Intrauterine Device Insertion Research Articles

Early provision of intrauterine contraception as part of abortion care-5-year results of a randomised controlled trial.

Can the incidence of subsequent termination of pregnancy (TOP) be reduced by providing intrauterine contraception as part of the abortion service? Provision of an intrauterine device (IUD) as part of TOP services reduced the need for subsequent TOP but the effect was limited to the first 3years of the 5-year follow-up. An IUD is highly effective in preventing subsequent TOP. Prompt initiation of IUD use leads to a higher usage rate during follow-up, as compliance with post-TOP IUD insertion visits is low. The objective of this randomised controlled trial was to assess the effect of early comprehensive provision of intrauterine contraception after TOP, with primary outcome being the incidence of subsequent TOP during the 5years of follow-up after the index abortion. This study was conducted at a tertiary care centre between 18 October 2010 and 21 January 2013. Altogether, 748 women undergoing a first trimester TOP were recruited and randomised into two groups. The intervention group (n= 375) was provided with an IUD during surgical TOP or 1-4weeks following medical TOP at the hospital providing the abortion care. Women in the control group (n= 373) were advised to contact primary health care for follow-up and IUD insertion. Subsequent TOPs during the 5-year follow-up were identified from the Finnish Register on induced abortions. The inclusion criteria were age ≥18years, duration of gestation ≤12weeks, residence in Helsinki and accepting intrauterine contraception. Women with contraindications to IUD were excluded. The overall numbers of subsequent TOPs were 50 in the intervention and 72 in the control group (26.7 versus 38.6/1000years of follow-up, P= 0.027), and those of requested TOPs, including TOPs and early pregnancy failures, were 58 and 76, respectively (30.9 versus 40.8/1000, P= 0.080). Altogether 40 (10.7%) women in the intervention and 63 (16.9%) in the control group underwent one or several subsequent TOPs (hazard ratio 1.67 [95% CI 1.13 to 2.49], P= 0.011). The number of TOPs was reduced by the intervention during years 0-3 (22.2 versus 46.5/1000, P= 0.035), but not during years 4-5 (33.3 versus 26.8/1000, P= 0.631). Both medical and surgical TOP were used. This may be seen as a limitation, but it also reflects the contemporary practice of abortion care. The immediate post-TOP care was provided by two different organizations, allowing us to compare two different ways of contraceptive service provision following TOP. Providing TOP and IUD insertion comprehensively in the same heath care unit leads to significantly higher rates of attendance, IUD use and a significantly lower risk of subsequent TOP. This study was supported by Helsinki University Central Hospital Research funds and by research grants provided by the Jenny and Antti Wihuri Foundation, the Yrjö Jahnsson Foundation and Finska Läkaresällskapet. E.P. has received a personal research grant from the Finnish Medical Society. The City of Helsinki supported the study by providing the IUDs. The funding organisations had no role in planning or execution of the study, or in analysing the study results. The trial was registered at clinicaltrials.gov (NCT01223521). 18 October 2010. 18 October 2010.

Does topical lidocaine reduce pain more than placebo during intrauterine device insertion in nulliparous women?

Does topical lidocaine reduce pain more than placebo during intrauterine device insertion in nulliparous women?

Cold Compress for Intrauterine Device Insertional Pain: A Randomized Control Trial.

Background: Pain with intrauterine device (IUD) insertion is identified as a barrier to uptake of this highly effective long-acting reversible contraceptive. Several studies have assessed the efficacy of interventions to alleviate patient discomfort associated with IUD insertion, but no interventions have been clearly shown to improve procedural pain. The aim of this study was to determine whether use of a cold compress on the abdomen during IUD insertion reduces pain.Materials and Methods: This was a prospective randomized control trial of women presenting to Virginia Commonwealth University for insertion of IUD from September 2016 to October 2017. A power analysis determined that 69 subjects were needed in each arm to detect a 30% reduction in pain with a power of 80%, significance value of p < 0.05. One hundred forty-two participants were consented for the study, 69 were randomized to the control group, which received the usual management, and 73 were randomized to the study group, which received a cold compress to the abdomen before the procedure. In addition to data on the difference from pre- to postprocedure pain scales, we collected information regarding inserting provider type, gravidity/parity, body mass index, demographic information (age, race, insurance type, and level of education), history of IUD placement or cervical procedure, history of chronic pain, and the use of regular pain medications (defined as more than once per week). Statistical analysis was accomplished using t-test and chi square tests.Results: There was no difference in pre and postinsertional pain in those who received a cold compress versus the control during insertion of an IUD (3.4 vs. 3.5). The insertional pain was rated at 4.3 and 4.6 for patients who received the cold compress and the control group, respectively (p = 0.805).Conclusion: Although a cold compress is a simple, inexpensive, and safe method of pain control, this study shows no reduction in insertional pain for IUD placement.

