Postplacental Intrauterine Device Insertion Research Articles

The Effect of Post-Placental Intrauterine Contraceptive Devices on Decreasing in Uterine Fundus Height in Postpartum SC Mothers

Introduction: Contraception and family planning services are an essential part of reproductive health. Postpartum IUDs in SC postpartum have a much lower expulsion rate than vaginal delivery. Objective: to determine the effect of post-placental intrauterine devices on the decrease in fundus uteri. Methods: Using a correlational analytical research design, the research design used is a prospective cohort with a sample size of 30 for the treatment group and 30 for the control group. Result: It can be concluded that the effect 2 hours after the installation of post-placental IUD is known (p-value = 0.279), which indicates that there is no influence between the variable of post-placental IUD installation of SC delivery mothers and the decrease in fundus uteri height. The effect of post-placental IUD insertion on the decrease in fundus uteri height in SC postpartum mothers at Karanganyar Regional Hospital on day 3 shows a p-value of 0.262, and it shows that there is no influence between the variable post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. On day 7, the p-value = 0.008 means that the p-value is smaller than the value of α = 0.05 (p-value < 0.05) and that there is an influence between the variable of post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. Post-placental IUD is a reference for making birth control choices during the postpartum period without interfering with breast milk. Conclusion: The conclusion does not prove the hypothesis in part because the rapid effect on the decrease in TFU in SC postpartum mothers is only after 7 days from the insertion of the IUD, while at 2 hours of IUD insertion and day 3 of IUD insertion, it does not have a rapid effect on reducing TFU in SC postpartum mothers. implications for the management of maternity women who plan to postpone the next pregnancy and this research can be used as empirical evidence that a post-placental intrauterine device acceptor has the potential to increase uterine contractions and accelerate the decrease in fundus uteri height on day 7.

Evaluation of IUD Insertion During CS In 100 Patient. A Prospective Study

Background: The application of an IUD to the female after placenta delivery during a caesarean section had several benefits since the female was under anesthetic, which reduced the need for additional manipulation and pain, and the female at the time of delivery had a strong desire for family planning. IUDs placed postpartum experienced numerous disengagements, including bleeding and displacement. Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section in 100 patients. Patient and methods: A prospective study was conducted at obstetrics and gynecology department of Damanhur Medical National Institute in the period from March 2022 to March 2023. Group I: included 52 women who agreed to insert immediate post placental IUD at the cesarean delivery. Group II: included 48 women as control group. 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: In both groups, the demographic information was comparable. The medical histories of the investigated patients and the control group did not differ significantly according to our research. The study group's caesarean procedure took a little longer to complete. There were no appreciable differences between the two groups in terms of infection, puerperal hemorrhage, or IUD displacement. Both groups' satisfaction levels were displayed as either pain or displacement. In the research and control groups, the expulsion rates were 3.92% and 0.00%, respectively. Conclusion: Based on our research, we draw the conclusion that IUD insertion during CS is safe and effective, avoiding the reasons why it can be challenging to insert an IUD after puerperium and having a low expulsion rate; so, it can be considered a standard procedure.

Conventional manual technique of post placental IUD insertion versus intra-cesarean post placental introducer withdrawal IUD insertion technique: a new standardized technique for IUD insertion during cesarean section: a randomized controlled trial

