Tolerability of a New Low-Dose Copper and Nitinol Intrauterine Device

To assess in parous and nulliparous women, the efficacy, safety, and tolerability of a new, low-dose copper (175 mm) intrauterine contraceptive with a flexible nitinol frame provided in a preloaded applicator. Institutional review boards at 12 U.S. sites approved this commercially funded project. Patients met standard inclusion and exclusion criteria for a copper-based intrauterine device (IUD), generally consistent with the Centers for Disease Control and Prevention's U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. Intrauterine device placement occurred at any day in the eligible patient's menstrual cycle after assuring she was not pregnant. The primary outcome measure assessed efficacy (measured by the Pearl Index) in this 1-year study with a 2-year extension. Secondary outcomes included placement success, ease of placement, safety as measured by adverse events, and tolerability assessed by discontinuation rate and bleeding and spotting patterns. A total of 286 women provided 5,640 cycles evaluable for pregnancy. Patients averaged 27.1 years of age. Nulliparous women represented 60.8% of the patients. Over 36 months of observation, we identified two pregnancies (Pearl Index 0.46 [95% CI 0.06-1.67]) and 10 serious adverse events; none were study-related. Successful placement occurred in 283 participants (99.0%). Median (range) continuation times were 2.7 years (0-3.4). We identified five expulsions (1.8%), zero uterine perforations, and one report of pelvic inflammatory disease. Adverse events prompted 30 women (10.6%) to discontinue early in the first year of use with 23 (8.1%) discontinuing for issues of bleeding, pain, or both. Altogether, 107 (37.8%) completed 36 months of device use. Mean bleeding days per cycle decreased from 7.6 in cycle 1 to 5.2 in cycle 13. The novel, low-dose copper and nitinol IUD demonstrated high efficacy and safety in this phase 2 U.S. Food and Drug Administration trial and warrants further expanded study in a phase 3 clinical trial. ClinicalTrials.gov, NCT02446821. Sebela Pharmaceuticals, Inc.

Identifying barriers to post-placental intrauterine device placement: male partners’ views

Objective: The use of post-placental intrauterine devices (IUDs) has potential to address the health issues of suboptimal breastfeeding rates and short inter-pregnancy intervals. An understudied factor that may influence choice of breastfeeding-compatible contraception among postpartum women is their romantic partner. We aimed to identify male partner influences on women’s postpartum breastfeeding-compatible contraception choices.Methods: Questionnaires were administered to 75 men in Cleveland, OH, USA. Data on partner priorities, opinions and knowledge about breastfeeding and contraception, and barriers to partner IUD receipt were collected. Survey data were summarised using frequencies and percentages, and univariate logistic regression models were used to explore associations between responses.Results: Participants were predominantly African American, unmarried and had at least one child. Twenty-six participants (36%) reported using contraception with their current partner; men who had discussions and agreed about contraception with their partner were more likely to use it. Thirty-nine men (54%) intended for a future child to breastfeed; this intention was more likely for men who had a child that was breastfed previously and for those with knowledge of breastfeeding benefits. Only 25 (35%) thought a post-placental IUD was safe for breastfeeding mothers; correct IUD knowledge and a partner’s positive IUD experience were significantly associated with this response.Conclusion: Our findings suggest that knowledge about breastfeeding and contraception as well as experiential learning regarding breastfeeding and contraception within a partnered relationship are important and that minimal prior experience and low knowledge in these areas may be a male partner barrier to post-placental IUD placement for breastfeeding mothers.

Further Support for Same-Day Intrauterine Device Placement

Current CDC guidelines support intrauterine device (IUD) placement whenever a clinician is reasonably sure the woman is not pregnant. As an aid in

Postplacental placement of intrauterine devices: A randomized clinical trial

ObjectiveTo compare the expulsion rate of the TCu380A intrauterine device (IUD) or levonorgestrel (LNG) 52 mg intrauterine system (IUS) up to 90 days after postplacental placement (10 min after delivery of the placenta). Study designRandomized trial (1:1) of women aged 18–43 years and ≥37 weeks pregnant enrolled during early or prodromal labor at the University of Campinas, Brazil. Follow-up was scheduled at 42 and 90 days after device placement. We confirmed the IUD or IUS location using ultrasonography. Multivariate logistic regression was used to assess variables associated with expulsion. ResultsWe enrolled 140 women, and assigned 70 to the TCu380A IUD and 70 to the IUS groups. By the 90-day follow-up visit, 22/60 women (36.7%) in the TCu380A IUD group had expelled the device, as had 12/60 women in the IUS group (20%). Thirty-three of the 34 expulsions had occurred by the 42-day visit. Multivariate analysis demonstrated that the expulsion odds ratio ([OR]; 95% confidence interval [CI]) was higher after vaginal delivery than after Cesarean delivery (OR 5.60; 95% CI 2.08–15.10; P < 0.00) and higher among women with one (OR 4.38; 95% CI 1.33–14.43; P 0.00) or three or more deliveries (including the present one) (OR 6.08; 95% CI 1.78–20.77; P 0.00) than those with two deliveries. ConclusionsPostplacental TCu380A IUD placement had a higher expulsion rate than the IUS, and the expulsion rate was higher among women who had a vaginal delivery than those who had a Cesarean delivery. Most of the expulsions occurred within 42 days. ImplicationsPolicy makers should increase the availability of both the TCu380A and the LNG intrauterine devices for the immediate postpartum period, even though the expulsion rate is higher than that after interval placement.