Importance of the delivery-to-insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis.

To evaluate the delivery-to-insertion interval for copper postpartum intrauterine devices (PPIUDs). Secondary analysis of two related studies at five academic sites in India from March 2015 to July 2016. IUDs were inserted within 48hours of vaginal delivery. Women (n=560) were grouped by whether they underwent postplacental (≤10minutes) or immediate (>10minutes) insertion. Outcomes were complete expulsion at the 6-8-week follow-up (primary), and IUD-to-fundus distance, as assessed by postinsertion ultrasound (secondary). Overall, 93 (16.6%) women received a postplacental PPIUD and 467 (83.4%) received an immediate PPIUD. Complete expulsion at follow-up was 3.2% (n=3) in the postplacental and 7.5% (n=35) in the immediate postpartum group (P=0.176; difference in proportions, 4.3%; 95% confidence interval, -2.0 to 8.1). Distance from the fundus did not differ between the two groups (P=0.107); high fundal placement (≤10mm from the internal endometrial verge) was achieved for most women. The present data challenge previous guidance on the timing of PPIUD insertion. The 10-minute insertion window is a barrier to uptake and should be reassessed for inclusion in service delivery guidelines. A flexible interval would accommodate the multiple post-delivery tasks of providers and increase access to PPIUD.

Insertion of Intrauterine Contraceptive Device at Cesarean Section: Randomized Clinical Trial

Abstract Background Postpartum period is highly vulnerable period to unintended pregnancy as there are limited contraceptive options available in the breast feeding women. At the same time ovulation is highly unpredictable in non breast feeding or non exclusive breast feeding women. an ideal time to begin contraception, as women are highly motivated to adopt contraception at this time, which also has the advantages of being convenient for both women and health care providers. Objective To evaluate and compare the efficacy of IUD (Pregna T Cu 380A) insertion at cesarean section and after puerperium in terms of expulsion rate, pain and amount of bleeding. Patients and Methods This study is a randomized Clinical Trial that was conducted at Ain Shams University Maternity Hospital during the period from December 2017 to May 2018. The study was approved by institute ethics committee of Ain Shams University Hospitals. Results There were no statistical significant differences in the rates of wound infection, postoperative pain, volume of bleeding, signs of infection, additional analgesic needs, dyspareunia and number of days till bleeding stops between both groups. There was no statistical significant between both groups as regard expulsion of IUD in the present study. Conclusion IUD is a contraceptive device which is commonly inserted after puerperium. This study will focus on insertion IUD during cesarean section.

Benefits of Self-administered Vaginal Dinoprostone 12 Hours before Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Adolescents and Young Women: A Randomized Controlled Trial.

