Intrauterine Device Insertion Research Articles

Statement of Retraction [Different analgesics prior to intrauterine device insertion: is there any evidence of efficacy?

Statement of Retraction [Different analgesics prior to intrauterine device insertion: is there any evidence of efficacy?

Risks of Uterine Perforation and Expulsion Associated With Intrauterine Devices.

The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD) insertion, breastfeeding, heavy menstrual bleeding, and IUD type (levonorgestrel-releasing vs copper) with risks of uterine perforation and IUD expulsion in usual clinical practice. We summarize the clinically important findings to inform counseling and shared decision making. APEX-IUD was a real-world (using U.S. health care data) retrospective cohort study of individuals aged 50 years and younger with IUD insertions between 2001 and 2018 and with electronic health record data. Cumulative incidences of uterine perforation and IUD expulsion were calculated. Adjusted hazard ratios (aHRs) and 95% CIs were estimated from proportional hazards models with control of confounding. Among the study population of 326,658, absolute risk of uterine perforation was low overall (cumulative incidence, 0.21% [95% CI 0.19-0.23%] at 1 year and 0.61% [95% CI 0.56-0.66% at 5 years]) but was elevated for IUDs inserted during time intervals within 1 year postpartum, particularly among those between 4 days and 6 weeks postpartum (aHR 6.71, 95% CI 4.80-9.38), relative to nonpostpartum insertions. Among postpartum insertions, IUD expulsion risk was greatest for insertions in the immediate postpartum period (0-3 days after delivery) compared with nonpostpartum (aHR 5.34, 95% CI 4.47-6.39). Postpartum individuals who were breastfeeding had a slightly elevated risk of perforation and lowered risk of expulsion than those not breastfeeding. Among nonpostpartum individuals, those with a heavy menstrual bleeding diagnosis were at greater risk of expulsion than those without (aHR 2.84, 95% CI 2.66-3.03); heavy menstrual bleeding also was associated with a slightly elevated perforation risk. There was a slightly elevated perforation risk and slightly lower expulsion risk associated with levonorgestrel-releasing IUDs compared with copper IUDs. Absolute risk of adverse outcomes with IUD insertion is low. Clinicians should be aware of the differences in risks of uterine perforation and expulsion associated with IUD insertion during specific postpartum time periods and with a heavy menstrual bleeding diagnosis. This information should be incorporated into counseling and decision making for patients considering IUD insertion. Bayer AG. EU PAS register, EUPAS33461.

Statement of Retraction [Self-administrated vaginal 2% lidocaine in-situ gel for pain relief during copper intrauterine device insertion in women with previous caesarean delivery only: a randomised, double-blind placebo-controlled trial

Statement of Retraction [Self-administrated vaginal 2% lidocaine in-situ gel for pain relief during copper intrauterine device insertion in women with previous caesarean delivery only: a randomised, double-blind placebo-controlled trial

Reproductive Planning and the Choice of Long-acting Reversible Contraceptive Primary to Health: A Cross-Sectional Study.

Evaluate the different perspectives that involve the choice of long-acting reversible contraceptives (LARCs), the issues related to this process and the consequences of deciding one method in the women's in the primary health care (PHC) center in Sousas, a district in Campinas, SP (Brazil). This is an analytical cross-sectional study, it was performed at the PHC in Sousas. Data were collected through the analysis of medical records and interviews with women who live in Sousas and had the insertion of the copper intrauterine device (IUD) (D) from April 2021 to April 2022 or the etonogestrel implant (I) from May to December 2022. The study was approved by the Research Ethics Committee of the Medical Science School at the State University of Campinas (UNICAMP). Reason for choosing this LARC: medical (D: 52%; I: 100%), easy adhesion (D: 71%; I: 67%), effectiveness (D: 55%; I: 100%). Indication by health professionals (D: 65%; I: 100%). And improvement of clinical characteristics: mood (D: 77%; I: 67%), body mass index (BMI; D: 52%; I: 33%), and libido (D: 84%; I: 67%). It is suggested that women tend to decide between LARCs when guided by their doctor or PHC health professionals, and they select LARCs because of the ease of use and low failure rates. Therefore, this study highlights how LARCs can positively interfere in the aspects that pervade contraception, such as BMI, libido, and mood.

