Postplacental Intrauterine Device Research Articles

Safety and Success of immediate post-placental intrauterine device insertion at the time of Cesarean Section

Background: Evidence is building up in favour of insertion of an intrauterine device (IUD) in the immediate postpartum period i.e.: post-placental IUD (PPIUD) insertion with regard to its safety and effectiveness as a method of contraception. PPIUD insertion at the time of Cesarean section (CS) is also a safe and acceptable method. However there is not much research evidence to encourage service providers to adopt this practice. We carried out this study to determine safety and success rates of immediate post caesarean IUD insertion. Materials And Methods: A cross sectional study was conducted on women who underwent PPIUD insertion following childbirth at the Teaching Hospital, Kandy from January 2013 to March 2013. Data were collected by an intervieweradministered questionnaire at postnatal wards as an exit interview. Repeat interviews were carried out at 6 weeks and 6 months since the date of PPIUD insertion. All women were assessed clinically and ultrasonically. Patient perceived morbidities following insertion of PPIUD and expulsion rates were assessed as outcome measures. Result: At the end of 3 months, 121 mothers had undergone PPIUD following CS and 362 following vaginal Delivery (VD). Eight women (6.7%) complained of abdominal pain following PPIUD insertion in the CS group while the same for the VD group was 3(0.8%). Abnormal vaginal bleeding was the second commonest complaint with 5(6%) and 8(2.2%) in CS group and VD group respectively. At the end of the observational period of 6 months, Six (5%) IUDs had been expelled in the CS group, where one (4.5%) was in elective CS and five (5.5%) were in emergency CS. This difference was not significant (p=0.5). The expulsion rate in women in VD group was found to be 17.7% (16), which was significantly higher than the same reported from the CS group (p Conclusions: Post caesarean IUD insertion appears to be a safe and effective option at this short term analysis. This could be an effective method of family planning for women wishing for long acting reversible contraception. Considering the poor compliance to other family planning methods and the rate of CS at hospitals, application of this intervention seems feasible. Further studies need to be carried out to evaluate the outcomes at long term.

Expulsion of Immediate Postplacental Copper IUDs at Six Weeks: A Prospective Cohort Study [5A

INTRODUCTION: Postplacental intrauterine device (IUD) placement could improve contraceptive access and child spacing. We sought to report a precise point estimate of the proportion of TCu380A IUDs expelled 6 weeks after immediate postplacental placement, and to assess risk factors for expulsion. METHODS: We enrolled women who received a TCu380A IUD after vaginal delivery beyond 33 weeks gestation from April 2015-August 2016. A sample size of 195 enabled us to detect a 15% expulsion proportion with a 95% confidence interval of ±6%. Follow-up to determine IUD status occurred 6 weeks postpartum. RESULTS: 195 women enrolled. Six weeks postpartum, 155 of 171 (90.6%) telephone survey respondents believed their IUD was in place, and 136 (79.5%) reported high satisfaction. Of the 147 women who completed a pelvic exam, 104 had a correctly positioned IUD and continued its use (70.7% [95% CI 63.4-78.1%]). Mechanical IUD complications included: 10 complete expulsions (6.8%), 14 partial expulsions (IUD in cervix; 9.5%), 5 devices in the lower uterine segment (3.4%), and 8 rotated in the uterus (5.4%). IUD strings were visible on exam for 112 subjects (76.2%); of these, 90 (80.4%) had correctly positioned devices. There were no statistically significant associations between clinical covariates assessed and IUD continuation. CONCLUSION: In our cohort, continuation of a correctly positioned IUD was 71% at 6 weeks postpartum. Mechanical complications occurred in 25%, and visualization of IUD strings did not assure fundal placement. The significance of malpositioned IUDs requires further investigation. Participants were satisfied with postplacental IUD access.

