Intrauterine Device Use Research Articles

Association Between Previous Cesarean Section and Subsequent Ectopic Pregnancy: A Comparative Observational Study

Background: The rise in cesarean delivery rates across the world has raised concerns about its potential impact on the outcome of subsequent pregnancies. Among the concerns is the increased risk of ectopic pregnancy, particularly in the tubal or scar site. This study aimed to assess the connection between previous cesarean delivery and subsequent ectopic pregnancy. Methodology: This is a comparative observational study conducted over a period of 1.5 years at Lalla Ded Hospital in Srinagar. The study recruited 148 cases with clinical symptoms of ectopic pregnancy and confirmed diagnosis, along with 4852 matched controls with intrauterine pregnancies. The inclusion criteria comprised women with a previous history of normal vaginal delivery or cesarean section. Patients with a history of ectopic pregnancy, pelvic inflammatory disease, abortions, tubal pathology or surgery, ARTs, and use of intrauterine contraceptive devices were excluded. The data were analyzed using SPSS version 20.0. Results: Out of the 148 eligible cases, 106 (4.2%) had a previous cesarean section, and 42 (1.7%) had a normal vaginal delivery. The odds ratio for women with a previous cesarean section was 2.59 (95% confidence interval= 1.81 to 3.75), which means that they had a 2.59 times higher risk of having subsequent ectopic pregnancy than those with normal vaginal delivery. Conclusion: The study concludes that a previous cesarean section is linked to an increased risk of subsequent ectopic pregnancy. Women with a history of cesarean section should receive close monitoring during early pregnancy to detect and manage ectopic pregnancy promptly. Further research is necessary to identify the underlying mechanisms and develop strategies to reduce the risk of ectopic pregnancy in these women. Keywords: cesarean delivery, ectopic pregnancy, long-term morbidity, risk factors

Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial

Many questions remain about the appropriate use of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that early use of intrauterine balloon tamponade might be beneficial. This study aimed to compare the effect of intrauterine balloon tamponade used in combination with second-line uterotonics vs intrauterine balloon tamponade used after the failure of second-line uterotonic treatment on the rate of severe postpartum hemorrhage in women with postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. This multicenter, randomized, controlled, parallel-group, nonblinded trial was conducted at 18 hospitals and enrolled 403 women who had just given birth vaginally at 35 to 42 weeks of gestation. The inclusion criteria were a postpartum hemorrhage refractory to first-line uterotonics (oxytocin) and requiring a second-line uterotonic treatment with sulprostone (E1 prostaglandin). In the study group, the sulprostone infusion was combined with intrauterine tamponade by an ebb balloon performed within 15 minutes of randomization. In the control group, the sulprostone infusion was started alone within 15 minutes of randomization, and if bleeding persisted 30 minutes after the start of sulprostone infusion, intrauterine tamponade using the ebb balloon was performed. In both groups, if the bleeding persisted 30 minutes after the insertion of the balloon, an emergency radiological or surgical invasive procedure was performed. The primary outcome was the proportion of women who either received ≥3 units of packed red blood cells or had a calculated peripartum blood loss of >1000 mL. The prespecified secondary outcomes were the proportions of women who had a calculated blood loss of ≥1500 mL, any transfusion, an invasive procedure and women who were transferred to the intensive care unit. The analysis of the primary outcome with the triangular test was performed sequentially throughout the trial period. At the eighth interim analysis, the independent data monitoring committee concluded that the incidence of the primary outcome did not differ between the 2 groups and stopped inclusions. After 11 women were excluded because they met an exclusion criterion or withdrew their consent, 199 and 193 women remained in the study and control groups, respectively, for the intention-to-treat analysis. The women's baseline characteristics were similar in both groups. Peripartum hematocrit level change, which was needed for the calculation of the primary outcome, was missing for 4 women in the study group and 2 women in the control group. The primary outcome occurred in 131 of 195 women (67.2%) in the study group and 142 of 191 women (74.3%) in the control group (risk ratio, 0.90; 95% confidence interval, 0.79-1.03). The groups did not differ substantially for rates of calculated peripartum blood loss pf ≥1500 mL, any transfusion, invasive procedure, and admission to an intensive care unit. Endometritis occurred in 5 women (2.7%) in the study group and none in the control group (P=.06). The early use of intrauterine balloon tamponade did not reduce the incidence of severe postpartum hemorrhage compared with its use after the failure of second-line uterotonic treatment and before recourse to invasive procedures.

