Postplacental Intrauterine Device Research Articles

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

Immediate postplacental IUD placement after cesarean and vaginal deliveries at an academic training center

Immediate postplacental IUD placement after cesarean and vaginal deliveries at an academic training center

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.

Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration

Background The objective of this study was to assess the effect of timing of postpartum levonorgestrel-releasing intrauterine device (IUD) insertion on breast-feeding continuation. Study Design Women interested in using a levonorgestrel IUD postpartum were randomized to immediate postplacental insertion (postplacental group) or insertion 6–8 weeks after vaginal delivery (delayed group). Duration and exclusivity of breast-feeding were assessed at 6–8 weeks, 3 months, and 6 months postpartum. Only women who received an IUD were included in this analysis. Results Breast-feeding was initiated by 32 (64%) of 50 of women receiving a postplacental IUD and 27 (58.7%) of 46 of women receiving a delayed IUD ( p=.59). More women in the delayed group compared with the postplacental group continued to breast-feed at 6–8 weeks (16/46 vs. 15/50, p=.62), 3 months (13/46 vs. 7/50, p=.13), and 6 months postpartum (11/46 vs. 3/50, p=.02). The results did not differ when only women who initiated breast-feeding or only primiparous women with no prior breast-feeding experience were analyzed. Conclusions Immediate postplacental insertion of the levonorgestrel IUD is associated with shorter duration of breast-feeding and less exclusive breast-feeding. Further studies on the effects of early initiation of progestin-only methods on women's lactation experience are needed.

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.

Postpartum contraception: needs vs. reality

Background The postpartum time is a unique time to address patient's contraceptive needs and provide education. There are little data to suggest the best approach to provide information about contraception after delivery. Study Design Postpartum patients in an urban university hospital were asked to complete a written survey on postpartum contraception. Participants were asked about contraception counseling offered both antepartum and postpartum. Participants were also asked if they would have elected to have an intrauterine device (IUD) inserted immediately after delivery. Participants were contacted 4–6 months after delivery regarding ongoing contraceptive use. Results One hundred seventy-five surveys were completed; 77% (134) reported discussing contraception antepartum, and 87% (153), postpartum. Thirty percent of women reported discussing IUD insertion at an antepartum visit and 31% reported discussing it in the hospital prior to discharge. Twenty-three percent (39) of women would have elected immediate post-placental IUD placement if available. Of the 59 patients who were able to be contacted 4–6 months after delivery, 5% reported using an IUD. Twenty-two percent (13) of the participants contacted at follow-up still desired an IUD, of which 62% would have elected postplacental placement, if available. Twenty-nine percent of women reported using no contraceptive method and 32% reported using a method which is not highly effective. Conclusions Prenatal visits and postpartum contact with providers create an opportunity to discuss family planning and contraception and most patients report receiving counseling. However, significantly fewer reported continued contraceptive use at 4–6 months postpartum. Initiation of postplacental IUD placement would be acceptable and would increase contraceptive use at 6 months postpartum.

A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device

Background Postplacental intrauterine device (IUD) insertion is a safe, convenient and effective option for postpartum contraception. Few studies involve ultrasound-guided insertion, and none involve the levonorgestrel IUD or take place in the United States. Study Design The study was conducted to assess the safety and feasibility of ultrasound-guided postplacental insertion of the levonorgestrel IUD following vaginal delivery in a U.S. residency program. Levonorgestrel IUDs were inserted under ultrasound guidance within 10 min of placental delivery by hand or using ring forceps. Subjects were examined at 4 and 10 weeks postpartum for evidence of expulsion or infection. Results Thirty-four subjects were enrolled and 20 received an IUD. Follow-up data are available for 19 subjects over the 10-week follow-up period; 16 subjects returned for the 4-week follow-up, and 14 returned at 10 weeks. Two additional subjects could be contacted by telephone only. At 4 and 10 weeks postpartum, no subjects had evidence of infection. There were two expulsions (2/19, 10.5%) by 10 weeks postpartum. None of the subjects examined had a partial expulsion (intracervical location of the IUD). Conclusions In this pilot study, ultrasound-guided postplacental insertion of the levonorgestrel IUD was feasible and not associated with infection. The risk of expulsion was acceptable. Ultrasound-guided postplacental insertion of the levonorgestrel IUD may be an alternative to delayed insertion but warrants further study.

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.

What we have learned from recent IUD studies: A researcher's perspective

Many studies published on intrauterine devices (IUDs) during the last six years have consistently reported findings in favor of IUD use. Notable among these findings are: IUDs are not abortifacients; newly developed IUDs are highly effective and the efficacy is long-lasting; IUDs can be safely used by most lactating women, with lower removal rates attributable to bleeding and/or pain; and immediate postplacental IUD insertion reduces the risk of expulsion usually associated with postpartum insertion. Most importantly, in apparent contrast to results often reported in the late 1960s through the early 1980s, recent findings show that IUDs per se, especially the medicated ones, are not associated with an increased risk of pelvic inflammatory disease (PID), nor are they associated with an increased risk of ectopic pregnancy or subsequent infertility.There are still issues concerning IUD use that are controversial in spite of numerous studies. Should some of the contraindications currently listed for IUD use be modified according to the newer findings? Is the risk of uterine perforation increased when the IUD is inserted in lactating women? Do IUD tails increase the risk of PID? Does oral use of antibiotics at IUD insertion help prevent postinsertion PID? There are also issues that have not been sufficiently addressed, and more information from empirical studies is needed. These include: the effect of the insertor's skill on IUD performance; IUD use in nulliparous as well as in older women; the relationship between IUD use and chlamydia infection; and long-term IUD use and safety, including actinomycosis, etc. Answers are also needed by administrators facing difficult programmatic decisions. For instance, should programs involving massive IUD re-moval be implemented as many IUD-wearing women aie approaching or passing menopause? Similarly, are large programs to remove less-effective devices and replace them with newer and more effective IUDs advisablei This article reviews the state-of-the-art findings from recent IUD studies on the above issues.

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.