Removal Of Intrauterine Contraceptive Device Research Articles

Using Papaya as a simulation based training tool to develop competency in IUCD insertion & removal in interns - Perspective of teachers and students

As per MCI’s new curriculum, insertion & removal of Intrauterine contraceptive device (IUCD) is a competency to be acquired by an Indian Medical Graduate. Only few students get the opportunity to learn this skill in a real patient. Simulation based teaching could improve the opportunity to learn. Hence we have done this study to use papaya as a cost effective simulation model for teaching IUCD insertion & removal.Institutional ethical committee approval was obtained and a workshop was conducted to all the 158 interns of Government Thoothukudi Medical College in groups of ten. Briefing and demonstration was done with an IUCD simulator. Then the students were given an opportunity to practice the procedure in papaya individually. Feedback was obtained from interns and teachers by a structured questionnaire and analyzed. The feedback was analyzed to assess the reaction, knowledge, fidelity and transfer of the knowledge by students and teachers. Skill developmentby the students before and after the training showed a significant rise (p < 0.05)This hands-on training on IUCD insertion & removal using papaya is found to have high fidelity and is very useful for the students to acquire knowledge and skill and is also approved and appreciated by the teaching faculty. Hence this can be included regularly in the teaching schedule for final year students and in Intern orientation programs.

The role of uterine artery colour doppler in intrauterine contraceptive device IUCD – Related Abnormal Uterine Bleeding

This study was conducted to assess the role of Uterine Artery Colour Doppler velocimetry in prediction of intrauterine contraceptive device (IUCD) - Related Abnormal Uterine Bleeding. From this study, we concluded that the initial pre-IUCD insertion measurement of uterine artery Doppler PI and RI indices can be used as an useful predictor in Cu-T associated AUB, thus help in reducing the number of IUCD removal and non-compliance by the patient within the first year of insertion.

Unintended Journeys: Intrauterine Contraceptive Device Migration to The Sigmoid Colon and Right Ovary – A Report of Two Cases

Ectopic migration of intrauterine contraceptive devices (IUCDs) to neighboring organs is infrequent but can lead to severe consequences. This article presents two cases of IUCD migration resulting in serious consequences, including sigmoid colon penetration in the first case (25-year-old) and right ovary penetration and contraceptive failure leading to pregnancy in the second case (19-year-old). The IUCD was inserted 6 months ago and 2 years ago in the first and the second cases, respectively. Both cases underwent surgical exploration and IUCD removal. Fortunately, both patients experienced uneventful recoveries without any complications. In conclusion, although uncommon, IUCD ectopic migration may result in contraceptive failure and/or organ perforation. Thorough evaluation during care visits is necessary for proper IUCD placement, and radiological assessment should be performed in cases of "missed IUCD" even if the patient is asymptomatic. Timely removal of ectopic IUCD is strongly advised to minimize potential risks.

Extrauterine Migration of a Displaced IUD Leading to Bladder Wall Perforation: A Case Report

Background: Uterine perforation and Intrauterine contraceptive device (IUD) migration into adjacent organs is a serious complication of IUD insertion with an incidence of 0.1% to 0.9%. Only 2% of all migrated IUD cases have included the bladder. Case Presentation: In this report we discuss the presentation and management of a 54-year-old female diagnosed with extrauterine IUD migration into the bladder with consequent stone formation. She underwent an IUD insertion 28 years ago after her third pregnancy. She presented to our clinic complaining of lower urinary tract symptoms for 2 years. An initial urinary tract ultrasound showed an intravesical echogenic structure with posterior acoustic shadowing that was initially thought to represent a stone. The patient underwent an elective open cystolithotomy under general anesthesia where the IUD was located and then removed. The patient tolerated the procedure well and had an uneventful recovery period. Conclusion: IUD migration is a rare yet serious complication of IUD placement and should be ruled out in females with chronic urinary symptoms. WHO recommends removal of any displaced IUD regardless of location and severity of symptoms.