Use of postpartum intrauterine contraceptive device among women in northern Uganda: A cross‐sectional study

AbstractIntroductionThe aim of this study was to determine the prevalence and factors associated with postpartum intrauterine contraceptive device use among postpartum mothers in Lira district, northern Uganda.MethodsWe designed a cross‐sectional study among postpartum mothers with the outcome as postpartum intrauterine contraceptive device use defined as the insertion of an intrauterine contraceptive device within 10 min to 48 h following placental delivery. Data were collected using a researcher‐administered structured questionnaire. We descriptively summarized numerical data using the mean and the standard deviation and categorical data using frequency and percentages. We performed bivariate analysis using either the χ2 test or Fisher's exact test, and determined factors associated with the outcome using binary logistic regression analysis at a 5% level of statistical significance. We reported the results as adjusted odds ratio (aOR) and 95% confidence interval (CI).ResultsOf 384 postpartum women studied, 37 (9.6%) had used a postpartum intrauterine contraceptive device and the associated factors included maternal age <35 years with an aOR of 0.12 (95% CI: 0.02, 0.72), parity ≥3 with aOR of 4.25 (95% CI: 1.79, 11.03), at least secondary level of education with aOR of 0.27 (95% CI: 0.07, 0.92) and knowledge of adverse effects of a postpartum intrauterine contraceptive device with aOR of 9.56 (95% CI: 4.13, 24.36).ConclusionsThe prevalence of postpartum intrauterine contraceptive device use is low in this setting. Interventions to improve the use of a postpartum intrauterine contraceptive device such as health education should target younger and multiparous women including those without adequate knowledge about it.

Perbandingan Kejadian Anemia Pada Penggunaan Kontrasepsi Intra Uterine Device (Iud) Dan Suntik Kb 1 Bulan Di Desa Joho, Kecamatan Mojolaban, Kabupaten Sukoharjo, Jawa Tengah

<p><em>Anemia associated with the use of modern contraception causes changes in menstrual patterns that lead to anemia. Modern contraceptives such as sterilization, intrauterine devices (IUD), pills, birth control injections, implants, condoms, the lactation amenorrhea method (MAL) are preferred by married women in Indonesia, the prevalence was recorded at 58.7% in 2018, then 59, 7% in 2022 and the number will continue to grow until it is estimated to reach 61.9% in 2030. Contraception is an effective innovation in the public health sector, enabling family planning and pregnancy prevention, one of which is the Intra Uterine Device / IUD which is divided into four types and 1 month birth control injection which can cause side effects, one of which is anemia. The aim of the study was to analyze the comparative incidence of anemia in the use of intrauterine device (IUD) contraception and 1-month contraceptive injections in Joho Village, Mojolaban District, Sukoharjo Regency, Central Java. This study uses a comparative analysis and a pre-experimental one shot case study approach. the target population is married women or couples and the actual population is mothers using intrauterine contraception devices (IUDs) and 1 month injectable birth control. With a sample requirement of 44 respondents. There is a difference in the incidence of anemia in the use of intra uterine device (IUD) contraception and 1 month contraceptive injection in Joho Village, Mojolaban District, Sukoharjo Regency, Central Java with the average hemoglobin level of 1 month contraceptive injection users being higher than IU users</em></p>

Long-Acting Reversible Contraception Continuation After Management of a Malpositioned Intrauterine Device [ID: 1376021

INTRODUCTION: Studies have investigated risk factors for intrauterine device (IUD) malposition, but there is a paucity of data regarding patients’ contraceptive decisions after experiencing a malpositioned IUD. Therefore, we sought to investigate continued long-acting reversible contraception (LARC) usage after management of a malpositioned IUD. METHODS: After IRB approval, a retrospective cohort study was conducted, which included 541 patients who underwent IUD insertion at one institution with subsequent pelvic imaging. One hundred six had a malpositioned IUD and were age-matched to controls. Chart and imaging reports were abstracted. Long-acting reversible contraception retention was documented through 24 months from index imaging. RESULTS: Most patients had a levonorgestrel IUD (90.9%) for the indication of contraception alone (54.1%). The imaging indication of abnormal uterine bleeding (AUB) was most likely to be associated with malposition (odds ratio [OR] 1.67 [1.03–2.71], P=.038), as well as a copper IUD type (OR 5.31 [2.14–13.18], P<.001). Most patients with a malpositioned IUD did not have an IUD replaced after removal (57.8%). Of those who abandoned IUD therapy, only six chose to initiate an alternative LARC. Malposition was not an independent risk factor for LARC abandonment between the two groups over the 24 months of follow-up. Risk factors for abandonment over the follow-up period included AUB, copper IUD use, younger age, and shorter duration of use before undergoing imaging. CONCLUSION: Most patients with a malpositioned IUD did not have IUD replacement and abandoned all LARC therapy. These are important preliminary findings regarding LARC abandonment associated with IUD malposition that will help shape further studies as well as clinical counseling.