BackgroundInserting IUDs during cesarean section reduces the need for more manipulation and discomfort. The current conventional manual technique for IUD insertion during cesarean section is not standardized with many modifications and high rates of expulsion, displacement, missed threads, and discontinuation. This study aims to find a standard technique for IUD insertion during cesarean section with the least possible problems, especially displacement and missed threads.MethodsA randomized controlled study was conducted at Kasr Al-Ainy Maternity Hospital, Cairo University, Egypt. The study was performed over 12 months, from September 2020 to September 2021. Two groups of patients were selected; each group included 420 patients with a desire for IUD insertion during cesarean section. Group (A) (Control group) was subjected to a post-placental intrauterine device (Copper T380) during cesarean section using a conventional manual method; Group (B) (Study group): the IUD (Copper T380) was placed at the top of the uterine fundus using a new technique (intra-cesarean post placental introducer withdrawal IUD insertion technique).ResultsThere was a significant statistical difference between the two groups regarding displacement of the IUDs at the end of puerperium, at 6 months, non-visibility of IUD threads, and continuation of use with p-value < 0.05. There was no significant statistical difference in the term of duration of surgery.ConclusionThe new technique of post-placental IUD insertion can be the standard technique of intra-cesarean section IUD insertion as it is associated with more favorable outcomes among the included women in the form of lower incidence of IUD displacement, non-visibility of IUD threads, and higher rates of continuation without increasing the duration of surgery as compared with the conventional manual technique.Trial registrationClinicalTrial.gov ID: NCT05788354, registration date: 28/03/2023 (retrospectively registered).

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

Incidence of Post-Placental IUD Expulsion in Women of Childbearing Age

Background:The United States Medical Eligibility Criteria for Contraceptive Use and the American College of Obstetricians and Gynecologists recommend insertion of an Intra Uterine Device (IUD) immediately after delivery, due to the low complication rate. Postplacental IUD insertion is the insertion of an IUD immediately after delivery of the placenta during vaginal delivery. This method serves to reduce the number of births. However, post-placental insertion is believed to have a high expulsion rate. which is around 2-27%Purpose : To analyze and summarize the results of one study with another regarding the incidence of postplacental IUD expulsion in women of childbearing ageMethod:The research method used is literature review by searching for articles related to the theme taken from several search engines namely Pubmed, and Google Scholar and Search is done using the keyword IUD expulsion, Postplacental, women of childbearing age.Results: the installation of post placental IUDs has the opportunity to experience an expulsion eventConclusion: From all the journals that have been reviewed It can be concluded that the installation of post placental IUD has the opportunity to experience an expulsion event.

Post-Placental Intrauterine Device Insertion in Brazilian Adolescents: Clinical Outcomes at 12 Months

To assess the acceptability, expulsion and continuation rates, satisfaction, and complications associated with post-placental intrauterine device insertion (PPIUDI) in Brazilian adolescents DESIGN: Prospective cohort SETTING: A single public, tertiary teaching hospital PARTICIPANTS: Adolescents (≤ 19 years) giving birth by vaginal delivery or cesarean section INTERVENTION: PPIUDI MAIN OUTCOME MEASURES: Primary outcomes were PPIUDI acceptability, expulsion, continuation, and user satisfaction. Secondary outcomes were changes in menstrual bleeding and pain, infection, uterine perforation, and repeat pregnancy up to 12 months after PPIUDI. Of 1710 adolescents who delivered during the study period, 294 accepted PPIUDI (acceptability 17.2%). There were no cases of infection or uterine perforation among the 91 adolescents who completed the 12-month follow-up. Overall expulsion rate was 28.6%, and most cases (54%) occurred in the first 6 weeks after insertion. At 12 months, 85.7% of users were satisfied with the method, and continuation rate was 69.2%. At the end of 12 months, there were no repeat pregnancies among the adolescents who remained with the device in place. PPIUDI can be an effective and safe method to reduce repeat unplanned pregnancies in adolescents who have just given birth.

THE DIFFERENCESS OF DISCONTINUITAS IUD IN POST PLACENTAL AND INTRA-CESAREAN IN MADIUN

AbstractBackground: Intra Uterine Device (IUD) which is placed after delivery of the placenta is an attempt to reduce the rate of population growth. However, the achievement is still very low, especially in the post-placental IUD insertion. It is this high expulsion rate that continues to be a concern for service providers, so this method is acceptable. The purpose of this study is to compare the sustainability of IUD acceptors in post-placental and intra-cesareann placement. Methods: The design of this study was cross sectional with an observational analytic method. Location of this research in the family planning clinic of Dr. Soedono Madiun Hospital, Banjarejo Health Center, Tawangrejo Health Center, and PMB Ny. “P” Madiun City in 2019.The sample used consecutive sampling as many as 114 acceptors. The independent variable was the time of IUD insertion. The dependent variable is the discontinuity of the IUD acceptor. The instrument used was the 2019 IUD acceptor medical record. The Fisher Exact Test on SPSS was used to perform data analysis. Results: From 114 acceptors, there was no difference in the discontinuity of IUD acceptors in post-placental and intra-cesarean placement (p=0.1). The incidence of expulsion was found in post-placental insertion (p=0.02). In intra-cesarean IUD acceptors more confirmed using ultrasound examination (p = 0.03). There was no perforation in both. Conclusion: There is no difference in IUD acceptor discontinuity in post-placental and intra-cesarean placement.

Factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices.

To identify clinical and demographic factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices (TCu380A IUD). This is a secondary analysis of an implementation study. We followed participants who had a postplacental TCu380A IUD insertion, at two postpartum visits: 45-90days (visit 1) and 6-9months (visit 2). We used multiple log-binomial regression models to evaluate the demographic and clinical variables associated with missing strings and with IUD expulsion. We included 705 participants who had a postplacental IUD insertion. We observed missing strings in 275 (47.9%) participants at visit 1, and in 127 (34.2%) participants at visit 2. We identified 61 expulsions (8.9%) by visit 2. In the multiple regression models, only the delivery type was associated with missing strings and expulsion. Compared with vaginal delivery, cesarean delivery increased the risk of missing strings (adjusted relative risk [aRR] 6.21; 95% confidence interval [CI] 4.29-8.99) but reduced the risk of IUD expulsion (aRR 0.24; 95% CI 0.13-0.43). The delivery mode was the only factor associated with missing strings and expulsion after postplacental IUD insertion. Cesarean section was associated with an increased risk of missing strings but decreased risk of expulsion after postplacental TCu380A IUD insertion.

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. material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to December, 31, 2017.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 and group II was subjected to interval IUD insertion (3 months after cesarean delivery). 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 6 months was 5.88% in study group compared to 8.33% in the control group. The satisfaction rate 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 3.92% in study group and 4.17% in control group with p.value =0.949. Conclusion:Post-placental IUD insertion was found to be a sound, safe and effective clinical approach taking advantages of the possible desire of patients for immediate contraception , so achieving the right goal of pregnancy spacing and decreasing unintended pregnancies.

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

We, the Editor and Publisher of the European Journal of Contraception & Reproductive Health Care, have retracted the following article: Yomna A. Bayoumi, Dina M. R. Dakhly, Yasmin A. Bassiouny, Hisham M. Gouda, Mohamed A. Hassan & Ayman A. Hassan (2020) Post-placental intrauterine device insertion vs puerperal insertion in women undergoing caesarean delivery in Egypt: a 1 year randomised controlled trial, The European Journal of Contraception & Reproductive Health Care, 25:6, 439-444, DOI: 10.1080/13625187.2020.1823366 Following the article’s publication, significant concerns were raised about the integrity of the data and reported results in the article. When approached for an explanation, the authors kindly provided their data, but they have not sufficiently addressed the concerns raised. As verifying the validity of published work is core to the integrity of the scholarly record, we are therefore retracting the article. The authors have been notified of the retraction. We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

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.

Post-placental Intrauterine Device Insertion Versus Delayed Intrauterine Device Insertion: An Observational Study.