Experience of Women after Immediate Postpartum Insertion of Intrauterine Contraceptive Device (PPIUCD), a Long-Acting Reversible Contraception

ABSTRACT
 Objective: To assess the experience (during and post procedure) of women after immediate postpartum and post placental Insertion of intrauterine contraceptive device (IUCD), a long acting reversible contraceptive (LARC).
 Methods: This prospective and longitudinal study was conducted during February 2019 to September 2019 in Gynae and Obstetrics department Unit 1 at Abbasi Shaheed Hospital. All 141 booked and non-booked patients who delivered in the hospital and received immediate postpartum intrauterine contraceptive device (PPIUCD),either post placental, intra cesarean or within 48 hours after delivery were included in the study regardless of the mode of delivery either intra-cesarean or spontaneous vaginal delivery. Written consent was taken for the contraceptive device insertion and verbal consent was taken to fill the proforma which included basic demographic information, their overall experience with postpartum intrauterine contraceptive device. Immediate experience was measured by assessing the pain during procedure and post insertion period. Further all participants were followed at six weeks and 6 months to collect information about any complains removal of IUCD and overall experience.
 Results: The mean age was 27.3 years with a standard deviation (SD) of 4.42. Among all the participants, 77(54.6%) had Cesarean section and 64(45.4%) had vaginal delivery. During procedure only 5(3.5%) had complain of mild pain and no immediate post procedural complains was recorded. 86(73.5%) participants at 6 weeks and 78(69.03%) participants at 6 months had no complained. Overall experience was found satisfactory in 86(73.5%) participants.
 Conclusion: Postpartum intrauterine contraceptive device (PPIUCD) provided satisfactory experience to majority of the women. So we recommend its use for better maternal and child health.

Postpartum Intrauterine Contraceptive Device (PPIUCD) Versus Interval Intrauterine Contraceptive Device (IUCD) Complications: Which is better?

Introduction: Intrauterine Contraceptive Device (IUCD) is an effective mode of contraception. But its timing of insertion remained debateable. Studies has shown that Postpartum Intrauterine Contraceptive Device (PPIUCD) is associated with less complications as compared to interval IUCD. But controversial results have been noted. This study aims to compare intricacy & efficacy of PPIUCD Vs interval IUCD. 
 Aims & Objectives: To compare the complications of postpartum versus interval intrauterine device insertion (Copper T) in females seeking contraception in teaching hospital of Lahore.
 Place and duration of study: The six months study was conducted in Department of Obstetrics & Gynecology, Shaikh Zayed Medical Complex, Lahore from 15-3-2018 to 15-9-2018.
 Material & Methods: In this Randomized controlled trial 200 women were enrolled and divided into 2 groups. In group A, IUCD (Copper T) was implanted within 10 minutes of delivery of placenta (PPIUCD). In group B, IUCD (Copper T) was implanted after 6 weeks of delivery (Interval IUCD) and both groups were asked to follow up for 6 months and present in case of any complication. Data was analyzed using SPSS version 21.
 Results: In this study, the frequency of bleeding was (Group-A: 12% & Group-B: 18%, p-value=0.235), per vaginal discharge (Group-A: 4% & Group-B: 9%, p-value=0.152), abdominal pain (Group-A: 4% & Group-B: 14%, p-value=0.013), pelvic inflammatory disease (Group-A: 5% & Group-B: 11%, p-value=0.118) and IUCD removal (Group-A: 9% & Group-B: 14%, p-value=0.268) was higher in Group-B patients. However, expulsion rate was observed to be higher in Group-A patients (8% Vs 3% in Group B).
 Conclusion: Based on this study, it can be analyzed that Postpartum Intrauterine Contraceptive Device (PPIUCD) is more effective than Interval IUCD in terms of lower bleeding, PV discharge, pelvic inflammatory disease, abdominal pain and IUCD removal.

Office hysteroscopy safety and feasibility in women receiving anticoagulation and anti-platelet treatment

ObjectivesMore than 60,000 hysteroscopies are performed every year in the UK for common reasons such as heavy menstrual bleeding (HMB) or postmenopausal bleeding. A significant number of women requiring hysteroscopy receive oral anticoagulants and there is often a reluctance to perform these procedures due to bleeding concerns. Study DesignWe are presenting the first proof of concept cohort of patients undergoing minor hysteroscopic procedures while on anticoagulant or antiplatelet medication. A variety of minor procedures such as cervical dilatation, targeted endometrial biopsies, Pipelle endometrial biopsies and insertion or removal of intrauterine contraceptive devices were performed alongside hysteroscopy. ResultsCompletion of planned procedures was feasible in all women due to minimal bleeding despite the ongoing anticoagulation or anti-platelet treatment. ConclusionMore research is needed to establish the safety of performing diagnostic and operative hysteroscopies without bridging or interrupting anticoagulation or antiplatelet treatment.