Systemic Progestins and Progestin-Releasing Intrauterine Device Therapy for Premenopausal Patients With Endometrial Intraepithelial Neoplasia.

To estimate trends in use and outcomes of progestin therapy for premenopausal patients with endometrial intraepithelial neoplasia. The MarketScan Database was used to identify patients aged 18-50 years with endometrial intraepithelial neoplasia from 2008 to 2020. Primary treatment was classified as hysterectomy or progestin-based therapy. Within the progestin group, treatment was classified as systemic therapy or progestin-releasing intrauterine device (IUD). The trends in use of progestins and the pattern of progestin use were examined. A multivariable logistic regression model was fit to examine the association between baseline characteristics and the use of progestins. The cumulative incidence of hysterectomy, uterine cancer, and pregnancy since initiation of progestin therapy was analyzed. A total of 3,947 patients were identified. Hysterectomy was performed in 2,149 (54.4%); progestins were used in 1,798 (45.6%). Use of progestins increased from 44.2% in 2008 to 63.4% in 2020 ( P =.002). Among the progestin users, 1,530 (85.1%) were treated with systemic progestin, and 268 (14.9%) were treated with progestin-releasing IUD. Among progestin users, use of IUD increased from 7.7% in 2008 to 35.6% in 2020 ( P <.001). Hysterectomy was ultimately performed in 36.0% (95% CI 32.8-39.3%) of those who received systemic progestins compared with 22.9% (95% CI 16.5-30.0%) of those treated with progestin-releasing IUD ( P <.001). Subsequent uterine cancer was documented in 10.5% (95% CI 7.6-13.8%) of those who received systemic progestins compared with 8.2% (95% CI 3.1-16.6%) of those treated with progestin-releasing IUD ( P =.24). Venous thromboembolic complications occurred in 27 (1.5%) of those treated with progestins; the venous thromboembolism (VTE) rate was similar for oral progestins and progestin-releasing IUD. The rate of conservative treatment with progestins in premenopausal individuals with endometrial intraepithelial neoplasia has increased over time, and among progestin users, progestin-releasing IUD use is increasing. Progestin-releasing IUD use may be associated with a lower rate of hysterectomy and a similar rate of VTE compared with oral progestin therapy.

Heavy Menstrual Bleeding Treatment With a Levonorgestrel 52-mg Intrauterine Device.

To evaluate heavy menstrual bleeding treatment outcomes with levonorgestrel 52-mg intrauterine device (IUD) use in participants without body mass index (BMI) or parity restrictions. Investigators included participants aged 18-50 years with no pelvic or systemic pathology causing heavy menstrual bleeding at 29 U.S. centers in a prospective trial. Participants had up to three screening cycles with menstrual product collection for alkaline hematin blood-loss measurements. Investigators enrolled those with two menses with blood loss of 80 mL or more (values averaged for baseline blood loss), placed the IUD, and followed participants for up to six 28-day cycles. Participants collected any menstrual products used during cycles 3 and 6 for blood-loss measurement. We evaluated outcomes in participants with at least one follow-up assessment for the primary outcome of median absolute blood-loss change and, secondarily, treatment success , defined as the proportion with a final measured blood loss less than 80 mL and at least 50% reduction from baseline. We evaluated exploratory outcomes of differences in blood-loss changes by BMI and parity using Wilcoxon rank sum test. Of 105 enrolled participants, 47 (44.8%) had obesity (BMI 30.0 or higher) and 29 (27.6%) were nulliparous. Baseline mean blood loss ranged from 73 to 520 mL (median 143 mL, interquartile range 112-196 mL). Eighty-nine (84.8%) had at least one evaluable follow-up evaluation. Participants had median (interquartile range) absolute blood-loss decreases at cycles 3 (n=86) and 6 (n=81) of 93.3% (86.1-97.7%) and 97.6% (90.4-100%), respectively. At cycle 6, participants without obesity (n=43) and with obesity (n=38) had similar median [interquartile range] decreases (97.6% [91.8-100%] and 97.5% [90.3-100%], respectively; P =.89), with comparable findings for nulliparous (n=25) and parous (n=56) participants (97.0% [91.7-99.1%] and 98.1% [89.9-100%], respectively; P =.43). Treatment success occurred in 81.8% (95% CI 74.2-89.4%) of 99 participants, excluding those with no outcomes due to lost to follow-up or consent withdrawal, and did not vary by BMI or parity. The most common adverse events leading to discontinuation were bleeding or cramping (n=6 [5.7%]) and expulsion (n=5 [4.8%]). This levonorgestrel 52-mg IUD reduces blood loss by more than 90% over 6 months compared with baseline for most users with heavy menstrual bleeding. Medicines360. ClinicalTrials.gov , NCT03642210.