To assess safety and efficacy of self-administered vaginal dinoprostone 12hours before a 52-mg levonorgestrel intrauterine device (LNG-IUD) insertion in adolescents and young nulliparous women. Randomized controlled trial. Tertiary referral hospital. Nulliparous adolescents and young women aged 18-22years. Participants were randomly assigned into 2 groups; the dinoprostone group (n=65) received dinoprostone 3mg vaginally, and the placebo group (n=65) received placebo tablets vaginally. Primary outcome was pain scores during LNG-IUD insertion measured using a visual analogue scale. Secondary outcomes were pain scores during speculum insertion, tenaculum placement, uterine sounding, and 20minutes postprocedure, ease of insertion, Women's satisfaction score, need for additional analgesics, and side effects. The dinoprostone group had significantly lower pain scores during LNG-IUD insertion (2.83±1.08 vs 3.95±1.63), tenaculum placement (2.97±1.41 vs 4.55±1.53) and sounding of uterus (3.55±1.71 vs 5.12±1.37) compared with the placebo group (P<.001). No significant differences were found between both groups regarding anticipated pain scores (P=.85), pain during speculum insertion and 20minutes postinsertion and insertion duration (P=.53). Women's satisfaction, provider reported ease of insertion, and need for additional analgesia were significantly better among dinoprostone users (P<.001, < .001, and .02, respectively). Side effects and procedure complications were similar for the 2 groups. Self-administered dinoprostone 3mg vaginally 12hours before a 52-mg LNG-IUD insertion in nulliparous adolescent and young women effectively reduced pain during insertion and increased women's satisfaction and ease of insertion reported by clinicians.

31: Randomized controlled trial of ultrasound-guided intrauterine device insertion

31: Randomized controlled trial of ultrasound-guided intrauterine device insertion

Investigating the quality of family planning counselling as part of routine antenatal care and its effect on intended postpartum contraceptive method choice among women in Nepal

BackgroundThough modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the quality of FP counselling services provided during ANC visits and women’s perceptions of its effectiveness in assisting them to make a post-partum family planning (PPFP) decision.MethodsIn-depth interviews (IDIs) were conducted with 24 pregnant women who had attended at least two ANC visits in one of the six public hospitals that had received an intervention that sought to integrate FP counselling in maternity care services and introduce postpartum intrauterine device insertion in the immediate postpartum period. IDIs data were collected as part of a process evaluation of this intervention. Women were selected using maximum variation sampling to represent different socio-demographic characteristics. IDIs were audio recorded, transcribed verbatim in Nepali, and translated into English. Data were organized using Bruce-Jain quality of care framework and analyzed thematically.ResultsOverall, the quality of FP counselling during ANC was unsatisfactory based on patient expectations and experience of interactions with providers, as well as FP methods offered. Despite their interest, most women reported that they did not receive thorough information about FP, and about a third of them said that they did not receive any counselling services on PPFP. Reasons for dissatisfaction with counselling services included very crowded environment, short time with the provider, non-availability of provider, long waiting times, limited number of days for ANC services, and lack of comprehensive FP-related information, education and counselling (IEC) materials. Women visiting hospitals with a dedicated FP counselor reported higher quality of FP counselling.ConclusionsThere is an urgent need to re-visit the format of counselling on PPFP during ANC visits, corresponding IEC materials, counselling setting, and to strengthen availability and interaction with providers in order to improve quality, experience and satisfaction with FP counselling during ANC visits. Improvements in infrastructure and human resources are also needed to adequately meet women’s needs.

Patient Satisfaction with IUD Services in a School-Based Health Center: A Pilot Study.

We aimed to determine the acceptability to and satisfaction of high school students receiving an intrauterine device (IUD) at a school-based health center (SBHC). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: In this prospective pilot study at a Bronx SBHC, adolescent patients who had an IUD inserted in the SBHC between November 2010 and June 2013 completed a self-administered survey on the day of IUD insertion and a follow-up survey within 6months. The initial survey addressed patient sexual and contraceptive history, reasons for choosing the IUD, and the insertion experience, whereas the follow-up survey addressed IUD continuation and side effects. In all, 104 of 139 (75%) eligible patients agreed to participate, and 75 (72%) of those completed the follow-up survey. Respondents chose IUDs because they were long-lasting, effective, private, and easy to remember, and chose the SBHC for services because it was convenient, recommended, free, and a trusted setting. Participants rated their interactions with SBHC staff highly, and almost all described their procedure experience as somewhat or very acceptable. Of the respondents, 92% were still using the IUD at the time of the follow-up survey, with 32% stating that they were somewhat satisfied and 65% stating they were very satisfied with this method of contraception. Our research demonstrates that IUD services can be integrated into the SBHC setting with high rates of acceptability and satisfaction. Furthermore, SBHCs provide a unique and acceptable option for providing these services and have the potential to increase adolescents' contraceptive access and choice.