Combined Laparoscopic and Fluoroscopic Removal of Intrauterine Contraceptive Device Embedded in the Omentum

Combined Laparoscopic and Fluoroscopic Removal of Intrauterine Contraceptive Device Embedded in the Omentum

Removal of a missing intrauterine contraceptive device after location through an ultrasound: a case report within a rural setting and review of literature

BackgroundIn the last decade, (2000–2019), the modern contraceptive prevalence among married women of reproductive age (14–49 years), has increased by only 2.1%. The slow progress was due to limited access to services and myths surrounding methods held by both users and providers. This case report was identified, diagnosed and managed by a midwife working in rural health center in low resource setting. However, literature is scare on the management of missing Intra-Uterine Contraceptive Device (IUCD) thread removal services of confirmed diagnosis using Vscan or limited ultrasound services in rural health centers. The aim of reporting this case report was developed to enhance easy access to intra-uterine contraceptive method removals, which may address myths associated with difficulties of undergoing the services in rural set-up.A 26 year-old married woman, Gravida 1 and Para 1, attended Mekoy Health Center for IUCD removal service after 7 years of protection and internally referred to limited obstetric ultrasound service room due to non- visualization of IUCD thread with Vaginal Speculum examination. An ultrasonography scan however, showed a centrally located copper-T 380A IUCD in the endometrial cavity. As a result, after dilatation of the cervix, a successful removal of the Copper-T 308A was conducted. The client received followed up care for 2 hours post-procedure and was then discharged.ConclusionsThis case highlights the importance of availing diagnostic and removal services in rural set ups to mitigate myths in the community. The availability of limited obstetric ultrasound scanning services can improve the diagnoses and management of conditions in clients. The reported case shows that although, the basic infrastructure was limited, ultrasound scanning and Long Acting Reversible Contraception (LARC) trained midwives can ensure the provision of safe IUCD removal services in rural areas.

Twin gestation: An unusual intrauterine contraceptive device failure outcome

The copper-T intrauterine contraceptive device is an effective long-acting reversible contraceptive option. However, there exists a slim chance of failure. The Copper T 380A has a 1 year failure rate of 0.8% and a 12 year cumulative failure rate of 2.2%. On long-term basis, the cumulative life failure rate for Copper T 380A is 22/1000 long-acting contraceptives after a single application from the 1st to 10th year of insertion, comparable to 18.5 for all tubal sterilisation procedures. When failure happens, the patient is usually at the crossroads of either to terminate the pregnancy or continue with the unplanned pregnancy. Therefore, the patient ought to be adequately counselled on management options, which includes termination of pregnancy where there are no restrictive laws, intrauterine contraceptive device (IUCD) removal if accessible otherwise leave in situ with risks of miscarriage, pre-labour rupture of membrane, and pre-term delivery. The patient's choice is usually laden with emotional and psychological adjustments, especially if the IUCD failed with twin gestation, as seen in this case of a 39-year-old multipara who had Copper-T IUCD inserted 6 months after her last delivery. She opted to carry on with the pregnancy despite associated medical conditions. Attempt at IUCD removal failed at 19 weeks gestational age (GA), and she subsequently drained liquor and was delivered of live pre-term babies at 32 weeks GA. The IUCD was picked up extra chorion and not embedded close to the cervical internal os. Her gestational diabetes and hypertension were co-managed with physicians, while the neonatologists managed the pre-term babies before they were all discharged.