Intraoperative insertion of intrauterine contraceptive device at cesarean section: A survey on the experiences of trainee and practicing obstetricians

Background: Intrauterine contraceptive device (IUCD) placement during cesarean section has been shown to be a safe and effective method of contraception with very low complication and disuse following insertion. Its practice can be of immense benefit, especially in developing countries like Nigeria where high unmet needs for contraception and increasing cesarean section rates are prevalent. Objective: The objective of this study is to evaluate the practice of obstetricians and trainees on counseling and insertion of IUCD during cesarean section. Materials and Methods: A questionnaire-based cross-sectional study was conducted among obstetricians and trainees at the 49th Annual Scientific Conference of the Society of Gynecology and Obstetrics of Nigeria held in November 2015. The data were analyzed using the SPSS version 20. Results: Of 150 respondents, 134 returned completed questionnaires, giving a response rate of 89.3%, 130 of these were adjudged to be correctly filled and were analyzed. Majority of the respondents, 97 (74.6%), were consultants. The mean age of the respondents was 42.01 years ± 7.00. About 95% (125) of the respondents admitted performing cesarean sections, but only 13 (10%) had ever inserted IUCD during cesarean operations. Counseling for the procedure was also low, as only 35 (26.9%) of the respondents had ever counseled the clients toward IUCD placement at cesarean section. Conclusion: For counseling and practice of insertion of IUCD at cesarean section is very low among Nigerian obstetricians, revealing a major barrier to clients' access to this effective and safe method of contraception. Advocacy, education, and training of this category of health-care providers are necessary for improved contraceptive access to cesarean section clients.

Evaluation of Post-Placental IUD Insertion during Cesarean Section at a Tertiary Care Hospital in Egypt

Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. Background: IUD could be applied to the female after delivery of placenta during cesarean section, it had many advantages as the female is under anesthesia so no extra manipulation needed, decrease pain, and also the female at the period of delivery had high motive for family planning. Post placental IUD insertion also had many disengages like bleeding and displacement. Material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to May 31 2019. Two groups of patients were selected; each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion during cesarean section and group II was subjected to interval IUD insertion (3 months after cesarean delivery). The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 12 months was 13.72% in study group compared to 16.66% in the control group. The satisfaction rates in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 1.96% in study group and 4.17% in control group with p value = 0.949. Conclusion: Post-placental IUD insertion is found to be safe, easily applied during cesarean section with slight prolongation of cesarean section duration. Post-placental IUD insertion is also effective, with few complications compared to interval IUD insertion. This modality of insertion was accepted by the great majority of patients being painless and at the same time of surgery with no added cost or maneuver and utilizing the enthusiasm of patients for immediate contraception. The continuation rates are good in the study follow up duration.

Obstetrics–gynecology resident long-acting reversible contraception training: the role of resident and program characteristics