Teaching Minor Surgical Procedures in Internship in Primary Care: A Necessary Approach

Skin and subcutaneous lesions (nevus, fibromas, lipomas), lacerations, ingrown toenails, abscesses, musculoskeletal disorders such as arthritis, bursitis, trigger points, neuropathies and tendinitis are the main causes of problems in primary care that can be resolved with minor procedures. Performing these procedures is an important part of the general practitioner's competencies. The National Medical Course Curriculum Guidelines in Brazil show that medical students should be aware of these diagnostic and therapeutic procedures, based on current literature. In addition to the financial benefits, performing minor procedures in primary care also reduce patient anxiety, has greater convenience due to the proximity and familiarity with the health facility, requires less waiting for treatment, and allows for complete patient care. This paper is an experience report, with the objective of reporting the teaching-learning process during the internship of Family and Community Medicine of the Faculdades Pequeno Príncipe, regarding the performance of outpatient procedures in the primary health care. During the internship, it was possible to perform small procedures such as skin lesion excision, Intrauterine Device (IUD) insertion and trigger point needling. Thus, it is concluded that the teaching of small procedures is an essential part of the medical curriculum and helps to form a physician who addresses the most common complaints of patients in primary care.

The effect of antenatal counseling and intrauterine device insertion services on postpartum contraceptive use in Nepal: Results from a stepped-wedge randomized controlled trial

ObjectiveThere is high unmet need for family planning in the postpartum period in Nepal. The current study assessed the effects of a contraceptive counseling and postpartum intrauterine device (PPIUD) insertion intervention on use of contraception in the postpartum period. Study designWe utilized a cluster, stepped-wedge design to randomly assign two hospital clusters (compromised of six hospitals) to begin the intervention at time one or time two. From 2015 to 2017, women completed surveys after delivery but before discharge (n = 75,893), and then at one year and two years postpartum. We estimated the intent-to-treat effect of the intervention using weighted, linear probability models and the adherence-adjusted effect (antenatal counseling) using an instrumental variable approach. Outcomes included modern contraceptive use and method mix measured at one and two years postpartum in a sample of 19,298 women (year I follow-up sample) and a sample of 19,248 women (year II follow-up sample). We used inverse probability weights to adjust for incomplete follow-up and bootstrap methods to give correct causal inference with the small number of six clusters. ResultsThe intervention increased use of modern contraceptives by 3.8 percentage points [95% CI: −0.1, 9.5] at one-year postpartum, but only 0.3 percentage points [95% CI: −3.7, 4.1] at two years. The intervention significantly increased the use of PPIUDs at one year and two years postpartum, but there was less use of sterilization. Only 42% of women were counseled during the intervention period. The adherence-adjusted effects (antenatal counseling) were four times larger than the intent-to-treat effects. ConclusionsProviding counseling during the antenatal period and PPIUD services in hospitals increased use of PPIUDs in the one- and two-year postpartum period and shifted the contraceptive method mix. ImplicationsIn order for antenatal counseling to increase postpartum contraceptive use, counseling may need to be provided in a wider range of prenatal care settings and at multiple time points. Healthcare providers should be trained on contraceptive counseling and PPIUD insertion, with the goal of expanding the available method mix and meeting postpartum women’s contraceptive needs.

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.

A psychological factor associated with pain during intrauterine device insertion: emotional reactivity

A psychological factor associated with pain during intrauterine device insertion: emotional reactivity