Abstract 1186: Contraception and ovarian cancer risk by tumor immune profiles

Abstract Introduction: An estimated 38 million US women currently use contraception, a critical component of women’s health. Yet, the impact of changing contraceptive types and patterns of use on ovarian cancer incidence is unclear and the biologic pathway through which contraception influences ovarian cancer risk is not well understood. Using multiplex immunofluorescence (mIF) technology, we evaluated how contraception influences the tumor immune microenvironment (e.g., T cells) to better understand the association of intrauterine device (IUD) and oral contraception (OC) use on ovarian cancer risk. Methods: We measured tumor immune profiles via mIF on tissue microarrays including tumor cores from 214 women with ovarian cancer (85% high grade serous) and 414 population-based controls frequency matched on age who participated in the New England Case Control Study. T cell types were defined by expression of CD3+ (total T cells), CD3+CD4+ (helper), CD3+CD8+ (cytotoxic), CD3+CD4+FoxP3+ (regulatory), CD3+CD4+CD69+ or CD3+CD8+CD69+ (recently activated), or CD3+Tim3+ or CD3+Lag3+(exhausted). The average immune cell density across 3 cores per tumor was used to categorize tumors as high or low abundance based on the median across all tumors. Contraception use was self-reported and included having ever used an IUD and/or OCs and duration of use. Polytomous logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for ovarian cancer defined by tumor immune cell abundance adjusted for age at diagnosis or interview, parity, and family history of breast or ovarian cancer in first degree relative. Results: Overall, ever use of IUD or OC was not differentially associated with ovarian cancer risk by T cell tumor immune profiles. However, for OC use of 5 years or longer, we observed a significant reduction in risk for low-abundance total T cell (ORlow=0.44, 95% CI 0.21-0.94), cytotoxic T cell (ORlow=0.44, 95% CI:0.21-0.94), regulatory T cell (ORlow=0.31, 95% CI: 0.14-0.68), and recently activated T cell (CD3+CD4+CD69+ ORlow=0.34, 95% CI: 0.17-0.68) tumors with significant trends with longer duration. There was no significant decrease in risk of tumors with high abundance of these T cell types, although statistically significant heterogeneity was only observed in the association for duration of OC use and risk by low and high abundance of recently activated helper T cells (CD3+CD4+CD69+, p-het=0.006). Conclusion: These results suggest that ever use of IUD and OCs are not associated with risk of ovarian tumors by immune phenotype, though risk by T cell abundance may vary with longer duration. Analyses are ongoing and will be expanded to include types and patterns of contraception, other immune markers, and additional studies. Citation Format: Jennifer Mongiovi, Ana Babic, Naoko Sasamoto, Mary Townsend, Allison Vitonis, Jonathan Hecht, Jose Conejo-Garcia, Brooke Fridley, Shelley Tworoger, Kathryn Terry. Contraception and ovarian cancer risk by tumor immune profiles [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1186.

Factors Related to Use KB Participants are Active in Understanding Contraceptive Devices (IUD) UPT Working Area DPPKB Bandar District, Simalungun Regency