Hang-up IUD, New Technique for Suturing CuT-380A IUD to Uterine Fundus in Immediate Postplacental Insertion during Cesarean Delivery: Twelve Months Follow up

Objective: The aim of this study was to evaluate the effectiveness, side effects and acceptability of postplacental CuT-380A IUD insertion using new technique for suturing to uterine fundus during cesarean section (hang up technique). Method: Prospective cohort study of postplacental IUD CuT-380A insertion during cesarean delivery. Hang-up technique consists of performing a puncture in the center of the fundus wall using straight needle into the uterine cavity and subsequently using chromic catgut no. 1 to tie the IUD using anchor knot and hanging the IUD to the fundus. Our subjects were women who underwent caesarean delivery at dr. Kariadi Hospital between 1st June 2009 to 31st April 2011 and followed up at 12 months follow-up, one woman underwent IUD removal because of severe dysmenorrhea. No perforation or expulsion was reported. Conclusion: Immediate postplacental insertion of IUD CuT-380A using hang-up technique is safe and effective. Typical use effectiveness is high (Pearl Index 0.93) and there were no reported incidents of expulsion or perforation. Acceptance and continuation rate were high, 98.15% and 95.37% respectively. [Indones J Obstet Gynecol 2014; 2-31: 132-139] Keywords: anchor knots, cesarean section, hang-up IUD, postplacental IUD insertion

The Risk of Expulsion is Higher in IUD-Endometrium Distance of More than 10 mm

Objective: To acknowledge the rate of expulsion in post placental IUD CuT-380A insertion after vaginal delivery.
 
 Method: Postplacental IUD Cu T-380A insertion was performed at least 10 minutes after the placenta has been delivered by inserting IUD Cu T-380A in uterine cavity using index finger, and positioned the IUD in uterine cavity and pushed as high as possible directly to the uterine fundus. Then the IUD-endometrium distances were
 checked using transvaginal USG on the seventh and forty second day after IUD insertion.
 
 Result: From May and August 2012 has been done post placental IUD Cu T-380A set in 38 women, found that average of women age was ≥ 30 years old (34.21%), multi parities (63.16%), and gestation age for 37-42 weeks (100%). In this study found that three expulsion
 cases. Totally expulsion found in 2 cases, each found in days of 16 with averages distances of IUD and endometrium for 16.8 mm and in days of 19 with average distances of IUD-ED for 13.5 mm after IUD set. While partially expulsion found in 1 case, occurred in days
 of 11 after IUD set with average distance IUD-ED for 13.2 mm.
 
 Conclusion: IUD Cu T-380A set after vaginal delivery that observed for 42 days found that 3 (7.89%) peoples have expulsion. There is significant correlation the distance between IUD and ED in expulsion occurrences.
 
 [Indones J Obstet Gynecol 2013; 37-1: 26-31]
 
 Keywords: expulsion, post placental IUD Cu T-380A

Postplacental IUD Insertion Using Ring Forceps versus Push and Push Technique

Objective: To compare IUD-endometrium (ED) distance and the incident
 of malposition postplacental CuT-380A IUD insertion in vaginal
 delivery between ring forceps technique and push and push
 technique.
 Method: This study was a double-blind randomized control trial,
 performed in September 2014 until March 2015 at Dr. Kariadi Hospital.
 Ring forceps and push and push insertion technique groups
 consisted of 25 subjects in each group. Follow-up was performed at
 1-2 weeks, 6-8 weeks and >12 weeks after insertion.
 Result: The mean of IUD-ED distance in push and push group was
 shorter (but not statistically significant) than ring forceps group. The
 IUD-ED distance was at 1-2-week follow-up 4.1 (2.2) vs. 4.9 (3.4)
 mm; p=0.208, at 6-8-week follow-up: 2.6 (1.8) vs. 3.2 (3.7) mm;
 p=0.452, and at > 12-week follow-up: 0.9 (0.8) vs. 1.0 (0.9) mm;
 p=0.427, respectively. Malposition was found in 1-2-week follow-up,
 but the IUD was changed to the normal position (sagital position in
 uterine fundus) at 6-8-week and >12-week follow-up. Up to 3
 months of follow-up, there was no occurrence of perforation, expulsion
 or pregnancy in both groups. Most of subjects (56% in the
 ring forceps, 68% in push and push groups) did not feel painful during
 IUD insertion.
 Conclusion: Push and push insertion technique clinically tends to
 produce IUD-ED distance shorter than ring forceps technique. Both
 techniques are comfortable, safe and effective.
 [Indones J Obstet Gynecol 2016; 4-2: 78-87]
 Keywords: immediate postplacental IUD insertion technique, IUDendometrium
 distance, IUD malposition, push and push technique,
 ring forceps technique

Modification of Immediate Postplacenta CuT-380A IUD Insertion Using Ring Forceps and Standard Inserter: Twelve Months Follow-up

Objective: To evaluate the outcome of CuT-380A IUD postplacental
 insertion in vaginal delivery using new modification insertion technique.
 