Hysteroscopic Removal of Intrauterine Contraceptive Device During the First Trimester. Procedure Description and Pregnancy Outcomes

Study Objective To evaluate the efficacy and safety of intrauterine contraceptive device (IUD) removal during the first trimester for desired pregnancies. Design prospective cohort study. Setting single tertiary, university affiliated, medical center. Patients or Participants 7 first trimester gravid women who underwent hysteroscopic removal of an IUD at an operating room (OR) setting. Interventions After sonographic evaluation of the IUD location, as well as gestational age and vitality, patients were transferred to the OR. All 7 IUD removals were performed in vaginoscopic approach without any anesthesia or cervical dilation using 3.5mm Gynecare Versascope (Ethicon). Prior to the procedure, all patients received a single dose of intravenous prophylactic antibiotic (Cefamezine), vagina was washed with an antiseptic solution. After clear intrauterine view was achieved using 0.9% normal saline solution, instillation of fluid was stopped in order to decrease the risk for hydro-dissection of the gestational tissue. IUD was removed using semirigid 5F grasping forceps (Karl-Stortz, Tuttlingen, Germany). Ultrasound examination at the end of procedure was performed to ensure fetal pulse. Measurements and Main Results All IUD were copper covered, timing of IUD extraction was between 6-9 weeks of gestation. All 7 pregnancies carried on after the procedure. In our cohort, all 7 women delivered at term (37-42 weeks). All deliveries were spontaneous vaginal deliveries of healthy babies at appropriate weight for gestational age (2859-3756gr). No marked complications during pregnancy or delivery were noted. Conclusion Hysteroscopic removal of IUD in the first trimester is a safe procedure not linked to major adverse pregnancy outcomes. This procedure should be offered to gravid women in the first trimester who desire to preserve pregnancy.

Ureteric Avulsion following Blind Attempts at Retrieval of Intrauterine Contraceptive Device: A Clinical Lesson to Primary Care Givers

Intra Uterine Contraceptive Device (IUCD) is the most popular method of reversible contraception in India because of their high efficacy for fertility regulation, low-risk, low-cost, and lack of required maintenance. Uterine perforation remains one of the most serious complications, with an incidence 0.87 per 1000 insertions. The IUCD strings are used to monitor and remove the device. Missing IUCD strings are observed in about 5% of the users. Such patients require localisation of the device using Transvaginal Scan (TVS) and X-Ray, and combined hysterolaparoscopic approach for its retrieval. Hereby we report a case of young primipara, who consulted a local practitioner requesting IUCD removal, as she was planning to conceive her second child. On examination, Cu-T threads were not found. A plain X-Ray of the pelvis was reported as: Cu-T limbs seen in the left side of the pelvis, “in the region of uterus”. Blind attempts led to damage to ovary and uterus along with the ureter. By reporting this case, we hope to raise awareness on the management of misplaced IUCD, among primary care givers; and the need for set protocols on the management of such cases.

Visibility of Strings After Postplacental Intracesarean Insertion of CuT380A and Cu375 Intrauterine Contraceptive Device: A Randomized Comparative Study.

To compare the incidence of visible strings after postplacental intracesarean insertion of Cu375 and CuT380A intrauterine contraceptive devices (IUD). This was a prospective, randomized comparative study. A total of 100 women fulfilling the inclusion and exclusion criteria underwent postplacental intracesarean insertion of either Cu375 IUD or CuT380A IUD. Women were followed up at 1, 6weeks and 3months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualize the IUD strings. Data were analyzed by Chi-square test. At 6-week follow-up, 97.9% women in group A versus 41.7% women in group B had strings visible at the cervical os and at 3months 100% women in group A versus only 47.9% women in group B (p<0.001) had visible strings of IUD. Both Cu375 and CuT380A IUD are safe postpartum method of contraception but Cu375 if used for intracesarean IUD insertion increases the incidence of visible IUD strings. Hence, it avoids radiological investigations and invasive procedures at follow-up visits required to locate the IUD when strings are not visible. CTRI No. CTRI/2015/09/006221.

A case of laparoscopic removal of intrauterine contraceptive device perforated to the intraabdominal cavity

A case of laparoscopic removal of intrauterine contraceptive device perforated to the intraabdominal cavity

Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device

AimTo assess the incidence of visible strings of intrauterine contraceptive devices (IUDs) after postplacental insertion following vaginal or caesarean delivery and to establish a management protocol of follow-up visits when...