Based on a preliminary survey conducted in the working area of UPT. DPPKB found that the use of Intrauterine Contraceptive Devices (IUD) was still small compared to other contraceptive methods. Meanwhile, IUD use has begun to be targeted every year. The purpose of this research is to find out what are the factors associated with IUD use. This type of research is quantitative research that is analytic in nature. This research was conducted in the working area of UPT. DPPKB Bandar District in August 2017. The population in this study amounted to 10,429 people with a sample of 189 people. The instrument used was a questionnaire using the Chi-sguare test and SPSS program assistance. Based on the results of the study it was found that the total number of family planning participants had low education, namely 123 people (65.1 % ). The majority of respondents with low education did not use the IUD as many as 118 people (95.9 % ) while only $ people (4.1%) used it. There is a relationship between education and IUD use (P=0.000&lt;0.05 ). Family planning participants had low knowledge, namely 123 people (65.1 % ). The majority of respondents with low knowledge did not use the IUD as many as 121 people (98.4 % ) while only 2 people (1.6%) used it. There is a relationship between knowledge and use of the IUD (P=0.000&lt;0.05 ) . Family planning participants who did not receive support from their husbands were 175 people (92.6 % ). The majority of respondents who did not receive support from their husbands did not use the IUD as many as 164 people ( 93.7 %) while only 1 person (6.3%) used it. There is a relationship between husband's support and IUD use (P=0.000&lt;0.05 ).

Patient satisfaction, sexual function and decision regret in use of levonorgestrel intrauterine device

Aim: Abnormal uterine bleeding is a common condition. The etiological cause and treatments are diverse. LNG-IUD can be used to treat abnormal uterine bleeding.It has been shown to reduce the amount of bleeding in patients with menorrhagia and increase hemoglobin and hematocrit (Hct) values. The aim is to investigate the effects of LNG-IUD on hemoglobin, Hct, bleeding pattern, and its effect on sexual function, decision regret, and menorrhagia effects according to the etiologic cause.&#x0D; Material and Method: Our study included patients who underwent LNG-IUD implantation and had been using it for over six months. Patients with a history of postmenopausal or adolescent bleeding, hematologic or oncologic diseases, and a history of drug use that may cause coagulation disorders were excluded. Patients were grouped according to their indications as polyp (n=26), adenomyosis (n=16), leiomyoma (n=27), hyperplasia (n=18), and non-structural causes (n=81). Hemoglobin (Hb) and Hct values were examined before and after the application, and bleeding patterns were questioned. Participants were administered Menorrhagia Impact Questionnaire (MIQ), Arizona Sexual Experience Scale and Decision Regret Scale. &#x0D; Results: 168 patients were included in our study. The average duration of LNG-IUD use was 627.0±319 days and the average age was 43.4±6.1 years. The frequency of bleeding (number of bleedings per year) was 18.0±8.0 before LNG-IUD application and 7.8±8.0 after treatment (p

Early vs Interval Postpartum Intrauterine Device Placement

The early postpartum period, 2 to 4 weeks after birth, may be a convenient time for intrauterine device (IUD) placement; the placement could then coincide with early postpartum or well-baby visits. To determine expulsion rates for IUDs placed early postpartum compared with those placed at the standard interval 6-week visit. In this randomized noninferiority trial, people who had a vaginal or cesarean birth were randomly assigned to undergo early (14-28 days) or interval (42-56 days) postpartum IUD placement. Clinicians blinded to participant study group used transvaginal ultrasonography to confirm IUD presence and position at the 6-month postpartum follow-up. The study assessed 642 postpartum people from 4 US medical centers, enrolled a consecutive sample of 404 participants from March 2018 to July 2021, and followed up each participant for 6 months postpartum. Early postpartum IUD placement, at 2 to 4 weeks postpartum, vs standard interval placement 6 to 8 weeks postpartum. The primary outcome was complete IUD expulsion by 6 months postpartum; the prespecified noninferiority margin was 6%. Secondary outcomes were partial IUD expulsion, IUD removal, pelvic infection, patient satisfaction, uterine perforation, pregnancy, and IUD use at 6 months postpartum. IUD malposition was an exploratory outcome. Among 404 enrolled participants, 203 participants were randomly assigned to undergo early IUD placement and 201 to undergo interval IUD placement (mean [SD] age, 29.9 [5.4] years; 46 [11.4%] were Black, 228 [56.4%] were White, and 175 [43.3%] were Hispanic). By 6 months postpartum, 53 participants (13%) never had an IUD placed and 57 (14%) were lost to follow-up. Among the 294 participants (73%) who received an IUD and completed 6-month follow-up, complete expulsion rates were 3 of 149 (2.0% [95% CI, 0.4%-5.8%]) in the early placement group and 0 of 145 (0% [95% CI, 0.0%-2.5%]) in the interval placement group (between-group difference, 2.0 [95% CI, -0.5 to 5.7] percentage points). Partial expulsion occurred in 14 (9.4% [95% CI, 5.2%-15.3%]) participants in the early placement group and 11 (7.6% [95% CI, 3.9%-13.2%]) participants in the interval placement group (between-group difference, 1.8 [95% CI, -4.8 to 8.6] percentage points). IUD use at 6 months was similar between the groups: 141 (69.5% [95% CI, 62.6%-75.7%]) participants in the early group vs 139 (67.2% [95% CI, 60.2%-73.6%]) in the interval group. Early IUD placement at 2 to 4 weeks postpartum compared with 6 to 8 weeks postpartum was noninferior for complete expulsion, but not partial expulsion. Understanding the risk of expulsion at these time points may help patients and clinicians make informed choices about the timing of IUD placement. ClinicalTrials.gov Identifier: NCT03462758.

