Postplacental Intrauterine Device Insertion Research Articles

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.

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.

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.

Intrauterine Device Insertion during Caesarean Section – A Boon for Rural Women.

Objectives: To determine the safety of immediate post-placental intrauterine device insertion at the time of caesarean delivery. Method: This study was conducted in the Department of Obstetrics and Gynecology, Bundelkhand Medical College and associated Tili hospital, Sagar, from September 2010 to August 2011. Patients undergoing caesarean section for varied indications were counselled regarding intra-operative CuT380A insertion and those who agreed were allocated to the study group and the rest were allocated to the control group. The patients were observed during the post-operative period for complications associated with either caesarean section or intrauterine device insertion. Result: During the study period, 100 patients underwent CuT380A insertion immediately after removal of the placenta during caesarean delivery. There was no significant difference in the post-operative complication rates between both the groups. The rates for post- operative bleeding being 15% in both the groups and that of post-operative infection being 5% and 7% in the study and control groups respectively. Keywords: Complications, Intracaesarean, Intrauterine device insertion, Postplacental, Acceptance.

O711 ENHANCING CONTRACEPTIVE USAGE BY POST PLACENTAL IUD INSERTION – A STUDY OF SAFETY AND EFFICACY OF POST PLACENTAL IUD IN INDIA

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S511-S511 Free communication (oral) presentations O711 ENHANCING CONTRACEPTIVE USAGE BY POST PLACENTAL IUD INSERTION – A STUDY OF SAFETY AND EFFICACY OF POST PLACENTAL IUD IN INDIA J. Vajpayee, J. VajpayeeSearch for more papers by this authorH. Diwakar, H. DiwakarSearch for more papers by this authorS. Singh, S. SinghSearch for more papers by this author J. Vajpayee, J. VajpayeeSearch for more papers by this authorH. Diwakar, H. DiwakarSearch for more papers by this authorS. Singh, S. SinghSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61141-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S511-S511 RelatedInformation

Evaluation of a novel program to encourage immediate postplacental insertion of intrauterine devices in an urban hospital

Evaluation of a novel program to encourage immediate postplacental insertion of intrauterine devices in an urban hospital

Immediate postplacental IUD insertion at cesarean delivery: a prospective cohort study

BackgroundImmediate postplacental insertion of intrauterine devices (IUDs) during cesarean delivery could reduce a substantial barrier to access to long-term effective contraception. Initiating IUD use prior to discharge from the hospital postpartum eliminates a 6-week postpartum waiting period and an additional office visit. Study DesignThis was a prospective cohort study of 90 patients undergoing cesarean delivery. After delivery of the placenta, a copper T380A IUD was inserted into the endometrial cavity through the incision. The study participants were followed up at 6 weeks and 6 months postpartum. This study was conducted at the Weiler Division of the Montefiore Medical Center and at the Jacobi Medical Center in the Bronx, NY. ResultsForty-three (48%) women returned for their 6-week follow-up visits, and among those, no expulsions were recorded. Forty-two (47%) women were reached for phone follow-up at 6 months postpartum, and 80% reported being “happy” or “very happy” with their IUD. ConclusionsImmediate postplacental IUD insertion at the time of cesarean delivery is safe and acceptable.

Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section

Background An intrauterine device (IUD) is an effective reversible form of contraception. We determined the efficacy and safety of immediate postplacental IUD insertion during cesarean section. Study Design Two hundred forty-five women with term pregnancies delivering by cesarean section between September 2006 and December 2007 were included in the study. A copper IUD (TCu 380A) was inserted using a ring forceps within 10 min of removing the placenta. The participants were examined before hospital discharge and at 6 weeks, 6 months and 12 months postpartum. Results None of the patients were lost to follow-up. There was one case of an unplanned pregnancy (0.4%). There were no serious complications associated with immediate IUD insertion during cesarean section. The cumulative rates of expulsion, removal for bleeding/pain and other medical reasons were 17.6, 8.2 and 2.4 per 100 women per year, respectively. The continuation rates were 81.6% and 62% at 6 and 12 months, respectively. Conclusion Immediate postplacental IUD insertion during cesarean section provides adequate protection against pregnancy. However, greater than one fourth of the participants discontinued IUD use due to spontaneous expulsion or other medical reasons.

Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices

Objectives To assess the efficacy, safety and, thus, advantages and disadvantages, of early postplacental intrauterine device (IUD) insertion. Methods IUDs were inserted within 10 min after postplacental expulsion in term pregnancy both in vaginal and cesarean deliveries via a ring forceps. Of the 276 patients enrolled, 235 were included in the study. Recipients were scheduled for examination before hospital discharge and at 6 weeks, 6 months and 12 months after postplacental insertion. Results The percentages of women returning for a follow-up visit were 221 (94%), 210 (89%) and 183 (78%) at 6 weeks, 6 months and 12 months, respectively. Among IUD acceptors, 74% of the cases had vaginal deliveries and 26% had cesarean deliveries. Continuation rates were relatively high, 87.6% and 76.3%, at 6 and 12 months, respectively, after postplacental insertion of IUD. In this study, the 1-year cumulative expulsion rate with TCu 380A device was 12.3%, which may be regarded as a standard expulsion rate for immediate postplacental insertion of similar models of IUDs. Conclusion The evidence from this study suggests that immediate postplacental insertion of CuT 380 models is an effective, useful, safe, convenient and low-cost procedure for early postpartum contraception.