The management of the malposition of intrauterine devices at the tertiary center

Aims: The malposition of intrauterine devices (IUD) is a major problem in contraception and this study aims to evaluate the surgical procedures used in the management of these cases. Methods: Patients who were operated on for malposition of copper T IUD between 2018-2021 were evaluated retrospectively. The cases were analyzed in 4 groups as followed; instrumental removal, hysteroscopic (H/S), laparoscopic (L/S), and laparotomic (LPT) procedure. The groups were compared in age, obstetric history, IUD insertion time, and intraoperative outcomes. Results: There were a total of 39 cases and the groups consisted of instrumental removal (n=8), H/S (n=24), L/S (n=6), and LPT (n=1) procedure. In the H/S group, mean age (44 ±10) and duration of IUD use (10.1 ±7.5 years) were found to be significantly higher than the other groups (p=0.03 and p=0.001 ). Six cases (25%) in the H/S group IUD was in the uterine cavity while in 5 (20.8%) it was embedded in the endometrium and myometrium. In the L/S group, the duration of IUD use was shorter (1.3 ± 0.8 years) and the mean age (29±10) was lower and all cases were managed laparoscopically except in one case that was extracted after conversion to laparotomy. Conclusion: Advanced age and prolonged IUD use are risk factors for embedded of the IUD in the uterine cavity in the hysteroscopy group, however, IUDs that reach the abdomen by ruptured uterus are detected at younger ages and earlier in IUD use, and minimally invasive methods are eligible surgical procedures for these cases.

Effects of a short training workshop on the insertion/removal of intrauterine devices and contraceptive implants by general practice residents and their supervisors in France

ObjectivesThe skill of general practitioners (GPs) in performing the insertion/removal of intrauterine devices (IUDs) and contraceptive implants is one of the factors that determines patient's access to these contraceptive devices. In France, GP residents have few opportunities to perform these procedures during their internships. This study aimed to measure the effects of a single short training workshop on the number of residents and supervisors offering these procedures. Study designEach participant attended a unique 2-hour session. After a brief didactic review and video presentations, participants received hands-on training in technical procedures (insertion/removal of IUDs and contraceptive implants) using procedural simulators. The evaluation measured the number of GPs offering these procedures before, 1 month after, and 3 months after the workshops. ResultsFourteen sessions were organized from February 2017 to June 2022. Among the 387 residents and 123 supervisors invited, 143 (37.0%) and 56 (45.5%), respectively, participated in this workshop. Of 199 participants, 66.3% completed all questionnaires. There was a significant increase in the number of GPs inserting IUDs by direct method 3 months after training (20.5% vs 9.0%, p = 0.005). GPs providing information to patients about contraceptive implants were significantly higher at 1 month (80.6% vs 64.8%, p = 0.001) but this increase was no longer significant at 3 months (75.0%, p = 0.07). Residents changed their practices more than their supervisors, and women more than men. ConclusionsA short training workshop increased the number of GPs inserting IUDs, influenced by the gender and the number of years practicing. ImplicationsA single workshop had positive effects on IUD insertion and patient education about contraceptive implants. Repeating several times this training could be an option in the initial and ongoing training of general practitioners. Work on the general practitioners' own feeling of legitimacy in their practice context could also increase the effectiveness of these workshops and the practical implementation of the procedures taught.

Insertion Of Intrauterine Device During Cesarean Section

Insertion Of Intrauterine Device During Cesarean Section

Socio-Demographics and Contraceptive Acceptance of Women of Reproductive Age in Peshawar Pakistan: A Cross-sectional Study