Lidocaine for Pain Control during Intrauterine Device Insertion

Long-acting reversible contraception methods, such as intrauterine devices (IUDs), are associated with high effectiveness in preventing unintended pregnancies, and thereby their significant health and economic consequences. IUCD insertion is generally associated with fear, which may decrease its acceptability, and anticipated pain or discomfort at the time of insertion could be a major barrier to the acceptance of IUCDs among both clients and healthcare providers. IUCD. Insertion pain may be felt during various stages of the procedure, including the vaginal examination, placement of the speculum, tenaculum use, and traction of the uterus, hysterometry and insertion of the IUCD. On assess the viability of lidocain former will iud insertion clinched alongside lessening torment contrasted with placebo. This will be An randomized control study; toward gynecology outpatient facility in Benha college healing facility Also Berket elsabee doctor's facility from january should june 2018. Partitioned under two aggregations; bunch A: ponder gathering of 75 cases, utilization lidocaine spread. Aggregation B: control assembly for 75 cases, utilization saline spread. Examination of Information uncovered that lidocaine spread requisition of the cervix Throughout IUCD insertion adequately diminished ache felt Throughout the the sum phases of the procedure Furthermore agony felt 5 minutes then afterward the entire methodology. There might have been secondary huge distinction the middle of lidocaine aggregation What's more control assembly viewing agony score Throughout tenaculum placement 1. 82±0. 84Vs4. 10±1. 00, heartless insertion, 1. 32±0. 87 vs 2. 49±1. 13, iud insertion, 0. 85±0. 80 vs1. 36±1. 05 Furthermore five minutes’ post insertion 0. 53±0. 77vs0. 78±0. 77. They were the greater part more level On lignocaine assembly over control bunch (P worth 0. 001). Our examine showed that nearby lidocaine spread is compelling for control for ache connected with IUCD insertion when compared placebo aggregation.

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.

Influence of the Simulation in the Training of the 7&lt;sup&gt;th&lt;/sup&gt; Grade Medical Students in the Insertion of the Interval Intra-Uterine Device

Introduction: A simulation laboratory has been set up in the Department of Obstetrics and Gynaecology at Yalgado Ouedraogo Teaching Hospital. The objective of this study was to evaluate the role of the simulation in training of 7th grade students on interval IUD insertion. Material and Method: This was an evaluation study of skills before and after training that included 38 students of 7th grade medicine. Pre-training knowledges and skills were compared to those based on training using the paired Student test with a 5% significance level. Perceptions and suggestions for improvement of training made by students were collected. Results: The sex ratio of the study participants was 1.1. Their average age was 26.8 ± 0.9 years. The training increased the average knowledges score from 48.2% to 93.0% (p th grade medicine students had a good perception of this training. Conclusion: The training of 7th grade medicine students in IUD insertion using simulation had a positive impact on their knowledges and skills and was well appreciated.

Two cases of uterus-conserving treatment for early stage endometrial cancer

The aim of study is to present two successful cases of conservative surgical treatment of women with early-stage endometrial cancer who desired to have fertility in the two cases. A 32-year-old nulligravid woman had Stage IA endometrial cancer which was a 1.5-cm sized lesion confined to the left fundal side of the uterus. The other 35-year-old nulligravid woman had a 2-cm sized lesion suspicious for deep myometrial involvement suggesting Stage IB endometrial cancer. The women underwent hysteroscopic complete resection of tumor with safe resection margin just after laparoscopic tubal ligation, followed by insertion of a progesterone-releasing intrauterine device. The patients have no evidence of recurrence for 26 months and 27 months of follow-up, respectively. Hysteroscopic complete resection of tumor with safe margin combined with bilateral tubal ligation, followed by a progesterone-releasing intrauterine device could be a good option for early-stage endometrial cancer.

Study of outcome of Intrauterine Contraceptive device (CuT-380A) insertion immediately after vaginal delivery

Introduction Closely spaced pregnancies are associated with adverse outcomes both for mother and foetus. The recommendations based on the results of technical consultants for healthy timing & spacing of pregnancies (HTSP) are that after a live birth, a woman should wait at least 24 months but not more than 5 years before attempting the next pregnancy to reduce the health risks and better outcome for the mother & baby. Here, our study was to see the effects of IUCD (CuT-380A) insertion immediately after vaginal delivery for spacing. Methods This study was done at Agartala Government Medical College (AGMC) and GBP Hospital for one & half years (Jan'16–June'17). Antenatal mother of term pregnancy were counselled. They were recruited from Gynae OPD & emergency and evaluated for different outcomes at 6th, 12th& 18th months in terms of different complications. Results Total of 200 women of term period of gestation (POG) where counselled and 55 women participated in this study. Common complications were expulsion of IUCD 5 (9.1%) at 6th month & bleeding per vagina 3 (5.5%) at one year. Expulsion of IUCD at one & half year was 5 (9.1%) and infection 1 (1.8%). 23 (42.6%) subjects continued with IUCD. Conclusion Major complications are low here, but still outcomes in terms of different parameters are not encouraging. Health workers at different levels can overcome this gap to improve the outcome. All our efforts should be made to enhance the field activities in making people aware about PPIUCD.