Clinical and Morphological Study of Cervical Squamous Intraepithelial Lesions.

Squamous intraepithelial lesions (SILs) are cancer precursors targeted by secondary prevention of cervical cancer programs that are sometimes difficult to grade accurately. Mena is an actin regulatory protein involved in membrane protrusion, cell motility, in tumor invasion and metastasis. We studied retrospectively 68 cases of patients diagnosed with squamous intraepithelial lesions that received expedited treatment (treatment without colposcopic biopsy). We analyzed demographic, behavioral data, obstetrical and medical history, from the patients' medical charts and we studied the cervical fragments or cones harvested after the excisional procedure. Our study failed to identify a correlation between SILs and risk factors such as low socioeconomic status, combined oral contraceptive use, intrauterine device use, parity, gravity, except for the tobacco smoking habit that proved to be related to the cervical lesions' development. Mena was expressed in most of the analyzed SILs and its expression was correlated with lesions' grade in terms of both area and intensity, suggesting that Mena stains especially abnormal cells and that its expression intensity correlates with the risk of malignant transformation. Further studies are needed to validate Mena as an early stage of cervical carcinogenesis marker.

Study of acceptability for the use of postpartum intrauterine contraceptive device among women attending government general hospital, Guntur

Study of acceptability for the use of postpartum intrauterine contraceptive device among women attending government general hospital, Guntur

Uptake of postplacental intrauterine device placement at cesarean delivery

Several studies have investigated the effectiveness of intrauterine device placement at cesarean delivery as a contraceptive method. However, national-level use and outcomes of a postplacental intrauterine device at cesarean delivery are currently understudied in the United States. This study aimed to examine the trends, characteristics, and outcomes of patients who received a postplacental intrauterine device at cesarean delivery. This retrospective cohort study used the National Inpatient Sample. The study cohort included patients who underwent cesarean delivery from October 2015 to December 2018. The exclusion criteria included hemorrhage, chorioamnionitis, uterine anomaly, hysterectomy, and permanent surgical sterilization. Eligible cases were grouped on the basis of the use of a postplacental intrauterine device at cesarean delivery. The primary outcome measures were temporal trends and characteristics associated with the use of a postplacental intrauterine device at cesarean delivery, assessed using the generalized estimating equation model in multivariable analysis. The secondary outcome measure was perioperative morbidity (leukocytosis, endometritis, myometritis, and sepsis). Propensity score matching was used to balance the baseline characteristics. Among 2,983,978 patients who met the inclusion criteria, 10,145 patients (0.3%) received a postplacental intrauterine device at cesarean delivery. The use of a postplacental intrauterine device increased from 0.1% in the fourth quarter of 2015 to 0.6% in the fourth quarter of 2018 (P<.001). In a multivariable analysis, the use of a postplacental intrauterine device increased by 14% every quarter-year (adjusted odds ratio, 1.14; 95% confidence interval, 1.13-1.15). In addition, (1) patient characteristics of young age, non-White race, obesity, tobacco use, lowest quartile median household income, and insured with Medicaid; (2) hospital characteristics of large bed capacity and urban teaching setting in Northeast region; and (3) pregnancy characteristics of early gestational age at cesarean delivery, hypertensive disease, previous cesarean delivery, multifetal pregnancy, grand multiparity, placenta previa, and nonelective cesarean delivery represented the independent characteristics associated with the use of a postplacental intrauterine device (all P<.05). A regression tree model identified 35 discrete patterns of the use of a postplacental intrauterine device based on 8 factors (time, race or ethnicity, primary expected payer, obesity, hospital bed capacity, hospital teaching status, hospital region, and previous cesarean delivery). There were 9 patterns, representing 8.8% of the study population, exhibiting a use rate of ≥1.0%, whereas there were 7 patterns, representing 16.0% of the study population, exhibiting no use of a postplacental intrauterine device (absolute rate difference from the highest group to the lowest group, 4.7%). In a propensity score-matched model, postplacental intrauterine device placement at cesarean delivery was not associated with increased risk of measured morbidity (any, 1.8% vs 1.7%; odds ratio, 1.06; 95% confidence interval, 0.66-1.69; P=.812), including postpartum endometritis (1.2% vs 1.0%; odds ratio, 1.19; 95% confidence interval, 0.67-2.14; P=.554). The use of a postplacental intrauterine device at cesarean delivery increased significantly in recent years in the United States.