Reasons for Insertion and Predictors of Removal of Intrauterine Contraceptive Devices in an Outpatient Clinic [1O

INTRODUCTION: The objective of this study was to examine reasons for insertion and discontinuation of IUDs as well as evaluate factors that predict discontinuation. METHODS: Medical charts of 84 female patients who had an IUD inserted from January 1999 through June 2014 were reviewed. Variables of interest included demographic variables, age, body mass index, parity, type of IUD, indications for insertion, removal of IUDs, and side effects. Descriptive and inferential statistical methods were used. RESULTS: Contraception (81%) was the main reason for insertion of IUDs followed by dysfunctional uterine bleeding (11.9%). With regard to removal, side effects of IUDs (13.1%) were the major reason revealed. Other minor reasons for removal included 5-year limit for Mirena, pregnancy desired, IUD fell out, and no follow up. Obese patients were more likely to have IUD removed than normal or overweight patients (P=.018). Patients with lower parity were more likely to have had their IUDs removed in fewer years before first removal (P=.001). Younger patients were more likely to have had their IUDs removed in fewer years than older patients (P=.002). CONCLUSION: Higher BMI, younger age, and lower parity were significant predictors of IUD discontinuation fewer years before first removal. Side effects necessitating removal were vaginal issues including bleeding, spotting, discharge, and cramping. Health care providers should counsel and educate their patients on IUD side effects at the time of insertion. Furthermore, patient characteristics associated with IUD removal should be considered in offering options of contraceptive methods.

Determinants of Method Switching among Social Franchise Clients Who Discontinued the Use of Intrauterine Contraceptive Device.

Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0) the chances of method switching. Compared with women who received free IUCD service (via voucher scheme), the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.

Rates of IUCD discontinuation and its associated factors among the clients of a social franchising network in Pakistan

BackgroundModern Intrauterine contraceptive device (IUCD) is very safe, highly effective reversible and inexpensive family planning method which offers 5-10 years of protection against pregnancy. The contraceptive use in Pakistan has been merely 30% for over a decade with IUCD being the least used method. Higher discontinuation rates are documented in developing countries; however no such data is available for Pakistan. Marie Stopes Society (MSS) established a social franchise outlets network branded as 'SURAJ' (Sun) in Pakistan to provide quality family planning services. This study attempts to determine IUCD discontinuation rates and its associated risk factors. Using a semi-structured questionnaire, a cross-sectional study was conducted with 3000 clients who availed IUCD services from Suraj provider 6, 12 and 24 month back,. Data were analyzed in SPSS 17.0; adjusted prevalence ratios were calculated to see associations between discontinuation and its risk factors.Case presentationWe found that 22.7% of the IUCD acceptors experienced some health problem; while the overall discontinuation rate was 18.9% with average time of usage of 7.4 (SD ± 5.8) months before discontinuation. Half of them showed health concerns (49.8%); of which a majority (70.2%) returned to Suraj provider for IUCD removal. Women living in Punjab, residing at a travelling time of 30-60 minutes and no previous use of contraceptive are more likely to discontinue IUCD. However, among total women 81.7% still expressed willingness to avail IUCD services from Suraj provider in future, if needed.ConclusionThe findings suggest a need for training the providers and field workers to prevent early discontinuation of IUCD among the Suraj clients and by addressing the health concerns through proper counseling, continued follow-up and immediate medical aid/referral in case of complications.

Pseudoactinomyces in Cervical Mucus

Actinomyces israelii are gram-positive filamentous bacteria forming yellow sulfur granules. They are the most well known complication of intrauterine contraceptive devices (IUCD). Healthcare staff dealing with reporting cervical smears should be aware of pseudoactinomyces entity in a cervical smears and biopsies as it may raise a false alarm to the clinician and may lead to unnecessary removal of IUCD and/or medical treatment.

The forgotten coil

To raise awareness of forgotten intrauterine contraceptive devices (IUDs). Case report. District general hospital in London. Two women, one with secondary infertility and one with heavy, painful periods, both unaware they had an IUD. Removal of the forgotten IUD. Return of fertility and improvement in gynecologic symptoms. After the removal of the IUD, the first patient who had had secondary infertility conceived within 1 month. In the second patient, the symptoms of menorrhagia and dysmenorrhea improved after removal of the IUD. Although it is rare, a forgotten IUD is a potential cause of unexplained infertility and a differential diagnosis for gynecologic symptoms.