Postpartum IUDs: Keys for success

Intrauterine device (IUD) insertion is convenient and efficient in the postplacental and immediate postpartum periods. Insertion at these times is demonstrably safe, having a low incidence of infection, few bleeding problems, and low perforation rates. IUD expulsion rates can vary widely, and are a function of timing of insertion, type of IUD, and insertion technique. When a copper T device is inserted postplacentally or immediately postpartum by an experienced and trained clinician, expulsion rates of about 7–15 per 100 users at six months can be expected. Women must be told how to detect expulsions and instructed to return for reinsertion or for another method. Most investigators emphasize that high fundal IUD placement will reduce the expulsion rate. Unplanned pregnancy rates for postplacental IUD insertion range from 2.0-2.8 per 100 users at 24 months when using modern copper IUDs, correct insertion technique, careful postinsertion instructions and good follow-up. Postplacental insertions are performed manually or with a ring forceps. Immediate postpartum insertions (10 minutes to 48 hours after delivery) are performed with the ring forceps.

The effect of postplacental insertion of the spiked and the standard Lippes loop on uterine involution

The spiked Lippes loop was inserted in 53 women and the standard loop in 55 women immediately following the delivery of the placenta after normal vaginal delivery. A group of 50 recently delivered women with no IUD was studied as a control. The cases were followed up for 1 year. Ultrasonic scanning was performed during the 6th week after insertion for 47 cases with the spiked loop and 43 cases with the standard loop. All loops were correctly positioned within the uterine cavity except in two cases; one using the spiked and the other using the standard loop. The loops were found displaced down wards and as there was excessive bleeding, the devices were removed. Regarding the effect of the IUD on uterine involution, it was found that the fundus to internal os length for the cases with IUDs was shorter than that among the controls, also this length among the standard loop users was significantly shorter than that of the controls (P < 0.01). Postplacental IUD insertion did not delay uterine involution, on the contrary, it helped involution. Regarding the effect of lactation, the fundus to internal os length for the fully lactating women either using a loop or not, was found to be significantly shorter than that of the non-lactating cases (P < 0.002).

Immediate postplacental IUD insertion: The expulsion problem

This paper reports an evaluation of immediate postplacental insertion of a non-copper (Lippes Loop D) and several copper-bearing IUD models (TCu200, TCu220C, MLCu375, MLCu250, Nova T-PP, Dimélys R). Based on the analysis of a total of 2, 646 insertions and 55, 794 woman-months of experience, we conclude that placement of an IUD within ten minutes of delivery of the placenta is a valuable alternative to interval insertion, because this method is safe and effective. Effectiveness was significantly lower for the Lippes Loop D than for the T- and ML-IUD models tested, the latter showing roughly comparable pertinent event rates. Pertinent event rates for copper IUDs were influenced by the skill of the operator; age of the recipient only had a significant effect on effectiveness, whereas parity had no significant effect on pertinent event rates. The single and still unsolved problem associated with immediate postpartum insertion is the greater likelihood of expulsion compared with interval insertion, and this hazard is significantly much greater for the Loop than for the copper-bearing devices assessed. The evolution of the expulsion rates shows a constant time-relationship. This pattern makes it obvious why follow-up of recipients, at least during the first trimester following insertion, is mandatory if immediate postplacental IUD insertion is to be optimally effective.

Immediate postplacental IUD insertion: A randomized trial of sutured (Lippes Loop and TCu220C) and non-sutured (TCu220C) models

A randomized clinical trial concerning immediate postplacental insertion (IPPI) of the Delta Lippes Loop, Delta TCu220C, and TCu220C was undertaken to assess the effect of the addition of catgut strands on IUD performance. A total of 906 devices were inserted and the subjects followed for 20 months, at which time 14,136 woman-months experience had been accumulated. The Delta Loop constantly had inadmissibly high expulsion and pregnancy rates. The two T-IUD models had significantly lower rates of expulsion and pregnancy, and these rates were similar for the sutured and the non-sutured TCu220C. Immediate postplacental insertion of the three IUD models was totally safe in terms of infection and perforation. Due to the difficulty of insertion and high expellability, the Delta Loop is considered unfit for IPPI. Performance of the TCu220C was good but the results did not indicate that “suturing” improved the retainability of this IUD model significantly.