 Method: We carried out a prospective cohort study of postplacental
 IUD insertion by means of ’push and push’ technique, using ring forceps and standard inserter (inserter tube and plunger rod). We included women who underwent vaginal delivery from 1st June 2009
 until 31st March 2011 and had postplacental IUD insertion. Followup
 was conducted for 12 months, including history, physical examination, ultrasound and questionnaires during evaluation, through home visits and by phone. The first monitoring is before 6 weeks after delivery, the second monitoring was after 6 weeks up to 3
 months, the third is after 3 months up to 6 months, the fourth is after 6 months up to 12 months, the fifth is after 12 months up to 24 months and the sixth is after 24 months up to 32 months after insertion.
 
 Result: On the second monitoring, 2 acceptors experienced expulsion.
 At the third monitoring period, one acceptor requested for IUD
 removal. At 9 months up to 12 months post-insertion, one expulsion
 was encountered, and one acceptor requested removal of device. At
 ≥12 months there was one acceptor who had IUD removal. We did
 not find any report of unintended pregnancy or perforation.
 
 Conclusion: Immediate post-placental insertion of CuT-380A IUD
 after vaginal delivery using ’push and push’ technique is safe and effective.
 The pregnancy rate at typical use is 0%, continuation rate is
 94.1% and low expulsion rate (2.86%). Loss of follow up was 5.6%
 and no perforation was reported.
 
 Keywords: continuation rate, immediate post-placental IUD insertion,
 ’push and push’ technique, typical use, vaginal delivery

Acceptance of Post-Placental Intrauterine Contraceptive Device in Denpasar

Background and purpose: The Indonesian Demographic Health Survey of 2012 indicated that the prevalence of contraceptive use in Bali Province has decreased compared to 2007. In addition, the proportion of the use an intrauterine device (IUD) also continues to decline. To increase number of IUD acceptors is to promote post-placental intrauterine device (PPIUCD), however the acceptance remains low. This study aims to determine factors associated with acceptance of post-placental intrauterine device in Denpasar.Methods: Study was cross sectional with a total of 100 respondents selected by consecutive sampling. Respondents were mothers who had gave birth in January-February 2016 at Wangaya General Hospital and three health centers (Dauh Puri Sub Health Center, East Denpasar I and South Denpasar IV). Data were collected by interview in hospital and health center. Chi square test was conducted for bivariate analysis and multivariate using logistic regression.Results: Proportion of PPIUCD acceptance was 35%. Multivariate analysis indicated that PPIUCD acceptance was associated with perception of benefits (AOR=10.39; 95% CI: 2.792-38.56), perception of low side effects (AOR=5.288; 95%CI: 1.085-25.761), role of health workers (AOR=7.1; 95%CI: 1.781-28.60) and support of the husband (AOR=12.020; 95% CI=2.888-50.01).Conclusion: Variables associated with PPIUCD acceptance were perception of low side effects, perception of benefits, role of health workers and husband support.