Pelvic Pain in Transgender People Using Testosterone Therapy.

Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.2%)* reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.

Assessment risk factors for women with ectopic pregnancy in Al-Zashraa teaching hospital at Al-Najaf city

Ectopic pregnancy (EP) is the leading cause of maternal death during the first trimester of pregnancy, accounting for approximately 10% of all pregnancy-related deaths. It remains to be a condition presenting as a serious health problem for women of childbearing age. It has been shown to reduce subsequent fertility and increase the chances of subsequent EP. Over recent decades, there has been a rise in the incidence of EP. There is extensive literature regarding the potential risk factors for EP. The identified risk factors for EP include age, previous EP, previous pelvic surgery, use of intrauterine devices (IUDs), female sterilization, history of pelvic inflammatory disease, history of infertility and smoking at the time of conception. Methodology: A descriptive cross sectional study was adopted in order to achieve the stated objectives. The study began from 2 November 2021 to 24 April 2022. A non-probability sampling technique (purposive sample) based on the criteria of patient with only women with ectopic pregnancy sample of (48) woman who admitted who were selected from Al Zahra Teaching Hospital. Results: The study show the previous abortion was risk factors of ectopic pregnancy which there was high significant association. Recommends: The study recommends Educational health programs for women regarding risk factors of ectopic pregnancy.

Immediate postpartum intrauterine contraceptive device use among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, Ethiopia: Intentions and barriers.

This study aimed to assess the intention and barriers to the use of immediate postpartum intrauterine contraceptive devices among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia. A facility-based cross-sectional study design was conducted from 1 September to 30 October 2020 by using a systematic sampling technique. Data were entered into Epi-data 3.1 version and exported to Statistical Package for Social Sciences 23 for analysis. A binary logistic regression analysis was done to sort candidate variables for multiple logistic regression, and multivariable logistic regressions were done to identify factors associated with the intention to postpartum intrauterine contraceptive devices. Factors associated with intention to use immediate postpartum intrauterine contraceptive device declared at 95% confidence interval. This study finding showed that 37.6% (95% confidence interval (31.5, 43.7)) of pregnant women intended to use the immediate postpartum intrauterine contraceptive device after their delivery. The main reason women refused to use immediate postpartum intrauterine contraceptive devices was being satisfied with other methods to use after they gave birth (27.5 %), the concern of health harm (22.2%), and the fear of impaired future fertility (16.4%). The identified factors that were statically significant with the intention to use immediate postpartum intrauterine contraceptive devices among pregnant women were included: attended secondary education (adjusted odd ratio = 2.36; p = 0.03; 95% confidence interval (1.089, 5.128)), attended college and above (adjusted odd ratio = 2.99; p = 0.020; 95% confidence interval (1.189, 7.541)), have high knowledge on immediate postpartum intrauterine contraceptive devices ((adjusted odd ratio = 2.10; p = 0.006; 95% confidence interval (1.236, 3.564)), the previous history of LACM used (adjusted odd ratio = 6.85; p = 0.0001; 95% confidence interval (3.560, 10.021)), parity >4 (adjusted odd ratio = 1.86; p = 0.043; 95% confidence interval (3.99, 8.703)). The intention of pregnant women to use after they gave birth in the study area was low. Maternal educational level, high knowledge, history of previous long-acting contraceptive methods use, and parity were significantly associated with pregnant women's intention to use immediate postpartum intrauterine contraceptive devices. Healthcare providers should focus on delivering crucial information about immediate postpartum intrauterine contraceptive device benefits for postpartum women, particularly concerning reducing barriers during antenatal care follow-up as they plan to use it after their delivery.

Factors Related to the Low Use of Intraceptive Devices (IUD) in Women Couple of Reproductive Age at Public Health Center Tiga Balata, Simalungun Regency

The Family Planning Program (KB) is a national program that improves the health status and welfare of women, children and families in particular, and the nation in general. The use of the IUD method in Indonesia is able to significantly reduce the Total Fertiliry Rate (TFR). The IUD is an effective contraceptive device but can cause interference with the reproductive organs due to its presence in the uterus where the IUD is a foreign body for the uterus so that it causes many side effects for the acceptor, for example resulting in increased volume and length of menstruation (metroragia) caused by mechanical factors in the uterus. endometriosis due to a mismatch between the size of the IUD and the uterine cavity and possibly due to intra-uterine or ectopic pregnancies. The purpose of this study was to determine the factors associated with low use of intrauterine contraceptive devices (IUD) in women of childbearing age couples at Tiga Balata Health Center. The results of the study based on the results of the Chi-Sguare statistical test showed that there was a relationship between age and IUD use p value = 0.001 ≤ α (0.05), there was a relationship between education and IUD use p value = 0.006 ≤ α (0.05,) there was a relationship between knowledge and IUD use p value = 0.019≤ α (0.05), there is a relationship between the number of children and IUD use p value=0.004 ≤α(0.05), there is a relationship between the availability of equipment and IUD use p value=0.000 ≤ α (0.05 ), there is a relationship between the support of health workers and IUD use p value = 0.001≤ α (0.05), there is a relationship between family support and IUD use p value = 0.008 ≤ α (0.05).

Successful pregnancy in women with endometrial carcinoma

Endometrial cancer is the sixth most common cancer in women worldwide and fourth in Europe. Global estimates show rising incidence in both developed and developing countries. Standard surgical treatment leads to permanent loss of fertility. With current trends of reproductive-age women delaying childbearing, rising endometrial carcinoma incidence rates and a growing epidemic of obesity, research on conservative treatment remains a priority. Fertility-sparing treatment involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, both shown to be beneficial and safe in early-stage endometrial carcinoma. We present a case of a 40-year-old female with endometrial adenocarcinoma grade 1 diagnosed during infertility workup. After one year of levonorgestrel-releasing intrauterine devices and almost three years after initial diagnosis was made, pregnancy was achieved. Term elective C-section delivery was done and a healthy infant was born. Today, a 46-yearold female, with six years of disease-free survival, still opts for conservative treatment. Aim of this paper is to show how conservative management with steady follow up in highly motivated individuals could be a reliable option for females of reproductive age with endometrial malignancies. Concept of fertility-sparing treatment should give hope to patients with malignant disease and unfulfilled reproductive goals.

Contraceptive exposure associates with urinary tract infection risk in a cohort of reproductive-age women: a case control study

Purpose Although non-barrier contraception is commonly prescribed, the risk of urinary tract infections (UTI) with contraceptive exposure is unclear. Materials and methods Using data from Vanderbilt University Medical Centre’s deidentified electronic health record (EHR), women ages 18–52 were randomly sampled and matched based on age and length of EHR. This case-control analysis tested for association between contraception exposure and outcome using UTI-positive (UTI+) as cases and upper respiratory infection+ (URI+) as controls. Results 24,563 UTI + cases (mean EHR: 64.2 months; mean age: 31.2 years) and 48,649 UTI-/URI + controls (mean EHR: 63.2 months; mean age: 31.9 years) were analysed. In the primary analysis, UTI risk was statistically significantly increased for the oral contraceptive pill (OCP; OR = 1.10 [95%CI = 1.02–1.11], p ≤ 0.05), intrauterine device (IUD; OR = 1.13 [95%CI = 1.04–1.23], p ≤ 0.05), etonogestrel implant (Nexplanon®; OR = 1.56 [95% CI = 1.24–1.96], p ≤ 0.05), and medroxyprogesterone acetate injectable (Depo-Provera®; OR = 2.16 [95%CI = 1.99–2.33], p ≤ 0.05) use compared to women not prescribed contraception. A secondary analysis that included any non-IUD contraception, which could serve as a proxy for sexual activity, demonstrated a small attenuation for the association between UTI and IUD (OR = 1.09 [95%CI = 0.98–1.21], p = 0.13). Conclusion This study notes potential for a small increase in UTIs with contraceptive use. Prospective studies are required before this information is applied in clinical settings. Condensation Although non-barrier contraception is commonly prescribed, the risk of urinary tract infections (UTI) with contraceptive exposure is poorly understood. This large-cohort, case-control study notes potential for a small increase in UTIs with contraceptive use.