Story of Management of a Challenging Case of a Fibrotic Uterine Cavity

ABSTRACTAimOur aim is to highlight the emerging trends of management of a moderate-to-severe degree of Asherman's syndrome/fibrotic uterine cavity in the form of either relook hysteroscopic surgery or postoperative hormonal therapy.BackgroundAsherman's syndrome also known as Fritsch syndrome or Fritsch–Asherman syndrome is a condition where iatrogenic intrauterine adhesions (IUA) develop and it occurs most commonly following dilatation and curettage or pelvic infections, e.g., endometrial tuberculosis. Diagnosis is based on the history and a high index of suspicion followed by confirmation by saline infusion sonography (SIS) or hysterosalpingography (HSG). Hysteroscopy is the gold standard for both diagnosis and treatment of Asherman's syndrome. This case highlights the importance of hysteroscopic management of a known case of Asherman's syndrome/IUA and also highlights how important are relook hysteroscopic surgeries and their interval from primary surgery and gradually decreasing the dose of postoperative hormonal therapy to cure the same and to improve the clinical outcome.Case descriptionWe present a case where a patient underwent curettage after retained products leading to fibrosis of the uterine cavity. Multiple surgeries abroad were unsuccessful to correct the problem. Then patient came to our institute where hysteroscopic adhesiolysis and lateral wall metroplasty along with laparoscopic adhesiolysis and right-sided ovarian cystectomy followed by intrauterine contraceptive device (IUCD) insertion, i.e., multiload without copper was done followed by two more relook hysteroscopic procedures leading to reformation of a normal uterine cavity. The authors discuss the stepwise management of a known case of Asherman's syndrome through this successful and challenging case.ConclusionIUA develop most commonly after vigorous curettage or endometrial tuberculosis. Diagnosis is based on the history and a high index of suspicion and confirmation by SIS and HSG. The hysteroscopic management of IUA is a safe and effective method. It is a surgical pearl for both diagnostic and therapeutic purposes. Sequential estrogen and progesterone therapy and a splint are found to be helpful, but further studies are needed to assess their efficacy. Relook hysteroscopy acts as an adjunctive method to improve the outcome. We emphasize on relook hysteroscopy and its interval from the primary surgery which is usually after next menses when the patient resumes menses as it helps to get a better and long-term clinical outcome.Clinical significanceHysteroscopy acts as both a diagnostic and therapeutic tool for the management of fibrotic uterine cavity. Relook hysteroscopic surgery is useful to manage a moderate-to-severe degree of fibrotic uterine cavity along with insertion of IUCD without copper to prevent further adhesions. Gradually decreasing the dose of hormonal therapy (estrogen plus progesterone) helps to regenerate the endometrium and to resume normal menses.How to cite this articleJain N, Kausar H, Manchanda R,et al.Story of Management of a Challenging Case of a Fibrotic Uterine Cavity. J South Asian Feder Obst Gynae 2020;12(6):432–435.

Follow-up of copper intrauterine device insertion by nurses: a prospective longitudinal study.

to assess the complications, acceptability and causes of discontinuation of women who inserted copper intrauterine devices at a usual risk maternity for one year. a longitudinal-prospective study, lasting 12 months. Eighty-three women who received the device by a doctor or nurse in a maternity hospital between September and October 2017 participated. Data were collected at one, six and 12 months after insertion and underwent descriptive analysis. most were inserted by nurses and 71 continued with the device. Women chose IUD use because there is no risk of forgetfulness, it is non-hormonal and effective. The 12 who discontinued use reported dysmenorrhea, menorrhagia, irregular bleeding, fall out, and endometrium perforation. the method was continued by most of participants and the complications found are common to the literature. There is a need to expand nursing training to increase the offer to the population.