Post-Placental IUD Insertion

INTRODUCTION: Studies examining patient-centered outcomes on post-placental intrauterine device (IUD) placement are currently lacking. The objectives of this study are: 1) describe women's experiences with post-placental IUD insertion through postpartum semi-structured interviews, 2) establish a mean pain score for the procedure using a 100 mm visual analogue scale (VAS), 3) assess insertional pain using a 4-point Likert verbal rating scale (VRS). METHODS: We enrolled women with and without an epidural in this concurrent mixed methods pilot study. Procedural pain was assessed using the VAS and VRS immediately after IUD placement and during the interviews. Interview data were coded and analyzed iteratively to identify emergent themes. Participants rated their overall satisfaction on a 5-point Likert scale. RESULTS: In the no epidural group 30 women underwent pain assessment and nine participated in an interview. In the epidural group 36 women underwent pain assessment and 12 participated in an interview. The median VAS scores were 40.5 mm and 2.8 mm in the no epidural and epidural groups, respectively. In the no epidural group, 53.3% of women reported none-mild pain. Most women (88.9%) in the epidural group reported none-mild pain. Women's satisfaction with the procedure was high in both groups. Convenience was the dominant decision-driver to undergo the procedure. Actual procedural pain and duration were less than expected among the majority of interviewees. CONCLUSION: Women who undergo post-placental IUD insertion report high satisfaction and no regrets about the procedure. Our study offers valuable counseling points to offer women if they are considering post-placental IUD placement.

Six-Week Retention Rate of Immediate Postplacental Intrauterine Devices at a University Teaching Hospital [3N

Six-Week Retention Rate of Immediate Postplacental Intrauterine Devices at a University Teaching Hospital [3N

The effect of skills training on attitudes, knowledge and clinical uptake of postplacental intra-uterine device use

The objective of the present study is to investigate the effect of skills training on knowledge and attitudes of post-placental intra-uterine device (PPIUD) use, including the uptake thereof, and suggest training proposals. In-service skills training, alongside departmental protocol implementation, on PPIUD insertions were offered to healthcare professionals at Tygerberg Hospital, South Africa. Training was based on <em>The postpartum intrauterine device. A training course for service providers</em>, participant handbook from EngenderHealth (New York, NY, USA). Participants completed a questionnaire at enrolment and after 6 months to assess their knowledge and attitude towards PPIUD use. Most participants reported having the necessary skills to fulfil their family planning responsibilities (Ppost-partum women (P=0.03), especially those who desire no more children (P=0.05), resulting in more participants providing IUDs (P=0.03) that could be attributed to the increased availability of reference material, <em>i.e.</em> training materials (P=0.02) and protocols (P=0.02). In conclusion, in-service PPIUD skills training guided by local protocol implementation resulted in an improvement of self-reported competency, counselling and PPIUD insertion. Repeated training with adequate supervision is imperative.

Twelve-month contraceptive continuation and repeat pregnancy among young mothers choosing postdelivery contraceptive implants or postplacental intrauterine devices

ObjectiveTo compare discontinuation rates and incidence of repeat pregnancy within 1 year among young mothers choosing postplacental intrauterine devices (IUDs) versus postpartum contraceptive implants. Study DesignWe enrolled a prospective cohort of postpartum adolescents and young women who chose either postplacental IUDs or postpartum contraceptive implants prior to hospital discharge. We used chart review and phone interviews to assess device discontinuation (by request or expulsion) and pregnancy within 12 months. ResultsOf the 244 13–22 year-old participants, 82 chose IUDs (74 levonorgestrel IUDs and 8 copper IUDs), and 162 chose implants. Both groups had participant-requested discontinuation rates of 14% (9/67 IUD; 19/135 implant) within 1 year. Participants choosing IUDs had a 25% (17/67) expulsion rate. Median time to expulsion was 4.1 weeks (range: 0.4–29.3 weeks, 16/17 within 12 weeks), and participants recognized 15/17 expulsions. IUD initiators had significantly higher pregnancy rates by 12 months (7.6% vs. 1.5%, p=0.04). Most pregnancies occurred when women discontinued their initial device and did not start alternative contraception. DiscussionParticipant-requested discontinuation was similar in both groups. Differences in overall device discontinuation rates were due to IUD expulsions. Pregnancy rates by 12 months postpartum were lower than previously reported in this age group in both implant initiators and IUD initiators. ImplicationsYoung mothers who choose postplacental IUDs or postpartum contraceptive implants are unlikely to request removal within the first year. Clinicians should counsel postplacental IUD users that early expulsion is common (25%) and may be unrecognized (11% of expulsions). Patients should have a plan for contraceptive management should expulsion occur.