Obstetrics-gynecology residents should graduate with competence in comprehensive contraceptive care, including long-acting reversible contraception. Lack of hands-on training and deficits in provider education are barriers to long-acting reversible contraception access. Identifying the number of long-acting reversible contraception insertions performed by obstetrics-gynecology residents could provide insight into the depth and breadth of long-acting reversible contraception training available to obstetrics-gynecology residents in Accreditation Council for Graduate Medical Education-accredited residency programs. Our study investigates long-acting reversible contraception-specific training in obstetrics-gynecology residency programs across the United States, including the self-reported number of long-acting reversible contraception insertions per resident and the impact of resident demographic characteristics and residency program characteristics on training. Obstetrics-gynecology residents completed a voluntary electronic survey during the 2016 Council on Resident Education in Obstetrics and Gynecology examination. The survey included resident demographic characteristics and residency program characteristics as well as resident education and training in long-acting reversible contraception (number of intrauterine devices and implants inserted, training in immediate postpartum intrauterine device placement). A binary "long-acting reversible contraception insertion experience" variable dichotomized respondents as having a low level of long-acting reversible contraception insertions (0 implants and/or 10 or fewer intrauterine devices ) or a high level of long-acting reversible contraception insertions (1 or more implants and/or 11 or more intrauterine devices). χ2 tests were used to compare the presence of long-acting reversible contraception insertion experience by postgraduate year, resident demographic characteristics, and residency program characteristics. Adjusted logistic regression was performed to ascertain the independent effects of gender, race/ethnicity (non-Hispanic white vs other), residency program type (university vs community), and residency program geographic region on the likelihood of "low" overall long-acting reversible contraception insertion experience. In total, 5055 obstetrics-gynecology residents completed the survey (85%); analysis included only residents in United States obstetrics-gynecology programs (N=4322). Of the total analytic sample, 1777 (41.2%) had low long-acting reversible contraception insertion experience. As expected, the number of intrauterine device insertions, implant insertions, and overall long-acting reversible contraception experience increased as residents progressed through training. Long-acting reversible contraception insertion experience varied by residency program geographic region: 169 (27.1%) residents in programs in the West had low long-acting reversible contraception insertion experience compared with 498 (39.0%) in the South, 473 (45.3%) in the Midwest, and 615 (46.0%) in the Northeast. Only 152 (14.9%) of all postgraduate year 4 residents had low long-acting reversible contraception insertion experience. Among postgraduate year 4 residents, low long-acting reversible contraception insertion experience was significantly associated racial/ethnic minority status and community-based residency program type (compared with university-based). Postgraduate year 4 residents in programs located in the Northeast and Midwest had 4.25 (95% confidence interval, 2.04-8.85) and 2.75 (95% confidence interval, 1.27-5.97) times the odds of low long-acting reversible contraception experience compared with those in residency programs in the West, even after adjusting for other respondent characteristics and other residency program characteristics. Obstetrics-gynecology residents experience a range of long-acting reversible contraception training and insertions, which differed according to resident race/ethnicity and residency program characteristics (program type and geographic region). Residency programs with low long-acting reversible contraception training experience should consider opportunities to improve competence in this fundamental obstetrics-gynecology skill.

Unintended pregnancy with IUD in situ reveals the IUD placement into one of the uterine horns in a bicornuate uterus

A 29-year-old gravida 2, para 1, with one living offspring born to a spontaneous vaginal delivery, presented to our outpatient clinic with a positive urine pregnancy test preceded by a...

A mystery shopper study identifying practice-level barriers to adolescent IUD access in western Pennsylvania

Objective(s)To identify practice-level barriers that adolescents experience when seeking a hormonal intrauterine device (IUD). Study designWe secret-shopped gynecological practices within a health system using a script targeting potential practice-level barriers. ResultsWe assessed 50 of a targeted 50 practices; only 8 (16%) would schedule a contraceptive appointment that permitted same-day IUD placement. Twenty-eight (56%) respondents stateda parent must accompany the adolescent. ConclusionPractice-level barriers toadolescentIUD access exist that are inconsistent with best-practice guidelines and Pennsylvania state law. ImplicationsPractice staff and providers need more medical and legal education regarding IUD provision to adolescents.

Bleeding assessment in haemophilia carriers-High rates of bleeding after surgical abortion and intrauterine device placement: A multicentre study in China.

An increased bleeding tendency has been shown in female haemophilia carriers compared to healthy females. Bleeding assessment tools (BATs) have mainly been performed in western cultures. It is unclear how they perform in populations with different healthcare, health/wellness concepts and awareness, as well as family planning practices. To (a) describe and compare the bleeding symptoms in carriers with healthy females, particularly for bleeding after surgical abortion and intrauterine device (IUD) placement which are performed frequently for family planning in China; (b) quantify scores of International Society on Thrombosis and Haemostasis Bleeding Assessment Tool (ISTH-BAT) and Chinese-BAT (C-BAT) developed to include surgical abortion and IUD placement as separate categories in Chinese haemophilia carriers; (c) correlate bleeding scores (BS) with factor levels. We conducted a multicentre, cross-sectional study on obligate haemophilia carriers and healthy controls using ISTH-BAT and C-BAT. We enrolled 125 haemophilia carriers and 106 controls. Carriers, compared to controls, had significantly higher median BS (3 vs 1 by both ISTH-BAT and C-BAT) and lower factor level (63.5 vs 101.8IU/dL). Bleeding after surgical abortion and IUD placement was significantly associated with carrier status. Bleeding scores from neither ISTH-BAT nor C-BAT showed significant correlation with factor levels. Haemophilia carriers in China experienced abnormal bleeding. Unique to the Chinese carriers is significant bleeding after surgical abortion (3rd highest incidence of bleeding symptom) and IUD placement (4th highest). However, both ISTH-BAT and C-BAT exhibited no correlation between BS and factor levels in this population and neither could identify carriers with low factor level (of <50IU/dL).