Background: Delaying in the initiation of effective contraception in postpartum period and during lactation puts a woman at risk of rapid, repeat, and unintended pregnancy. Postpartum Intrauterine Contraceptive Device (PPIUD) insertion during a Caesarean section allows obstetrician to insert it under vision thus excluding any fear of perforating the uterus with major side effects that is bleeding and abdominal cramps being masked in the puerperium. The aim of the currents study was to investigate knowledge, attitude, and acceptance trends of contraception practices among women from Peshawar Pakistan. Methods: Current six-month duration (January 1,2019 to June 30, 2019) based cross-sectional study was conducted at Obstetrics and Gynecology Unit B, Lady Reading Hospital, Peshawar by following non-probability purposive sampling approach. Detailed socio-demographic and obstetric history was obtained from 316 women who were admitted for elective lower segment Caesarean section by informed ethical concern. The major socio-demographic details collected from the study participants may include age, education level and number of total pregnancies conceived. Further, profession and duration from last childbirth related factor were compared with the knowledge and acceptance rates of intra-uterine postpartum contraception by using Chi-Square test. Further data analysis was made by using SPSS v. 20 and Microsoft office 2010 different tools. Results: Out of 316 participants, only 22 (6.96%) women accepted PPIUCD during Caesarean section. The mean age of participants was 33.26 ± 5.1 SD. About 243 (76.89%) cases had no normal schooling, 15 (4.7%) had primary education, 57 (18%) had secondary and only 1 (0.3%) had higher education. Similarly, 294 (93%) were housewives while only 22 (7%) were employed at work., no significant difference was noted among the acceptance of the different age groups. Conclusion: The uptake of PPIUCD is very low as observed in this study. To improve the situation, health authorities should be encouraged to provide counseling on postpartum contraceptive methods during ante- and post-partum care visits.

How does immediate postpartum insertion of contraceptive implants and intrauterine devices (IUDs) compare with delayed insertion for women needing contraception?

How does immediate postpartum insertion of contraceptive implants and intrauterine devices (IUDs) compare with delayed insertion for women needing contraception?

Blended Teaching Methodology of E-learning and Simulation Training in Obstetrics and Gynecology for Undergraduate Medical and Nursing Trainees.

Context The concept of simulation-based teaching has become a standard practice for health education in the present era. However, there is a paucity of literature on integrating simulation-based teachingin the conventional training of undergraduate medical and nursing students. Aim To explore the effectiveness and benefits of e-learning along with low-fidelity simulation in obstetrics and gynecology among undergraduate medical and nursing students at a tertiary care centerin India. Methodology It was a prospective study conducted on 53 final-year undergraduate medical students and 61 final-year undergraduate nursing students. All students underwent a knowledge-based pre-test followed by exposure to an e-learning module on four selected obstetrics and gynecology skills, namely, conducting normal delivery, episiotomy suturing, pelvic examination, and insertion of intrauterine device. Students practiced these four skills on low-fidelity simulators. After this, they underwent a post-test assessment and gave feedback. A focused group discussion was conducted to explore their experiences. Results There was a statistically significant difference between the pre-test and post-test knowledge scores of all the students (p =< 0.001). Students found this teaching strategy useful and reported an increase in self-assessed confidence. Focused group discussion revealed various themes like improved satisfaction and ability to practice repeatedly without fear of harming patients. Conclusions Based on the results, this teaching methodology should be integrated as an adjunct method of teaching in the undergraduate curriculum from the first year itself, which will motivate students to participate in clinical care and will result in quality improvement of health care.

Effect of the timing of insertion of postpartum intrauterine contraceptive device (PPIUCD) copper T380A on expulsion rates.

Postpartum intrauterine contraceptive device (PPIUCD) is well accepted and recommended for contraception. However, anxiety at the time of delivery may restrict the acceptance of a PPIUCD for its immediate insertion. So far there is limited evidence to conclude anything concrete on the association between the expulsion rates and the timing of insertion following a vaginal delivery. Thus, this study was undertaken to compare the expulsion rates in immediate and early insertions and their safety and complications. This prospective comparative study was carried out over 17 months on women delivering vaginally in a tertiary care teaching hospital in South India. A copper device (CuT380A) was inserted using Kelly's placental forceps either within 10 min of placental delivery (immediate group, n=160) or between 10 min upto 48 h postpartum (early group, n=160). Ultrasound was done before discharge from the hospital. The expulsion rates and any other complications at six-week and three-month follow up were studied. Chi-square test was used to compare the difference in expulsion rates. The expulsion rate was five per cent in the immediate compared to 3.7 per cent in the early group (no significant difference). In ten cases, the device was found to be in the lower uterus upon ultrasound before discharge. These were repositioned. There was no case with perforation, irregular bleeding or infection up to the three-month follow up. Higher age, higher parity, lack of satisfaction and motivation to continue were predictors of expulsion. In the present study PPIUCD was found to be safe with overall expulsion in 4.3 per cent. It was marginally, though not significantly, higher in the immediate group.