Immediate post-placental IUD insertion is defined as IUD insertion within 10min of the expulsion of the placenta. Although the expulsion rate in post-placental insertion is higher than interval insertion, the benefits of highly effective contraception immediately after delivery may outweigh the risks of expulsion. To compare post-placental IUD (PPIUD) insertion with interval IUD insertion (IIUD) in terms of safety, effect on menstrual cycle, efficacy and satisfaction. After meeting all eligibility criteria, the patients were asked to choose between post-placental IUD insertion and interval/delayed IUD insertion. In PPIUD group, insertion was done within 10min of expulsion of placenta by hand technique. Individuals in IIUD group were asked to return after 6weeks for IUD insertion by withdrawal technique. Both the groups were followed at 6weeks, 6months, 12months by history, physical examination, per speculum examination and ultrasonography. 238 patients were allocated to PPIUD group and 273 to IIUD group. In the PPIUD group, there was no bleeding/spotting demonstrable as it was masked by the lochia. Mild pain at insertion was seen in only 11 patients in the PPIUD group. Slight bleeding/spotting was seen in 7.8% patients in the IIUD group, while mild to moderate pain was seen in 39.9% patients. At 6weeks, 6months and 1year follow up with regard to patients complaining of pelvic pain/dysmenorrhea, the difference between the two groups was not statistically significant. Our study found that irregular bleeding or spotting was more in interval insertion than in the post-placental group. The difference in the two groups was statistically significant at 6weeks and 6months, but was not significant at 1year. There was no case of perforation in either group. Our study found a statistically significant difference in expulsion after post-placental compared to delayed insertion. The difference between the two groups was statistically significant (p = 0.006) for cumulative expulsion. However, for interval expulsion rate, the difference was not statistically significant (p = 0.6). In our study, continuation rates appear to be higher in the PPIUD group, but the difference is not statistically significant. PPIUD is a safe, easy and effective alternative to interval IUD insertion and qualifies to be popularized as a first-line contraceptive agent in eligible patients owing to its immediate and sustained contraceptive benefit, patient comfort, convenience and lower incidence of side effects.

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.

Immediate Postpartum LARC Reimbursement Increases Uptake of Effective Contraception After Pregnancy [22G

INTRODUCTION: Over one third of women have unfulfilled contraceptive needs during their first year postpartum, and women without health insurance are 30% less likely to use contraception. As states have begun to reimburse for immediate postpartum LARC placement (immediate post-placental IUD insertion and implant insertion before discharge), the objective of this study was to determine if LARC uptake increased in the Medicaid population after immediate postpartum reimbursement was instated. METHODS: Women receiving Medicaid were prospectively recruited from a postpartum service of a large, urban hospital before and after immediate postpartum reimbursement. They completed a survey regarding their contraceptive choices, and additional information was gathered from the medical record. A binary logistic regression was performed to determine if women receiving Medicaid were more likely to choose LARC as a contraceptive method after the policy took effect, adjusting for race, mode of delivery, and primiparity. RESULTS: 178 women were included in the analysis (70 before reimbursement, 108 after reimbursement). Women were 2.5 times more likely to use LARC as postpartum birth control after immediate postpartum reimbursement was instated (95% CI: 1.26-4.79). Of the 49 women who chose LARC after immediate postpartum reimbursement, 42 (86%) received their method before hospital discharge. CONCLUSION: Immediate postpartum reimbursement resulted in women being more than twice as likely to choose LARC as their postpartum contraceptive method. Removing this barrier to cost and access is particularly important in a population vulnerable to unintended pregnancy and loss of healthcare coverage.

Improving the Post-Placental Intrauterine Device Protocol to Reduce Patient Visits [2H

INTRODUCTION: Immediate post-partum intrauterine device (IUD) insertion is a safe and effective means of long-acting birth control. This project analyzes demographics, string visualization, and follow up of women who opted for post-partum IUD insertion and considers the need for follow up including ultrasound (TVS). METHODS: From March 2016 to March 2017, the Post-Placental IUD Insertion Protocol was used for immediate post-partum Mirena® and ParaGard® IUD insertion at University Hospital, San Antonio, Texas. Retrospective chart analysis was used to assess patient demographics, follow up rates, and expulsion rates. RESULTS: A total of 128 women received post-partum IUDs, 70 post-cesarean and 58 post-vaginal delivery. Patient age ranged from 16-43 (average = 26.76) and parity ranged from 1-10 (average = 3.1). Over 80% of the population was Hispanic. Per protocol, patients were scheduled for a string check follow up 7-14 days post insertion. Of the 89 patients who followed up, 27 were in the first three weeks of post-insertion. Over 88% (15/17) of the post-cesarean and 25% (2/8) of post-vaginal insertions did not have visible strings at the visit and 50% (44-89) eventually needed a TVS to confirm placement, 75% of which were post-cesarean. The expulsion rate was 9% (8/89) and 9 IUDs required removal per patient request or IUD not being at the uterine fundus. CONCLUSION: The Post-Placental IUD Insertion Protocol can be improved in efficiency and cost-effectiveness by reducing the number of post-partum visits to only one at six weeks as well as scheduling a pre-clinic TVS, especially for post-cesarean patients.