Barriers to Immediate Post-placental Intrauterine Devices among Attending Level Educators

ObjectiveTo determine whether barriers to immediate post-placental intrauterine device (PPIUD) placement exist at the provider level. Study DesignObstetrics providers at seven academic teaching hospitals in Massachusetts were asked to complete an electronic survey regarding their knowledge, experience, and opinions about immediate PPIUDs. ResultsEighty-two providers, including obstetricians, family medicine physicians, and midwives, completed the survey. Thirty-five (42.7%) reported experience placing an immediate PPIUD with the majority of them having placed three to five PPIUDs. Of participants who had never placed a PPIUD, the reason cited most frequently was inadequate training. Fewer than one-half (43.4%) correctly identified the PPIUD expulsion rate, whereas 75.9% knew the correct expulsion rate for interval IUD placement. The majority of providers responded that PPIUDs are acceptable in certain clinical scenarios. ConclusionsOverall, knowledge and experience with PPIUD placement is relatively low. As increasing numbers of states amend Medicaid policy to include reimbursement for immediate postpartum IUDs, additional education and training opportunities are needed.

Barriers to Immediate Postplacental Intrauterine Devices Among Attending Level Educators [190

INTRODUCTION: The purpose of the study is to determine whether there are barriers to immediate postplacental intrauterine device (IUD) placement at the health care provider level. METHODS: Obstetric providers at seven academic teaching hospitals in Massachusetts were asked to complete an electronic survey regarding their knowledge, experience, and opinion of immediate postplacental IUDs. The survey tool was designed through the research electronic data capture (REDCap) software and contacts at the seven academic teaching hospitals in Massachusetts were e-mailed to send the survey to their colleagues. Demographic data, including type of health care provider and location of care, were collected as well as training, knowledge, and experience with postplacental IUDs in the form of multiple-choice questions. The survey was e-mailed twice during the study period. The data were analyzed using MATLAB and Excel. RESULTS: Eighty-two health care providers including obstetricians, family medicine physicians, and midwives completed the survey with a response rate of 29%. Thirty-five (42.7%) reported experience placing an immediate postplacental IUD with the majority of them having placed three to five postplacental IUDs. Of participants who had never placed a postplacental IUD, the reason cited most frequently was inadequate training. Less than half (43.4%) correctly identified the postplacental IUD expulsion rate, whereas 75.9% knew the correct expulsion rate for interval IUD placement. The majority of health care providers responded that postplacental IUDs are acceptable in certain clinical scenarios. CONCLUSION: Overall acceptance of postplacental IUD placement is high among health care providers. However, experience and knowledge are relatively low. Additional training opportunities are needed to close this gap.

IUD insertion after cesarean section: a cost decision analysis of insertion at time of delivery versus at postpartum follow-up

Objectives: For many women, the year after delivery is a high-risk time for unintended pregnancy. Although many women desire long-acting contraception such as an intrauterine device (IUD), postpartum contraception plans and actual use vary significantly. A significant number of women who plan for an IUD at the postpartum visit do not present for the visit or have already experienced unintended pregnancy. Immediate postplacental IUD at the time of cesarean is safe and effective, though not widely practiced in the United States. We aim to estimate the costs and clinical outcomes of immediate postplacental IUD insertion at cesarean delivery versus insertion at the postpartum visit.

Intrauterine contraception after cesarean section and during lactation: a systematic review.

BackgroundAll postpartum women, including those who are breastfeeding or have had a cesarean section, appear potentially suited to intrauterine contraception, a long acting reversible contraceptive (LARC). Like any other method used after delivery, it should not interfere with lactation or be affected by cesarean section.Study designWe searched the MEDLINE, PubMed, Popline, Google Scholar, and Clinicaltrials.gov databases from January 1968 through to December 2012. Studies were included if they reported event rates in women who had a cesarean section and event rates and clinical outcomes in lactating women or their infants in the breastfeeding group. Summary odds ratios were not calculated because of the diverse methods of reporting event rates in the cesarean section group and the heterogeneity of the results in the breastfeeding group.ResultsWe found 26 articles on event rates in interval and post-placental intrauterine device (IUD) use, and 18 on event rates and clinical outcomes in breastfeeding IUD users. Four prospective studies and one retrospective study showed an increased expulsion rate in interval insertion. There were 19 studies, of which five were controlled in post-placental IUD insertion after cesarean section. Four studies had expulsion rates of 10 or more per 100 woman-years of use and 15 expulsion rates below 10 per 100 woman-years of use. Three studies showed that event rates for lactating IUD users are the same as those for non-lactating users. Fifteen controlled studies showed that the IUD had no effect on milk production and seven of these showed no effect on infant growth. Pharmacovigilance databases report an increased rate of IUD perforations in lactating women, while the event rate studies report that insertion is generally easier and less painful than expected. These were uncontrolled reports.ConclusionThe IUD is a long-acting reversible method of contraception with expulsion rates of 5–15 per 100 woman-years of use when used as a post-placental method immediately after cesarean section. As an interval procedure (6 or more weeks after cesarean section) it appears to have a high expulsion rate (5% or higher) notably in older devices. The IUD does not affect breastfeeding and is easy to insert in these women, but appears to be associated with a higher perforation rate (>1 per 100). Providers should not be deterred from using this contraception method, especially in developing countries, but should be attentive to preventing these potential problems.