Awareness and Acceptance of Post-Partum Intrauterine Contraceptive Device Insertion (PPIUCD) among Patients Attending a Tertiary Care Hospital Karachi

Background: The knowledge, awareness and acceptance regarding contraceptives are variable in different parts of world. Family planning is still considered a stigma in most parts of the world. Contraceptive use for family planning is a key to understand the profound changes in fertility and to improve reproductive health worldwide. Objective: To evaluate the awareness and acceptance of the post-partum intrauterine contraceptive Device Insertion (PPIUCD) among the pregnant women visiting the Outdoor Department of Obstetrics and Gynecology in a tertiary care Hospital Malir Cantt Karachi. Study design and setting: A cross sectional study was conducted during the period January 2022- June 2022. Material and Methods: This cross sectional study was conducted at the Tertiary care Hospital, Malir cantt, Karachi, for six months from (January 2022-June 2022) Data were collected using interviewer administered structured questionnaire was filled after the informed consent. The inclusion criteria: were the women agreed to participate the study and agreed to fill the questionnaires Urdu version, who visited outdoor department. The exclusion criteria were the women who refuse to ill the questionnaire. Results: This study shows the acceptance rate of PPIUCD is 12% of 200 women who participated this study. The commonest reasons for their denial were the inadequate information or knowledge of PPIUCD. The acceptance rate of PPIUCD was associated with their awareness and the long term effectiveness. Women who have completed their secondary or higher education were more informed and accepted than uneducated women. (AOR = 3, CI = 11.81, 53.91). The age group ranging from 25-30 years showed positive acceptance for PPIUCD. Conclusion: The rate of acceptance for postpartum intrauterine contraceptive device turns out to be low in this study, though this is an effective and safe method of postpartum family planning. The perceived concerns and fears about the PPIUCD are due to lack of awareness regarding its use among women attending the antenatal clinics. Keywords: PPIUCD, Contraception, Postpartum FP, awareness.

Novel Concepts for Intrauterine Device Placement at Caesarean Delivery: Description of Technique and Video Recording.

The International Federation of Gynaecology and Obstetrics recommend digital insertion of the copper intrauterine device (IUD) during caesarean delivery and note the risk of thread inclusion in the uterotomy closure and nonvisibility of threads at follow-up. We describe a novel method of inserting the IUD with the insertion straw and directing the lower end of the straw through the cervix for retrieval after the operation, to protect and ensure alignment of the threads. We also describe a simple method of lengthening one thread with part of the other thread, to avoid risks associated with braided suture extensions.

What Is the Most Cost-Effective Timing for Postpartum IUD Insertion? [ID: 1379571

INTRODUCTION: Postpartum intrauterine device (IUD) insertion is an effective contraception choice for reducing rates of unplanned and short-interval pregnancies. However, timing of placement is controversial, and risk of perforation and expulsion vary with timing. We aim to analyze the cost-effectiveness of postpartum IUD insertion intervals when considering risk of perforation or expulsion. METHODS: A decision-analytic model compared four intervals of postpartum IUD insertion: between 0 and 3 days, 4 days and 6 weeks, 6 and 14 weeks, or 14 and 52 weeks postpartum. A theoretical cohort of 600,000 was calculated using the estimate that 15.3% of postpartum people receive a long-acting reversible contraceptive. Probabilities, costs, and utilities were procured from the literature. Primary outcomes included IUD-related uterine perforation, expulsion, unplanned short-interval pregnancy, termination, stillbirth, ectopic pregnancy, and preterm delivery. The cost-effectiveness threshold was $100,000/quality-adjusted life-year (QALY). RESULTS: IUD insertion between 6 and 14 weeks postpartum was the cost-effective strategy despite having 1,978 and 1,982 additional perforations in intervals between 0–3 days and 14–52 weeks, respectively. All other outcomes were reduced. When compared to the intervals of 0–3 days, 4 days–6 weeks, and 14–52 weeks postpartum, this strategy resulted in 3,054, 282, and 3,816 more QALYs and decreased costs by $91 million, $22 million, and $316 million, respectively. CONCLUSION: Intrauterine device insertion between 6 and 14 weeks postpartum is the cost-effective strategy despite increased risk of perforation. Appropriately counseling patients on the risks and benefits associated with timing of IUD insertion is an important component of postpartum care.

Uterine sound-sparing approach in insertion of Nova T-380 intrauterine device

Uterine sound-sparing approach in insertion of Nova T-380 intrauterine device

Long-Acting Reversible Contraception Continuation After Management of a Malpositioned Intrauterine Device [ID: 1376021

INTRODUCTION: Studies have investigated risk factors for intrauterine device (IUD) malposition, but there is a paucity of data regarding patients’ contraceptive decisions after experiencing a malpositioned IUD. Therefore, we sought to investigate continued long-acting reversible contraception (LARC) usage after management of a malpositioned IUD. METHODS: After IRB approval, a retrospective cohort study was conducted, which included 541 patients who underwent IUD insertion at one institution with subsequent pelvic imaging. One hundred six had a malpositioned IUD and were age-matched to controls. Chart and imaging reports were abstracted. Long-acting reversible contraception retention was documented through 24 months from index imaging. RESULTS: Most patients had a levonorgestrel IUD (90.9%) for the indication of contraception alone (54.1%). The imaging indication of abnormal uterine bleeding (AUB) was most likely to be associated with malposition (odds ratio [OR] 1.67 [1.03–2.71], P=.038), as well as a copper IUD type (OR 5.31 [2.14–13.18], P&lt;.001). Most patients with a malpositioned IUD did not have an IUD replaced after removal (57.8%). Of those who abandoned IUD therapy, only six chose to initiate an alternative LARC. Malposition was not an independent risk factor for LARC abandonment between the two groups over the 24 months of follow-up. Risk factors for abandonment over the follow-up period included AUB, copper IUD use, younger age, and shorter duration of use before undergoing imaging. CONCLUSION: Most patients with a malpositioned IUD did not have IUD replacement and abandoned all LARC therapy. These are important preliminary findings regarding LARC abandonment associated with IUD malposition that will help shape further studies as well as clinical counseling.

Statement of Retraction [Post-placental intrauterine device insertion vs puerperal insertion in women undergoing caesarean delivery in Egypt: a 1 year randomised controlled trial

This article refers to:RETRACTED ARTICLE: Post-placental intrauterine device insertion vs puerperal insertion in women undergoing caesarean delivery in Egypt: a 1 year randomised controlled trial

Statement of Retraction [Ultrasound-guided intrauterine device insertion: a step closer to painless insertion: a randomized control trial

This article refers to:RETRACTED ARTICLE: Ultrasound-guided intrauterine device insertion: a step closer to painless insertion: a randomized control trial

Development and validation of a performance assessment checklist for insertion of an intra-uterine device (IUD).

The World Health Organization (WHO) supports increasing the availability and acceptability of long-acting reversible contraception including intra-uterine device (IUD), but its insertion includes certain risks (uterine perforation). The objective was to develop and validate an IUD insertion performance assessment checklist. This prospective study took place in hospitals and simulation center of the Poitou-Charentes region, France. The checklist content reached consensus among 10 experts solicited by a Delphi method. A modified gynecologic mannequin Zoe (Gaumard®) was used for simulations. Psychometric testing included 30 multi-professional participants for internal consistency and reliability between two independent observers, and 27 residents for assessment of score evolution over time and reliability. Cronbach alpha (CA) and intraclass coefficient (ICC) were used. Progression of performance was carried out using ANOVA for repeated measures. The data collected were used to plot receiver operating characteristic (ROC) curves for the score values and the area under the curve (AUC) was determined. The checklist included 27 items (2 sections, total score = 27). Psychometric testing showed CA = 0.79, ICC = 0.99, and good clinical relevance. The checklist is discriminative, showing a significant increase in performance scores when the simulations were repeated (F = 77.6, p < 0.0001). ROC curve [AUC: 0.792 (95% CI: 0.71-0.89); p < 0.0001] revealed the best score cutoff predictive of 100% sensitivity, i.e., true positive rate or success rate. Performance score was highly correlated to success rate. The cut-off score guaranteeing successful IUD insertion was 22/27. This coherent and reproducible checklist for IUD insertion provide an objective assessment of the procedure during SBT, with the aim of obtaining a score ≥ 22/27.

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