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.

Postplacental insertion of intrauterine devices in women after caesarean section

Postplacental insertion of intrauterine devices in women after caesarean section

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

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&#x0D; insertion in vaginal delivery using new modification insertion technique.&#x0D; &#x0D; Method: We carried out a prospective cohort study of postplacental&#x0D; 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&#x0D; until 31st March 2011 and had postplacental IUD insertion. Followup&#x0D; 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&#x0D; 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.&#x0D; &#x0D; Result: On the second monitoring, 2 acceptors experienced expulsion.&#x0D; At the third monitoring period, one acceptor requested for IUD&#x0D; removal. At 9 months up to 12 months post-insertion, one expulsion&#x0D; was encountered, and one acceptor requested removal of device. At&#x0D; ≥12 months there was one acceptor who had IUD removal. We did&#x0D; not find any report of unintended pregnancy or perforation.&#x0D; &#x0D; Conclusion: Immediate post-placental insertion of CuT-380A IUD&#x0D; after vaginal delivery using ’push and push’ technique is safe and effective.&#x0D; The pregnancy rate at typical use is 0%, continuation rate is&#x0D; 94.1% and low expulsion rate (2.86%). Loss of follow up was 5.6%&#x0D; and no perforation was reported.&#x0D; &#x0D; Keywords: continuation rate, immediate post-placental IUD insertion,&#x0D; ’push and push’ technique, typical use, vaginal delivery

Postplacental IUD Insertion Using Ring Forceps versus Push and Push Technique

Objective: To compare IUD-endometrium (ED) distance and the incident&#x0D; of malposition postplacental CuT-380A IUD insertion in vaginal&#x0D; delivery between ring forceps technique and push and push&#x0D; technique.&#x0D; Method: This study was a double-blind randomized control trial,&#x0D; performed in September 2014 until March 2015 at Dr. Kariadi Hospital.&#x0D; Ring forceps and push and push insertion technique groups&#x0D; consisted of 25 subjects in each group. Follow-up was performed at&#x0D; 1-2 weeks, 6-8 weeks and &gt;12 weeks after insertion.&#x0D; Result: The mean of IUD-ED distance in push and push group was&#x0D; shorter (but not statistically significant) than ring forceps group. The&#x0D; IUD-ED distance was at 1-2-week follow-up 4.1 (2.2) vs. 4.9 (3.4)&#x0D; mm; p=0.208, at 6-8-week follow-up: 2.6 (1.8) vs. 3.2 (3.7) mm;&#x0D; p=0.452, and at &gt; 12-week follow-up: 0.9 (0.8) vs. 1.0 (0.9) mm;&#x0D; p=0.427, respectively. Malposition was found in 1-2-week follow-up,&#x0D; but the IUD was changed to the normal position (sagital position in&#x0D; uterine fundus) at 6-8-week and &gt;12-week follow-up. Up to 3&#x0D; months of follow-up, there was no occurrence of perforation, expulsion&#x0D; or pregnancy in both groups. Most of subjects (56% in the&#x0D; ring forceps, 68% in push and push groups) did not feel painful during&#x0D; IUD insertion.&#x0D; Conclusion: Push and push insertion technique clinically tends to&#x0D; produce IUD-ED distance shorter than ring forceps technique. Both&#x0D; techniques are comfortable, safe and effective.&#x0D; [Indones J Obstet Gynecol 2016; 4-2: 78-87]&#x0D; Keywords: immediate postplacental IUD insertion technique, IUDendometrium&#x0D; distance, IUD malposition, push and push technique,&#x0D; ring forceps technique