Postplacental intrauterine device insertion at a teaching hospital

ObjectiveTo determine whether postplacental intrauterine device (IUD) insertion can be safely and effectively performed within a teaching program. Study DesignThis was a prospective cohort of 177 subjects planning vaginal delivery enrolled antenatally who desired postplacental IUD insertion of either the copper T380A IUD or levonorgestrel IUS. Insertions were performed primarily by resident physicians following a training session. Follow-up included a 4- to 8-week visit and telephone calls at 3 and 6 months. ResultsNinety-nine subjects underwent successful postplacental IUD insertion of 100 attempts. Seventeen expulsions (17%) were noted: 10 complete and 7 partial. The study identified no differences in outcome by training level; however, the study lacked statistical power to evaluate anything other than large differences. ConclusionPostplacental IUD insertions can be safely and effectively performed within a training program. ImplicationsA training protocol may safely and feasibly be initiated among physicians, advanced practice clinicians or trainees with no prior experience with postplacental IUD insertion. By initiating this practice, access to highly effective contraception may increase for patients who have difficulty returning for a visit or otherwise receiving effective methods.

Post-placental iud placement in the United States, 2009

Post-placental iud placement in the United States, 2009

An unexpected difference in postplacental intrauterine devices at outpatient follow up

An unexpected difference in postplacental intrauterine devices at outpatient follow up

Postpartum contraception

Postpartum contraception is an integral part of women's reproductive healthcare that poses many challenges to both the new mother and her practitioner. These challenges are associated with having a newborn, breastfeeding, maternal medical comorbidities, as well as socioeconomic barriers. While we provide contraception counseling in the postpartum period during their hospital stay, 10���44% of women are at risk of an unplanned pregnancy in the first 12 months postpartum. This session will focus on understanding the medical eligibility criteria for providing contraception in both breastfeeding and non-breastfeeding women, as well as how to provide the most effective method of contraception as soon after delivery as possible. The audience will participate in a discussion regarding overcoming the challenges of post-placental IUD placement and implant placement prior to hospital discharge. Also, affecting a change in scheduling the postpartum visit earlier, as the current tradition is out of date, will be addressed.

Enhancing Contraceptive Usage by Post-placental Intrauterine Contraceptive Devices (IUCD) Insertion: Safety, Efficacy, and Expulsion

More than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. Objective: The study was conducted to assess the safety incidence of perforation/pain/bleeding/foul discharge and expulsion rates at 6 week follow-up and willingness to continue when Copper T 380A (Cu T 380A) inserted within 10 minutes of placental expulsion both in vaginal and C-section deliveries. Methods: This was an open label, prospective, and multicentric longitudinal study. The study was approved by the Ethics Committee of FOGSI. Results: The insertion of Intrauterine Contraceptive Devices (IUCD) was easy in 98.76 per cent of subjects after normal delivery, and 100 per cent in all subjects after assisted vaginal and c-section deliveries. The position of the Cu T was in situ in 97.61 per cent of subjects, ultra sonogram was used in 1 per cent to confirm location of IUCD and in 1 per cent of subjects the IUCD was in the cervix. There was no case of perforation in this series and no other major complications. Conclusion: Inserting Cu T 380A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus.