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Christensen T, Ostrowski S, McAllister A, Bynum B, Schapira MM, Sonalkar S. Patient Preferences for Immediate Compared With Delayed Postpartum Intrauterine Device Placement. Obstet Gynecol 2024:00006250-990000000-01100. [PMID: 38889434 DOI: 10.1097/aog.0000000000005647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/02/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To use choice-based conjoint survey methodology to evaluate patient values and decision making regarding immediate compared with delayed placement of postpartum intrauterine devices (IUDs). METHODS We conducted a cross-sectional study in which we surveyed 200 nonpregnant, parous patients. Participants chose between hypothetical postpartum IUDs varying in multiple attributes (hormonal or nonhormonal IUD type, placement timing, 1-year efficacy, expulsion risk, risk of lost strings, and malposition risk). The primary outcome was preference for immediate compared with delayed postpartum IUD placement and importance of placement timing relative to other attributes. Secondarily, we evaluated whether demographic and neighborhood characteristics were associated with timing preference and attribute importance. RESULTS We included 190 participants for analysis. Most participants (62.6%) preferred delayed placement. There was no significant difference in timing preference by race (P=.28) or block-level Area Deprivation Index score (P=.27). Patients who preferred immediate placement were more likely to have public insurance than private insurance (70.4% vs 29.6%, P=.04); however, the majority of patients (55.1%) with public insurance still preferred delayed placement. Attributes of IUD type, malposition risk, 1-year efficacy, and expulsion risk all had greater effects on patient decision making than placement timing. There was no difference in attribute importance by race (P=.30), Area Deprivation Index score (P=.88), or insurance type (P=.22). CONCLUSION Patients preferred the higher efficacy and lower complication rates of delayed postpartum IUD placement over the convenience of immediate placement. Insurance considerations may affect these timing preferences. There was no difference in attribute importance between demographic groups or based on neighborhood-level factors, indicating that, although both immediate and delayed postpartum IUD placement should be offered, counseling should not vary according to individual demographic characteristics.
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Affiliation(s)
- Theresa Christensen
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York; the Division of Complex Family Planning, Department of Obstetrics and Gynecology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania; and the DuPont Clinic, Washington, DC
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Liu SX, Dong XY. Using laparoscope to remove an ectopic intrauterine device in the anterior wall of urinary bladder: A case report. World J Clin Cases 2024; 12:3221-3225. [PMID: 38898866 PMCID: PMC11185367 DOI: 10.12998/wjcc.v12.i17.3221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/18/2024] [Accepted: 04/16/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND An intrauterine device (IUD) is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women. However, an IUD may cause complications due to placement time, intrauterine pressure and other factors. Ectopic IUDs are among the most serious complications. Ectopic IUDs are common in the myometrium and periuterine organs, and there are few reports of ectopic IUDs in the urinary bladder, especially in the anterior wall. CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography (CT) examination. The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain, accompanied by frequent urination, urgency, dysuria and other discomfort. Ultrasound examination revealed foreign bodies in the bladder cavity, with calculus on the surface of the foreign bodies. CT revealed a circular foreign body on the anterior wall of the urinary bladder, suggesting the possibility of an ectopic IUD. After laparoscopic exploration, an annular IUD was found in the anterior wall of urinary bladder, and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity. The IUD and calculus were successfully and completely removed. The patient recovered well after surgery. CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs. The IUD is located in the urinary bladder and requires early surgical treatment. The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer, the situation of complicated calculus, the situation of intravesical inflammation and medical technology and equipment.
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Affiliation(s)
- Shi-Xue Liu
- Department of Urology, Shapingba Hospital Affiliated to Chongqing University, Chongqing 400030, China
| | - Xing-You Dong
- Department of Urology, Shapingba Hospital Affiliated to Chongqing University, Chongqing 400030, China
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Hogmark S, Rydelius J, Envall N, Teleman P, Gemzell-Danielsson K, Kopp Kallner H. Placement of an intrauterine device within 48 hours after second-trimester medical abortion: a randomized controlled trial. Am J Obstet Gynecol 2024:S0002-9378(24)00627-6. [PMID: 38796039 DOI: 10.1016/j.ajog.2024.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND International guidelines recommend placement of intrauterine devices immediately after second-trimester medical abortion, but evidence concerning the optimal time for intrauterine device placement is lacking from clinical trials. OBJECTIVE This study aimed to investigate effectiveness, safety, and acceptability of intrauterine device placement within 48 hours, compared with placement at 2 to 4 weeks after second-trimester medical abortion. We hypothesized that intrauterine device placement within 48 hours would be superior compared with placement at 2 to 4 weeks after the abortion, in terms of the proportion of intrauterine device use after 6 months, with maintained safety and acceptability. STUDY DESIGN In this open-label, randomized, controlled, superiority trial, we recruited participants at 8 abortion clinics in Sweden. Eligible participants were aged ≥18 years, requesting medical abortion with gestation ≥85 days, and opting for use of a postabortion intrauterine device. Participants were randomized (1:1) to intrauterine device placement either within 48 hours of complete abortion (intervention) or after 2 to 4 weeks (control). Our primary outcome was self-reported use of an intrauterine device after 6 months. Secondary outcomes included expulsion rates, pain at placement, adverse events and complications, acceptability, and subsequent pregnancies and abortions. Differences in nonnormal continuous variables were analyzed with the Mann-Whitney U test, and differences in dichotomous variables with the chi-square or Fisher exact tests. A P value <.05 was considered statistically significant. Group differences are presented by modified intention-to-treat and per-protocol analyses. RESULTS Between January 2019 and June 2022, we enrolled 179 participants, of whom 90 were assigned to the intervention and 89 to the control arm. Enrollment was prematurely stopped after an interim analysis exceeded a predefined intrauterine device expulsion rate of 20%. According to modified intention-to-treat analysis, use of intrauterine device after 6 months was 50.7% (34/67) in the intervention group vs 71.6% (48/67) in the control group (proportion difference, 20.9%; 95% confidence interval, 4.4%-35.9%; P=.02). The intrauterine device expulsion rate was 30.1% (22/73) in the intervention group vs 2.9% (2/70; P<.001) in the control group. Other adverse events were rare and patient acceptability was high in both groups. CONCLUSION Intrauterine device placement within 48 hours after second-trimester medical abortion was nonsuperior in terms of the proportion of intrauterine device use after 6 months when compared with placement after 2 to 4 weeks. Placement within 48 hours after second-trimester abortion can be used in selected individuals after counseling on expulsion risk.
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Affiliation(s)
- Sara Hogmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden.
| | - Johanna Rydelius
- Department of Obstetrics and Gynecology, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Envall
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Pia Teleman
- Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Gynaecology and Obstetrics, Skåne University Hospital, Lund, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; World Health Organization Collaborating Centre for Research and Research Training in Human Reproduction, Karolinska University Hospital, Stockholm, Sweden, (j)Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology, University of Gothenburg, Gothenburg, Sweden
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Anjos FCQS, Marcelino AC, Espejo-Arce X, Pereira PDC, Barbosa PF, Juliato CT, Bahamondes L. Clinical Assessment of 3 Intrauterine Devices in Adolescent Girls: A Randomized Clinical Trial. J Pediatr Adolesc Gynecol 2024; 37:165-170. [PMID: 38113970 DOI: 10.1016/j.jpag.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
STUDY OBJECTIVE To assess clinical performance, bleeding pattern, dysmenorrhea, and satisfaction up to 1 year after placement of 3 types of intrauterine devices (IUDs) (TCu380A, levonorgestrel 52 mg, and levonorgestrel 19.5 mg) in adolescents METHODS: The study was a randomized trial with 318 adolescents allocated to the 3 IUDs. We assessed reasons for removal, continuation, menstrual patterns, dysmenorrhea, and satisfaction. RESULTS Participants aged (mean ± SD) 17.9 ± 1.4 years, with 80.8% being nulligravidae. After 1 year, 265 (83.3%) continued using the IUD; however, the continuation rate of TCu380A (75.4 ± 4.2) was lower than that of both the levonorgestrel 52-mg (88.6 ± 3.1) and 19.5-mg IUDs (86.8 ± 3.3), and bleeding/pain and expulsion were the main reasons for removal of the TCu380A IUD. The duration of menstruation was longer among the TCu380A IUD users (6.0 ± 2.0 days) than those using the levonorgestrel 52 mg (2.5 ± 3.9) and 19.5 mg (3.2 ± 3.2) devices, P < .001. Amenorrhea was reported by 49.5% and 37.8% users of the levonorgestrel 52-mg and 19.5-mg devices, respectively, P < .001. Dysmenorrhea was reported in 68.5% of all participants at the baseline; this was 67.9% of the TCu380A group and 33.3% and 36.0% of the levonorgestrel 52-mg and 19.5-mg IUD groups, respectively, P < .001. Satisfaction ranged from 80.7% in the TCu380A group to 97.8% in the levonorgestrel 52-mg group (P = .03). CONCLUSION The 3 IUDs are suitable for adolescents, with high contraceptive efficacies and rates of continuation within 1 year of use and high degrees of satisfaction. Users of the hormonal IUDs reported lower expulsion rates, more favorable menstrual patterns, and less dysmenorrhea compared with the TCu380A IUD.
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Affiliation(s)
- Fabiana C Q S Anjos
- Department of Obstetrics and Gynecology, University of Gurupi, Faculty of Medical Sciences, Gurupi, TO, Brazil
| | - Ana C Marcelino
- Department of Obstetrics and Gynecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Ximena Espejo-Arce
- Department of Obstetrics and Gynecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Paula da C Pereira
- Department of Obstetrics and Gynecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Priscila F Barbosa
- Department of Obstetrics and Gynecology, University of Gurupi, Faculty of Medical Sciences, Gurupi, TO, Brazil
| | - Cassia T Juliato
- Department of Obstetrics and Gynecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil.
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Araujo KG, Yoshida A, Juliato CRT, Sarian LO, Derchain S. Performance of a handheld point of care ultrasonography to assess IUD position compared to conventional transvaginal ultrasonography. EUR J CONTRACEP REPR 2024; 29:69-75. [PMID: 38651645 DOI: 10.1080/13625187.2024.2315231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/31/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To compare the performance of the abdominal handheld point-of-care ultrasonography (POCUS) Butterfly-iQ to gold standard transvaginal ultrasonography (US) in identifying the position of intrauterine devices (IUDs) in the hands of a medical doctor specialised in ultrasonography. METHODS In this diagnostic accuracy study, a single operator conducted abdominal POCUS followed by conventional transvaginal US. Seventy patients utilising copper or hormonal IUDs were assessed between June 2021 and October 2022. IUDs were categorised as entirely within the uterine cavity or malpositioned. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for detecting malpositioned IUDs, with conventional US results serving as the reference standard. Concordance rate and Kappa coefficient were computed to assess the agreement between the two ultrasound modalities. RESULTS Among the 70 patients, 46 (65.7%) used copper IUDs, and 24 (34.3%) used hormonal IUDs. Conventional transvaginal US showed IUDs entirely within the uterine cavity in 56 (80%) patients and 14 (20%) IUDs were malpositioned. Of the 14 malpositioned IUDs seen by conventional US, POCUS identified 13 demonstrating a sensitivity of 92.9% (66.1-99.8). Of the 56 IUDs entirely within the uterine cavity shown by conventional US, only two cases were considered malpositioned by POCUS demonstrating a specificity of 96.4% (87.7-99.6). The concordance rate was 95.7%, and the Kappa value was 0.87 in differentiating between IUDs entirely within the uterine cavity and those that were malpositioned. CONCLUSION Abdominal POCUS using Butterfly-iQ, when administered by an imaging specialist, exhibited excellent performance in confirming IUDs entirely within the uterine cavity.
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Affiliation(s)
- K G Araujo
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
- Section of Ultrasonography, Prof. José Aristodemo Pinotti Women's Hospital, CAISM, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - A Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - C R T Juliato
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - L O Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
| | - S Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil
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Amaya SI, Wolff SF, Ross M, French VA. Intrauterine devices are a safe form of contraception in users with solid organ transplantation: A single-center experience. Transpl Infect Dis 2023:e14220. [PMID: 38160328 DOI: 10.1111/tid.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Patients who undergo organ transplantation are advised to use contraception for health optimization, yet limited data exists on safe contraceptive options for this population. This study investigates the infection risk of intrauterine devices (IUDs) in patients who have received a solid organ transplant by evaluating the incidence of pelvic inflammatory disease (PID). We performed a retrospective chart review of subjects with a solid organ transplant who used an IUD between the years of January 2007 to February 2021. We included subjects ages 22-55 years at the time of IUD placement. We abstracted demographic information, transplant type, IUD type, immunosuppressive medications, screening for sexually transmitted infections, and diagnosis of PID. We identified 29 subjects that met the inclusion criteria. Six subjects had a copper IUD (21%) and 23 had a levonorgestrel IUD (79%). The most common organ transplanted was a kidney (n = 10) and liver (n = 10) while five subjects had multiple organs transplanted. Twenty-five (86.2%) subjects took immunosuppressive medications at the time of IUD insertion. Twenty-four (82.8%) patients had their IUD placed after transplantation. The average time of IUD use was 2.5 years. . In our study of IUD use in patients with solid organ transplantation, no patients developed PID. IUDs are a safe contraceptive option for immunosuppressed transplant patients.
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Affiliation(s)
- Stephanie I Amaya
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Sharon F Wolff
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Meghan Ross
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Valerie A French
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
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Thaxton L, Hofler LG. Prenatal Contraceptive Counseling. Obstet Gynecol Clin North Am 2023; 50:509-523. [PMID: 37500213 DOI: 10.1016/j.ogc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Pregnancy care should include open discussions with patients about their ideal family size and pregnancy spacing. With these patient-voiced goals in mind, clinicians should review contraceptive tools to meet these goals, including special considerations after birth. For patients that desire contraception, it is important to prioritize the provision of their chosen method as soon as safely possible and desired after birth.
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Affiliation(s)
- Lauren Thaxton
- Department of Women's Health, Dell Medical School, University of Texas, 2508 Greenlawn Parkway, Austin, TX 78757, USA
| | - Lisa G Hofler
- Department of Obstetrics & Gynecology, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC10 5580, Albuquerque, NM 87131, USA.
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Steiner ML, Mendes JL, Strufaldi R, Carneiro M, Giovanelli SA, da Silva MH. Epidemiological profile and effectiveness of immediate postpartum contraception in Brazilian women. Front Glob Womens Health 2023; 4:1052224. [PMID: 37637759 PMCID: PMC10450033 DOI: 10.3389/fgwh.2023.1052224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose To determine the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum period and compare the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC. Methods We analyzed the epidemiological profile of women who inserted copper intrauterine device (Cu-IUD), subdermal etonogestrel implant (ENG), tubal ligation (TL), depot medroxyprogesterone acetate (DMPA) or did not choose a contraceptive method (NCM) in the immediate postpartum. The data was collected by electronic medical records of postpartum women assisted at the University Hospital of São Bernardo do Campo (HMU-SBC) from January 2016 to December 2020. Also, we compared the contraceptive effectiveness of Cu-IUD and DPMA with non-MAC by identifying women who returned for second delivery during the study period and analyzing the contraceptive method chosen in the first hospitalization. Then the pregnancies interval and the sociodemographic characteristics were analyzed according to contraceptive method type. Results Data from 20,896 women were collected, of which 8,183 (39%) opted for Cu-IUD, 559 (2.5%) DPMA, and 10,989 (52.5%) chose not to use contraception at the time of hospital discharge. When comparing these groups, women in the DPMA were younger (26.5 ± 7.3, p < 0.05), and NCM showed women with a lower number of pregnancies (2.2 ± 1.3, p < 0.05). Subjects in the TL group (4.6%) had the higher number of pregnancies (3.8 ± 1.2, p < 0.05), and ENG group, the highest number of miscarriages (1.6 ± 1.3, p < 0.05). Of those women who returned pregnant, 5.5% belonged to the DPMA group, 6% to the NCM group, and 2.3% to the Cu-IUD. Conclusions Women who opted for Cu-IUD insertion were younger, had more pregnancies and vaginal delivery when compared to those who did not choose a method. Of those women who returned, the minority opted for Cu-IUD compared to those that opted for DPMA or no method.
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Affiliation(s)
- Marcelo Luis Steiner
- Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Julia Lorenzini Mendes
- Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Rodolfo Strufaldi
- Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Monica Carneiro
- Department of Gynecology and Obstetrics, Hospital Municipal Universitário de São Bernardo, São Bernardo do Campo, Brazil
| | - Silvana Aparecida Giovanelli
- Department of Gynecology and Obstetrics, Hospital Municipal Universitário de São Bernardo, São Bernardo do Campo, Brazil
| | - Mariliza Henrique da Silva
- Department of Gynecology and Obstetrics, Hospital Municipal Universitário de São Bernardo, São Bernardo do Campo, Brazil
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Averbach S, Vaida F, Hofler LG. IUD Expulsion Rates After Early Postpartum vs Interval Placement-Reply. JAMA 2023; 330:285. [PMID: 37462706 DOI: 10.1001/jama.2023.8893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego
| | - Florin Vaida
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - Lisa G Hofler
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
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10
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Skoczek AC, Sylvester J. Cervically Embedded Fragment of an Intrauterine Device in a Patient with a Bicornuate Uterus: A Case Report and Review of Current Management Strategies. Cureus 2023; 15:e40938. [PMID: 37496525 PMCID: PMC10368404 DOI: 10.7759/cureus.40938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
Intrauterine devices (IUDs) have become one of the most frequently used forms of long-acting reversible contraception (LARC) in women of childbearing age. While complications are generally considered to be minimal, they can occur during the insertion, during use, or upon removal. Uterine anomalies, such as a bicornuate uterus, can increase the risk of complications during all stages. Here, we describe a case of a patient with a bicornuate uterus who had a levonorgestrel IUD in place for five years before she experienced a dislodging of the IUD, fragmentation upon attempted removal, and ultimately required a hysteroscopy to remove an embedded fragment from the endocervical canal. Due to the limited reporting on fragmented IUDs, further studies will be required to assess the optimal management. While symptomatic patients should have the fragment removed, asymptomatic patients should have their individual history and desire for future pregnancy weighed against the risk and benefits of treatment.
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Affiliation(s)
- Alexandra C Skoczek
- Medicine, Edward Via College of Osteopathic Medicine - Auburn, Huntsville, USA
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Durante JC, Sims J, Jarin J, Gold MA, Messiah SE, Francis JKR. Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence. Adolesc Health Med Ther 2023; 14:97-114. [PMID: 37181329 PMCID: PMC10167958 DOI: 10.2147/ahmt.s374268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.
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Affiliation(s)
- Julia C Durante
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jessica Sims
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jason Jarin
- Children’s Health System of Texas, Dallas, TX, USA
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melanie A Gold
- Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
- Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Rosa Bolling K, Wahdan Y, Warnock N, Lott J, Schoendorf J, Pisa F, Gomez-Espinosa E, Kistler K, Maiese B. Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:e1. [PMID: 36600467 PMCID: PMC10176355 DOI: 10.1136/bmjsrh-2022-201579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/25/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Intrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden. METHODS This systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type. English language articles indexed in MEDLINE, Embase, and Cochrane from January 2010-October 2021 were included. RESULTS 133 articles met the inclusion criteria (46% interventional studies; 54% observational; n=87 from lower-income countries; n=46 from higher-income countries). PPIUD use was low in higher-income countries (6/10 000 US deliveries in 2013-2016) and varied widely in lower-income countries (2%-46%). Across both higher- and lower-income countries, in most studies (79%), >80% of women with PPIUDs had an IUD in place by 3 months; at 6 and 12 months, 76% and 54% of included studies reported that >80% of women had an IUD in place; reason for discontinuation was infrequently reported. Pregnancies were rare (96 pregnancies across 12 191 women from 37 studies reporting data) and were generally unrelated to device failure, but rather occurred in women no longer using a PPIUD. Expulsions occurred mainly in the early outpatient period and ranged widely (within 3 months: 0-41%). Abnormal bleeding, infections, or perforations were rare. CONCLUSIONS PPIUDs are safe and effective. Long-term follow-up data are limited. Future research elucidating reasons underlying lack of PPIUD use is warranted.
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Affiliation(s)
| | | | | | - Jason Lott
- Bayer Healthcare, Whippany, New Jersey, USA
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Averbach S, Kully G, Hinz E, Dey A, Berkley H, Hildebrand M, Vaida F, Haider S, Hofler LG. Early vs Interval Postpartum Intrauterine Device Placement: A Randomized Clinical Trial. JAMA 2023; 329:910-917. [PMID: 36943214 PMCID: PMC10031390 DOI: 10.1001/jama.2023.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/05/2023] [Indexed: 03/22/2023]
Abstract
Importance 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. Objective To determine expulsion rates for IUDs placed early postpartum compared with those placed at the standard interval 6-week visit. Design, Setting, and Participants 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. Interventions Early postpartum IUD placement, at 2 to 4 weeks postpartum, vs standard interval placement 6 to 8 weeks postpartum. Main Outcomes and Measures 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. Results 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. Conclusions and Relevance 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. Trial Registration ClinicalTrials.gov Identifier: NCT03462758.
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Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, La Jolla
- Center on Gender Equity and Health, University of California, San Diego, La Jolla
| | - Gennifer Kully
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, La Jolla
- Center on Gender Equity and Health, University of California, San Diego, La Jolla
| | - Erica Hinz
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of Illinois at Chicago
| | - Arnab Dey
- Center on Gender Equity and Health, University of California, San Diego, La Jolla
| | - Holly Berkley
- Department of Gynecologic Surgery and Obstetrics, Naval Medical Center, San Diego, California
| | - Marisa Hildebrand
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, La Jolla
| | - Florin Vaida
- School of Public Health, Division of Biostatistics, University of California, San Diego, La Jolla
| | - Sadia Haider
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of Chicago, Chicago, Illinois
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, Rush University, Chicago, Illinois
| | - Lisa G. Hofler
- Department of Obstetrics and Gynecology, Division of Complex Family Planning, University of New Mexico, Albuquerque
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FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Jacapenga RR, Surita F, Bahamondes L, Juliato CRT. Acceptance rate of post-placental plac ement of intrauterine devices during the SARS-CoV-2 (COVID-19) pandemic. EUR J CONTRACEP REPR 2023; 28:92-96. [PMID: 36803168 DOI: 10.1080/13625187.2023.2173004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To evaluate the acceptance rate of post-placental intrauterine device (PPIUD) placement during the SARS-CoV-2 (COVID-19) pandemic and to to assess factors associated with PPIUD acceptance. METHODS A cross-sectional study was conducted between August 2020 and August 2021. PPIUDs were offered to women scheduled for caesarean delivery or admitted in labour at the Women's Hospital of the University of Campinas. The study compared women according to whether they accepted or did not accept the IUD placement. The factors associated with PPIUD acceptance were analysed through bivariate and multiple logistic regression analyses. RESULTS We enrolled 299 women (15.9% of the deliveries that occurred during study period), aged 26.8 ± 6.5 years; 41.8% were White, almost one third were primiparous, and 155/299 (51.8%) had a vaginal delivery. The PPIUD acceptance rate was 65.6%. The principal reason for refusal was the desire for another contraceptive (41.8%). Women with the highest likelihood of accepting a PPIUD were younger (<30 years old has 1.7 more likely or 74% greater), those without a partner (3.4 times more likely) and those after vaginal delivery (1.7 times more likely or 69% greater). CONCLUSION The COVID-19 does not affected the PPIUD placement. PPIUD is a viable alternative during crisis in which women has difficult to access health services. Younger women, those without a partner and after vaginal delivery were more likely to accept a PPIUD during the COVID-19 pandemic.
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Affiliation(s)
- Rodolfo R Jacapenga
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
| | - Fernanda Surita
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP) Faculty of Medical Sciences, Campinas, Brazil
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Nahas G, Magalhães C, Bueloni-Dias F, Nahas E, Borges V. Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:31-37. [PMID: 36878250 PMCID: PMC10021007 DOI: 10.1055/s-0042-1759628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. MATERIALS AND METHODS In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. RESULTS There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. CONCLUSION Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.
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Affiliation(s)
- Georgia Nahas
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Claudia Magalhães
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Flavia Bueloni-Dias
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Eliana Nahas
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
| | - Vera Borges
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil
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Herculano TB, Surita FG, Juliato CRT, Rehder PM. Comparison between two methods of the immediate post-placental insertion of copper intrauterine device in vaginal birth-a protocol for a randomized clinical trial. Trials 2022; 23:1053. [PMID: 36575504 PMCID: PMC9793389 DOI: 10.1186/s13063-022-07041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Ensuring effective and long-term contraception in the immediate postpartum period is an effective strategy for reducing unplanned pregnancies. In the meantime, the intrauterine device (IUD) is an excellent option. The aim of our study was to evaluate the best way to insert post-placental IUDs in the immediate postpartum period. Discomfort during insertion, expulsion rate, uterine perforation rate, and proper positioning 40-60 days postpartum will be analyzed. METHODS Randomized, controlled, open clinical trial. The study group will be composed of women between 18 and 43 years old who are admitted for vaginal birth at the Women's Hospital of the State University of Campinas and who wish to use the IUD as a contraceptive method. The sample will be randomized into two insertion groups: manual and forceps. To calculate the sample size, the method of comparing the proportion between 2 groups was used, setting the level of significance alpha at 5% (alpha=0.05) and the power of the sample at 80% (beta=0.20). Based on the results, it was estimated that a sample of n=186 women (n=93 with manual insertion and n=93 with forceps) would be representative for comparison of expulsion between the 2 groups. All participants will undergo a postpartum consultation 40-60 days after birth with transvaginal ultrasound to assess the proper placement of the IUD. DISCUSSION Insertion of an IUD in the immediate postpartum period has been considered a good option to increase coverage and access to contraception, and its benefit outweighs the inconvenience of a higher expulsion rate. TRIAL REGISTRATION This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 50497321.4.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC) (number RBR-4j62jv6). This is the first version of the study protocol approved on 11/12/2021 prior to the start of participant recruitment.
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Affiliation(s)
- Thuany Bento Herculano
- grid.411087.b0000 0001 0723 2494Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP 101 Brazil
| | - Fernanda Garanhani Surita
- grid.411087.b0000 0001 0723 2494Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP 101 Brazil
| | - Cássia Raquel Teatin Juliato
- grid.411087.b0000 0001 0723 2494Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP 101 Brazil
| | - Patrícia Moretti Rehder
- grid.411087.b0000 0001 0723 2494Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Av. Alexander Fleming, Campinas, SP 101 Brazil
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Aemro E, Abdo M, Deksisa A, Alemayehu A, Mulatu T, Ahmed Hassen T, Molla A, Teji Roba K. Immediate postpartum intrauterine contraceptive device utilization and associated factors among women who gave birth in public health facilities of Adama town, Ethiopia. SAGE Open Med 2022; 10:20503121221142412. [PMID: 36568343 PMCID: PMC9768822 DOI: 10.1177/20503121221142412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives The evidence on utilization of immediate postpartum intrauterine contraceptive devices (IPPIUCDs) and its associated factors are limited in Ethiopia. Hence, this study intended to assess IPPIUCD utilization and related factors among women who gave birth in Adama town public hospitals, Ethiopia. Method A facility-based cross-sectional study was done among 493 postpartum mothers at selected government health facilities in Adama town from January 20 to February 20, 2021. All women who gave birth in selected government health facilities and within 48 h of postpartum were included in the study. Data were collected using an interviewer-administered questionnaire. Logistic regression models were used to identify the factors associated with IPPIUCD utilization. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were calculated to measure the strength of association and statistical significance was declared at p < 0.05. Result In this study, 22.1% (95% CI: 17.3-25.2) of the mothers used IPPIUCDs within 48 h of giving birth. Having three or more children (AOR = 4.18, 95% CI: 1.79-9.79), having no desire to have another child (AOR = 3.9, 95% CI: 1.86-8.17), counseling after delivery (AOR = 3.1 95% CI: 1.52-6.34), and having good knowledge about PPIUCD (AOR = 3.82, 95% CI: 1.94-7.49) were significantly associated with IPPIUCD utilization. Conclusion The utilization of IPPIUCD in this study was low. Strategies to raise pregnant mothers' awareness of IPPIUCD through mass media, and integrating standard counseling on immediate postpartum intrauterine device (IPPIUD) during antenatal care, and the immediate postpartum period are required to improve IPPIUD utilization.
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Affiliation(s)
| | - Meyrema Abdo
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
| | - Alem Deksisa
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
| | - Afework Alemayehu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia,Afework Alemayehu, School of Nursing and Midwifery, College of Health and Medical science, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tahir Ahmed Hassen
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Alemayehu Molla
- College of Health and Medical Science, Diredawa University, Diredawa, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Long-Acting Reversible Contraception. Obstet Gynecol 2022; 140:883-897. [DOI: 10.1097/aog.0000000000004967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
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Wojcik N, Watkins L, Nugent R. Patient acceptability, continuation and complication rates with immediate postpartum levonorgestrel intrauterine device insertion at caesarean section and vaginal birth. Aust N Z J Obstet Gynaecol 2022; 62:773-778. [PMID: 35451065 PMCID: PMC9790316 DOI: 10.1111/ajo.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/05/2022] [Accepted: 04/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Immediate postpartum long-acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. AIMS To assess self-reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). MATERIALS AND METHODS Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates. Secondary outcomes were reason for discontinuation, patient-reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data. RESULTS One hundred and ninety-three women had a hormonal IUD inserted and 143 consented to involvement (CS n = 79; VB n = 64). Six and 12 months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72; 95% CI 1.07-6.90; P = 0.036). There were 60.8% of women post-CS and 56.3% of women post-VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow-up with their GP (89.5%). CONCLUSION Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts.
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Affiliation(s)
- Natasha Wojcik
- Department of Obstetrics and GynaecologySunshine Coast University Hospital and Health ServiceSunshine CoastQueenslandAustralia
| | - Leah Watkins
- Department of Obstetrics and GynaecologySunshine Coast University Hospital and Health ServiceSunshine CoastQueenslandAustralia
| | - Rachael Nugent
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
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Effect of Mirena Intrauterine Device on Endometrial Thickness, Quality of Life Score, and Curative Effect in Patients with Perimenopausal Abnormal Uterine Bleeding. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5648918. [PMID: 36238482 PMCID: PMC9553334 DOI: 10.1155/2022/5648918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/25/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
Objective To study the effect of Mirena intrauterine device (IUD) on endometrial thickness, life quality score, and curative effect in patients with perimenopausal abnormal uterine bleeding. Methods Eighty patients with perimenopausal abnormal uterine bleeding cured from January 2020 to December 2021 were enrolled as the object of study. According to random number table, the patients were classified into the study (n = 40) and control (n = 40) groups. The control cases were cured with medroxyprogesterone. The study cases were cured with Mirena IUD. The effective rate of clinical therapies was evaluated after 3 months of treatment. The endometrial thickness, menstrual volume score, and life quality score (WHOQOL-BREF) was measured after 1 month, 2 months, and 3 months of treatment. Results The effective rate of patients with Mirena IUD for 3 months was higher compared to the control group (P < 0.05). The endometrial thickness and menstrual volume scores of study cohort after 1 month, 2 months, and 3 months following treatment were remarkably lower than those before treatment (P < 0.05) and were considerably lower than those of control cohort (P < 0.05). The hemoglobin level of the studied cases after 1 month, 2 months, and 3 months after therapy was remarkably upregulated (P < 0.05) and was greatly higher compared to the controlled cases (P < 0.05). After 3-month treatment, the WHOQOL-BREF score of the study group was higher compared to the control group (P < 0.05). Conclusion The Mirena IUD is far more effective in the treatment of perimenopausal abnormal uterine bleeding and is helpful in reducing the thickness of the endometrium. Patients' menstrual flow can be controlled, and anemia can be corrected; thus, patients improve their quality of life and health status and can be considered for further promotion.
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Tilahun T, Tadesse A, Oljira R. Spontaneously Expelled Lippes Loop IUD After 40 Years of Use: A Case Report and Review of the Literature. Int Med Case Rep J 2022; 15:373-377. [PMID: 35899089 PMCID: PMC9309274 DOI: 10.2147/imcrj.s374565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Intrauterine devices are a widely used method of contraception worldwide. These devices are reliable, cost-effective, long-acting, and reversible. Their placement in the uterus is usually simple and safe. Forgotten IUDs carry some complications and can adversely affect the health of women. Therefore, appropriate counseling during insertion and timely removal is crucial. Case Summary We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. Speculum exam showed part of loop at external cervical os. The loop was easily removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days. Conclusion In the absence of embedment of an IUD into the uterine wall or uterine perforation, spontaneous expulsion of an IUD after prolonged use is possible.
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Affiliation(s)
- Temesgen Tilahun
- Department of Obstetrics & Gynecology, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Correspondence: Temesgen Tilahun, Department of Obstetrics & Gynecology, Institute of Health Sciences, Wollega University, P.O Box 395, Nekemte, Ethiopia, Tel +251912057186, Email
| | - Asfaw Tadesse
- Department of Obstetrics & Gynecology, Nekemte Specialized Hospital, Nekemte, Ethiopia
| | - Rut Oljira
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Reed SD, Zhou X, Ichikawa L, Gatz JL, Peipert JF, Armstrong MA, Raine-Bennett T, Getahun D, Fassett MJ, Postlethwaite DA, Shi JM, Asiimwe A, Pisa F, Schoendorf J, Saltus CW, Anthony MS. Intrauterine device-related uterine perforation incidence and risk (APEX-IUD): a large multisite cohort study. Lancet 2022; 399:2103-2112. [PMID: 35658995 DOI: 10.1016/s0140-6736(22)00015-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Reports of perforation risk related to intrauterine devices (IUDs) inserted immediately post partum and among non-post-partum individuals are scarce, and previous studies with only 12-month follow-ups underestimate the risk. Breastfeeding at IUD insertion and insertion within 36 weeks post partum have been associated with increased risk of uterine perforation. The aim of these analyses was to compare the incidence and risks of IUD-related uterine perforations by non-post-partum and post-partum intervals at IUD insertion, and among post-partum individuals, to assess the impact of breastfeeding on these outcomes. METHODS We did a multisite cohort study in the USA, using electronic health records (EHR). Study sites were three health-care systems and a site that used data from a health-care information exchange. The study population included individuals who were aged 50 years or younger and had an IUD insertion between Jan 1, 2001, and April 30, 2018. Individuals were excluded if they had not been in the health-care system for at least 12 months before IUD insertion. The primary outcome for this analysis was any IUD-related uterine perforation diagnosis for the first IUD insertion in this time period. Both complete and partial IUD-related perforations were identified. Chart abstraction was done to validate EHR-based algorithms or confirm perforations. The crude rate and cumulative incidence of uterine perforation were evaluated by non-post-partum and post-partum intervals at IUD insertion in the full cohort, and by breastfeeding status in a subcohort of post-partum individuals. Cox models estimated crude and adjusted hazard ratios (aHRs). FINDINGS Data from 326 658 individuals in the full cohort and 94 817 individuals in the post-partum subcohort were analysed. In the full cohort, we identified 1008 uterine perforations (51·2% complete), with the 5-year cumulative incidence being the lowest in the non-post-partum group (0·29%, 95% CI 0·26-0·34). The aHR for the post-partum interval relative to non-post partum ranged from 2·73 (95% CI 1·33-5·63; 0 to 3 days post partum) to 6·71 (4·80-9·38; 4 days to ≤6 weeks post partum). The post-partum subcohort of individuals with breastfeeding information had 673 uterine perforations (62% complete), with a 5-year cumulative incidence of 1·37% (95% CI 1·24-1·52) and an increased risk with breastfeeding (aHR 1·37, 95% CI 1·12-1·66). INTERPRETATION Although the risk for uterine perforation with IUD insertion 4 days to 6 weeks or less post partum is nearly seven times that of insertion non-post partum, perforation remains an incredibly rare event for all clinical time points. Despite a slight increased risk of perforation with breastfeeding at IUD insertion, the benefits of breastfeeding and effective contraception generally outweigh risks and should have little clinical impact. Therefore, IUD insertion timing should be based on individual desire for IUD contraception and patient convenience to assure an IUD insertion can occur. Careful follow-up of individuals at higher risk of uterine perforation is warranted. FUNDING Bayer AG.
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Affiliation(s)
- Susan D Reed
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA.
| | - Xiaolei Zhou
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Mary Anne Armstrong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Health Systems Science at the Kaiser Permanente, Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Darios Getahun
- Department of Health Systems Science at the Kaiser Permanente, Bernard J Tyson School of Medicine, Pasadena, CA, USA; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Michael J Fassett
- Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Jiaxiao M Shi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Post-Placental Intrauterine Device Insertion in Brazilian Adolescents: Clinical Outcomes at 12 Months. J Pediatr Adolesc Gynecol 2022; 35:336-340. [PMID: 34737030 DOI: 10.1016/j.jpag.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To assess the acceptability, expulsion and continuation rates, satisfaction, and complications associated with post-placental intrauterine device insertion (PPIUDI) in Brazilian adolescents DESIGN: Prospective cohort SETTING: A single public, tertiary teaching hospital PARTICIPANTS: Adolescents (≤ 19 years) giving birth by vaginal delivery or cesarean section INTERVENTION: PPIUDI MAIN OUTCOME MEASURES: Primary outcomes were PPIUDI acceptability, expulsion, continuation, and user satisfaction. Secondary outcomes were changes in menstrual bleeding and pain, infection, uterine perforation, and repeat pregnancy up to 12 months after PPIUDI. RESULTS Of 1710 adolescents who delivered during the study period, 294 accepted PPIUDI (acceptability 17.2%). There were no cases of infection or uterine perforation among the 91 adolescents who completed the 12-month follow-up. Overall expulsion rate was 28.6%, and most cases (54%) occurred in the first 6 weeks after insertion. At 12 months, 85.7% of users were satisfied with the method, and continuation rate was 69.2%. At the end of 12 months, there were no repeat pregnancies among the adolescents who remained with the device in place. CONCLUSION PPIUDI can be an effective and safe method to reduce repeat unplanned pregnancies in adolescents who have just given birth.
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Averbach S, Hofler L. Long-Acting Reversible Contraception With Contraceptive Implants and Intrauterine Devices. JAMA 2022; 327:2013-2014. [PMID: 35522320 DOI: 10.1001/jama.2022.5448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego
- Center on Gender Equity and Health, University of California, San Diego
| | - Lisa Hofler
- Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque
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Bach S, Heavey E. How NPs can eliminate practice barriers to intrauterine device use. Nurse Pract 2022; 47:22-30. [PMID: 35470331 DOI: 10.1097/01.npr.0000827120.41973.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Barriers to intrauterine device use include cost, absence of qualified providers, the lack of simplified insertion protocols, cultural hesitation, and misconceptions of appropriateness of use. This article outlines how NPs can eliminate practice barriers to intrauterine device use and prevent unintended pregnancy.
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Gatz JL, Armstrong MA, Postlethwaite D, Raine-Bennett T, Chillemi G, Alabaster A, Merchant M, Reed SD, Ichikawa L, Getahun D, Fassett MJ, Shi JM, Xie F, Chiu VY, Im TM, Takhar HS, Wang J, Saltus CW, Ritchey ME, Asiimwe A, Pisa F, Schoendorf J, Wahdan Y, Zhou X, Hunter S, Anthony MS, Peipert JF. Association between intrauterine device type and risk of perforation and device expulsion: results from the Association of Perforation and Expulsion of Intrauterine Devices study. Am J Obstet Gynecol 2022; 227:57.e1-57.e13. [PMID: 35395215 DOI: 10.1016/j.ajog.2022.03.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intrauterine devices, including levonorgestrel-releasing and copper devices, are highly effective long-acting reversible contraceptives. The potential risks associated with intrauterine devices are low and include uterine perforation and device expulsion. OBJECTIVE This study aimed to evaluate the risk of perforation and expulsion associated with levonorgestrel-releasing devices vs copper devices in clinical practice in the United States. STUDY DESIGN The Association of Perforation and Expulsion of Intrauterine Devices study was a retrospective cohort study of women aged ≤50 years with an intrauterine device insertion during 2001 to 2018 and information on intrauterine device type and patient and medical characteristics. Of note, 4 research sites with access to electronic health records contributed data for the study: 3 Kaiser Permanente-integrated healthcare systems (Northern California, Southern California, and Washington) and 1 healthcare system using data from a healthcare information exchange in Indiana (Regenstrief Institute). Perforation was classified as any extension of the device into or through the myometrium. Expulsion was classified as complete (not visible in the uterus or abdomen or patient reported) or partial (any portion in the cervix or malpositioned). We estimated the crude incidence rates and crude cumulative incidence by intrauterine device type. The risks of perforation and expulsion associated with levonorgestrel-releasing intrauterine devices vs copper intrauterine devices were estimated using Cox proportional-hazards regression with propensity score overlap weighting to adjust for confounders. RESULTS Among 322,898 women included in this analysis, the incidence rates of perforation per 1000 person-years were 1.64 (95% confidence interval, 1.53-1.76) for levonorgestrel-releasing intrauterine devices and 1.27 (95% confidence interval, 1.08-1.48) for copper intrauterine devices; 1-year and 5-year crude cumulative incidence was 0.22% (95% confidence interval, 0.20-0.24) and 0.63% (95% confidence interval, 0.57-0.68) for levonorgestrel-releasing intrauterine devices and 0.16% (95% confidence interval, 0.13-0.20) and 0.55% (95% confidence interval, 0.44-0.68) for copper intrauterine devices, respectively. The incidence rates of expulsion per 1000 person-years were 13.95 (95% confidence interval, 13.63-14.28) for levonorgestrel-releasing intrauterine devices and 14.08 (95% confidence interval, 13.44-14.75) for copper intrauterine devices; 1-year and 5-year crude cumulative incidence was 2.30% (95% confidence interval, 2.24-2.36) and 4.52% (95% confidence interval, 4.40-4.65) for levonorgestrel-releasing intrauterine devices and 2.30% (95% confidence interval, 2.18-2.44) and 4.82 (95% confidence interval, 4.56-5.10) for copper intrauterine devices, respectively. Comparing levonorgestrel-releasing intrauterine devices with copper intrauterine devices, the adjusted hazard ratios were 1.49 (95% confidence intervals, 1.25-1.78) for perforation and 0.69 (95% confidence intervals, 0.65-0.73) for expulsion. CONCLUSION After adjusting for potential confounders, levonorgestrel-releasing intrauterine devices were associated with an increased risk of uterine perforation and a decreased risk of expulsion relative to copper intrauterine devices. Given that the absolute numbers of these events are low in both groups, these differences may not be clinically meaningful.
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Affiliation(s)
| | | | | | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
| | - Giulia Chillemi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Amy Alabaster
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Maqdooda Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Darios Getahun
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael J Fassett
- Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA; Department of Clinical Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
| | - Jiaxiao M Shi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Fagen Xie
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Vicki Y Chiu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa M Im
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Harpreet S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jinyi Wang
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | | | - Mary E Ritchey
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | | | | | | | | | - Xiaolei Zhou
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | - Shannon Hunter
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
| | - Mary S Anthony
- Research Triangle Institute Health Solutions, Research Triangle Park, NC
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J. Effectiveness, safety and overall satisfaction of early postpartum placement of hormonal IUD compared with standard procedure: An open-label, randomized, multicenter study. Acta Obstet Gynecol Scand 2022; 101:424-430. [PMID: 35141886 PMCID: PMC9564423 DOI: 10.1111/aogs.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this open-label, randomized controlled, non-inferiority, multicenter study we aimed to study the risk of termination of pregnancy within 1 year postpartum, the safety profile and patient acceptability after early postpartum insertion of a hormonal intrauterine device (LNG-IUS, Mirena®) compared with standard placement 6-8 weeks postpartum. MATERIAL AND METHODS April 2018 to January 2020 women with uncomplicated vaginal delivery at four urban birth centers in Sweden, were randomized to either early placement within 48 h after delivery (early group) or standard placement 6-8 weeks postpartum (standard group) of a hormonal intrauterine device. The main outcome measure was the proportion of terminations of pregnancies in each group during the first year after placement of the intrauterine device. Registration EudraCT database no. 2017-001945-29. RESULTS The study was prematurely stopped according to the protocol due to an expulsion rate >20% in the early group. No pregnancies occurred. Fifty-two women were randomized to early and 49 women to standard insertion. In the early group, 23/52 (44.2%) of the intrauterine devices were expelled. After expulsion, 10 women chose to have another hormonal intrauterine device placed but still significantly fewer women (39/52, 75%, p = 0.22) in the early group used the hormonal intrauterine device method at study completion. No expulsions occurred in the standard group, but 5/49 (10.2%) requested removal and 41/49 (83.7%, p = 0.22) had used the hormonal intrauterine device method continuously for 1 year. CONCLUSIONS Early hormonal intrauterine device insertion after vaginal delivery is associated with high expulsion rates. Despite this, a high continuation rate of the hormonal intrauterine device method is seen among women once choosing the method. In the light of high continuation rates, the advantages of early insertion could balance the risk of expulsion for well-informed women.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Linköping, Sweden
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Henkel A, Blumenthal PD. Missing strings following immediate postpartum IUD placement. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:152-155. [PMID: 35277465 DOI: 10.1136/bmjsrh-2021-201400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Andrea Henkel
- Department of Obstetrics & Gynecology, Division of Family Planning Services & Research, Stanford University, Stanford, California, USA
| | - Paul D Blumenthal
- Department of Obstetrics & Gynecology, Division of Family Planning Services & Research, Stanford University, Stanford, California, USA
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Rodriguez MI, Skye M, Samandari G, Darney BG. Timing of postpartum long acting, reversible contraception was not associated with 12-month removal rates in a large Medicaid sample. Contraception 2022; 113:49-56. [DOI: 10.1016/j.contraception.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/02/2022] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
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Armstrong MA, Raine-Bennett T, Reed SD, Gatz J, Getahun D, Schoendorf J, Postlethwaite D, Fassett MJ, Peipert JF, Saltus CW, Merchant M, Alabaster A, Zhou X, Ichikawa L, Shi JM, Chiu VY, Xie F, Hunter S, Wang J, Ritchey ME, Chillemi G, Im TM, Takhar HS, Pisa F, Asiimwe A, Anthony MS. Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion. JAMA Netw Open 2022; 5:e2148474. [PMID: 35226086 PMCID: PMC8886522 DOI: 10.1001/jamanetworkopen.2021.48474] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile. OBJECTIVE To evaluate the association of postpartum timing of IUD insertion and breastfeeding status with incidence and risk of IUD expulsion. DESIGN, SETTING, AND PARTICIPANTS The Association of Perforation and Expulsion of Intrauterine Devices (APEX-IUD) cohort study included women aged 50 years or younger with an IUD insertion between 2001 and 2018. The breastfeeding analysis focused on a subcohort of women at 52 or fewer weeks post partum with known breastfeeding status. The study was conducted using data from electronic health records (EHRs) at 4 research sites with access to EHR: 3 Kaiser Permanente sites (Northern California, Southern California, Washington) and the Regenstrief Institute (Indiana). Data analysis was conducted from June to November 2019. EXPOSURES Timing of IUD insertion post partum was categorized into discrete time periods: 0 to 3 days, 4 days to 6 or fewer weeks, more than 6 weeks to 14 or fewer weeks, more than 14 weeks to 52 or fewer weeks, and non-post partum (>52 weeks or no evidence of delivery). Breastfeeding status at the time of insertion was determined from clinical records, diagnostic codes, or questionnaires from well-baby visits. MAIN OUTCOMES AND MEASURES Incidence rates and adjusted hazard ratios (aHRs) were estimated using propensity scores to adjust for confounding. RESULTS The full cohort included 326 658 women (mean [SD] age, 32.0 [8.3] years; 38 911 [11.9%] Asian or Pacific Islander; 696 [0.2%] Hispanic Black; 56 180 [17.2%] Hispanic other; 42 501 [13.0%] Hispanic White; 28 323 [8.7%] non-Hispanic Black; 137 102 [42.0%] non-Hispanic White), and the subcohort included 94 817 women. Most IUDs were levonorgestrel-releasing (259 234 [79.4%]). There were 8943 expulsions. The 5-year cumulative incidence of IUD expulsion was highest for insertions 0 to 3 days post partum (10.73%; 95% CI, 9.12%-12.61%) and lowest for insertions more than 6 weeks to 14 or fewer weeks post partum (3.18%; 95% CI, 2.95%-3.42%). Adjusted HRs using women with non-post partum IUD insertion as the referent were 5.34 (95% CI, 4.47-6.39) for those with postpartum insertion at 0 to 3 days; 1.22 (95% CI, 1.05-1.41) for those with postpartum insertion at 4 days to 6 or fewer weeks; 1.06 (95% CI, 0.95-1.18) for those with postpartum insertion at more than 6 to 14 or fewer weeks; and 1.43 (95% CI, 1.29-1.60) for those with postpartum insertion at more than 14 to 52 or fewer weeks. In the subcohort, 5-year cumulative incidence was 3.49% (95% CI, 3.25%-3.73%) for breastfeeding women and 4.57% (95% CI, 4.22%-4.95%) for nonbreastfeeding women; the adjusted HR for breastfeeding vs not breastfeeding was 0.71 (95% CI, 0.64-0.78). CONCLUSIONS AND RELEVANCE In this study of real-world data, IUD expulsion was rare but more common with immediate postpartum insertion. Breastfeeding was associated with lower expulsion risk.
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Affiliation(s)
| | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Health Systems Science, the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | | | - Darios Getahun
- Department of Health Systems Science, the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | | | - Michael J. Fassett
- Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
- Department of Clinical Science, the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | | | - Maqdooda Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Amy Alabaster
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Xiaolei Zhou
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jiaxiao M. Shi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Vicki Y. Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Fagen Xie
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Shannon Hunter
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Jinyi Wang
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Mary E. Ritchey
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Giulia Chillemi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Theresa M. Im
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Harpreet S. Takhar
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | | | - Mary S. Anthony
- RTI Health Solutions, Research Triangle Park, North Carolina
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Bléas C, Llouquet F, Neveu ME, Gaudu S, Fernandez H, Vigoureux S. Study on the use practices and knowledges of French practitioners about the use of intra-uterine devices in early post-partum contraception in France. J Gynecol Obstet Hum Reprod 2022; 51:102240. [PMID: 34610488 DOI: 10.1016/j.jogoh.2021.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intra-Uterine Device (IUD) insertion is possible in early postpartum. Although this contraception method is recognized and used in lots of country, it seems infrequent and poorly known in France. Our study aims to assess the barriers to the application of this method in France. METHODS A questionnaire was sent to obstetricians-gynaecologist professionals and midwives in France, through the affiliation to CNGOF (French National College of Obstetricians and Gynecologists) and to CNSF (French National College of Midwives). Questions were focused on the practices and knowledge about the insertion of IUD in early postpartum. RESULTS four hundred eight practitioners responded. Amongst them, 63% knew about the possibility to use IUDs after a vaginal delivery and 31% knew it could be inserted during cesarean section. Ten percent of them used this method. Most of these practitioners (80% of them) would like to discuss the insertion of an IUD in early postpartum with their patients and 71% would like to perform the insertion themselves after training. Besides, this study shows that contraception is rarely addressed by physicians during the follow-up of pregnancies. Less than 15% of respondents report discussing the topic systematically with the patient during the pregnancy follow during pregnancy follow. CONCLUSION insertion of IUDs in early postpartum is uncommon in France. The main limitation seems to be a lack of knowledge, but practitioners seem to be interested in this practice. Training courses could be created in order to rase up the adoption of this practice.
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Affiliation(s)
- C Bléas
- Faculty of medicine University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France.
| | - F Llouquet
- Faculty of medicine Université Paris-Descartes, 12 Rue de l'École de Médecine, 75006 Paris, France
| | - M-E Neveu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - S Gaudu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - H Fernandez
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France
| | - S Vigoureux
- CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France; Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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Complications after interval postpartum intrauterine device insertion. Am J Obstet Gynecol 2022; 226:95.e1-95.e8. [PMID: 34461075 PMCID: PMC8940222 DOI: 10.1016/j.ajog.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND: In the United States, up to 57% of women report resumption of sexual activity by the 6 week postpartum visit. Effective contraception should be addressed and provided at that time, to avoid unintended pregnancies and optimize interpregnancy intervals. Long-acting reversible contraceptives are the most effective forms of reversible contraception and are increasingly popular during the postpartum period. However, timing of postpartum intrauterine device (IUD) placement varies among providers and many delay insertion due to concerns for uterine perforation or expulsion of the IUD. OBJECTIVE: This study aimed to evaluate uterine perforation and expulsion rates with IUD insertion at 4–8 weeks postpartum vs 9–36 weeks postpartum. STUDY DESIGN: We performed a retrospective cohort study using the Kaiser Permanente Southern California electronic medical record from 2010 to 2016. We calculated the proportion of perforations and expulsions with IUD insertion at 4–8 weeks vs 9–36 weeks postpartum. Our primary outcome was the perforation rate. Secondarily, we evaluated the expulsion rate. For our minimum sample size calculation, to detect a difference of 0.5% in the perforation rate, with a baseline perforation rate of 0.5% for the 9–36 week postpartum IUD placement group, 80% power, and 5% alpha error rate, we would need at least 4221 participants per group, 8442 in total. RESULTS: A total of 24,959 patients met inclusion criteria (n=13,180 in the 4–8 week group, n=11,777 in the 9–36 week group). Of 430 patients with a confirmed complication, 157 uterine perforations and 273 IUD expulsions were identified. Perforation rates were significantly higher with placement at 4–8 weeks than at 9–36 weeks (0.78% vs 0.46%; P=.001). After adjusting for race and ethnicity, breastfeeding, IUD type, provider type, parity, most recent delivery, and body mass index, the odds of perforation remained higher with placement at 4–8 weeks than at 9–36 weeks (adjusted odds ratio, 1.92; 95% confidence interval, 1.28–2.89). Our Kaplan-Meier survival curve showed that the risk of uterine perforation remained elevated until approximately 22–23 weeks postpartum. Expulsion rates were similar between the 2 groups (1.02 vs 1.17; P=.52). CONCLUSION: Uterine perforation after interval postpartum IUD insertion is greater at 4–8 weeks than at 9–36 weeks, although perforation rates remain low at <1%. Expulsion rates did not differ between the groups. Because overall rates of uterine perforation are low, women can safely be offered IUDs at any interval beyond 4 weeks with minimal concern for perforation.
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Examining the association between short interpregnancy interval births and the type and timing of postpartum long acting reversible contraception. Contraception 2021; 112:61-67. [PMID: 34971615 DOI: 10.1016/j.contraception.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether the type (intrauterine device or implant) or timing (immediately postpartum vs interval) of postpartum long-acting reversible contraception was associated with a reduction in short interpregnancy interval births. STUDY DESIGN We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 - 2018. Our primary outcome was short interpregnancy interval, defined as repeat pregnancy within 18 months of the index delivery. We determined postpartum contraceptive method and timing of receipt. To assess the association of timing of long acting reversible contraception with short interpregnancy interval, we calculated adjusted probabilities from a logistic regression model incorporating covariate balanced propensity score weights, sociodemographic factors, and clustered at the woman-level. RESULTS Our study sample included 121,422 births to 97,084 individuals who had more than one birth during the study period; 41% had a short interpregnancy interval. A majority of individuals had not received any contraception by six months postpartum (68.6%). Overall, 15,477 individuals used long acting reversible contraception postpartum, with the majority receiving interval rather than immediate postpartum long acting reversible contraception (92.9% vs 7.1%). In multivariable analyses, both immediate postpartum (23.0%, 95% CI: 20.5 - 25.8%) and interval long acting reversible contraception (15.2%, 95% CI: 14.4 - 16.1%) are associated with a lower probability of short interpregnancy interval than short acting methods (42.1%, 95% CI: 41.2 - 43.0%). CONCLUSION Compared to short-acting methods, receipt of both immediate postpartum and interval long-acting reversible contraception is associated with lower probabilities of a subsequent short interpregnancy interval.
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da Silva Nóbrega AB, Pitangui ACR, Vieira CS. Factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices. Int J Gynaecol Obstet 2021; 157:67-75. [PMID: 34197636 DOI: 10.1002/ijgo.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/13/2021] [Accepted: 06/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify clinical and demographic factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices (TCu380A IUD). METHODS This is a secondary analysis of an implementation study. We followed participants who had a postplacental TCu380A IUD insertion, at two postpartum visits: 45-90 days (visit 1) and 6-9 months (visit 2). We used multiple log-binomial regression models to evaluate the demographic and clinical variables associated with missing strings and with IUD expulsion. RESULTS We included 705 participants who had a postplacental IUD insertion. We observed missing strings in 275 (47.9%) participants at visit 1, and in 127 (34.2%) participants at visit 2. We identified 61 expulsions (8.9%) by visit 2. In the multiple regression models, only the delivery type was associated with missing strings and expulsion. Compared with vaginal delivery, cesarean delivery increased the risk of missing strings (adjusted relative risk [aRR] 6.21; 95% confidence interval [CI] 4.29-8.99) but reduced the risk of IUD expulsion (aRR 0.24; 95% CI 0.13-0.43). CONCLUSION The delivery mode was the only factor associated with missing strings and expulsion after postplacental IUD insertion. Cesarean section was associated with an increased risk of missing strings but decreased risk of expulsion after postplacental TCu380A IUD insertion.
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Affiliation(s)
| | | | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Eva G, Gold J, Makins A, Bright S, Dean K, Tunnacliffe EA, Fatima P, Yesmin A, Muganyizi P, Kimario GF, Dalziel K. Economic Evaluation of Provision of Postpartum Intrauterine Device Services in Bangladesh and Tanzania. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:107-122. [PMID: 33795364 PMCID: PMC8087427 DOI: 10.9745/ghsp-d-20-00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Postpartum family planning is an effective means of achieving improved health outcomes for women and children, especially in low- and middle-income settings. We assessed the cost-effectiveness of an immediate postpartum intrauterine device (PPIUD) initiative compared with standard practice in Bangladesh and Tanzania (which is no immediate postpartum family planning counseling or service provision) to inform resource allocation decisions for governments and donors. METHODS A decision analysis was constructed to compare the PPIUD program with standard practice. The analysis was based on the number of PPIUD insertions, which were then modeled using the Impact 2 tool to produce estimates of cost per couple-years of protection (CYP) and cost per disability-adjusted life years (DALYs) averted. A micro-costing approach was used to estimate the costs of conducting the program, and downstream cost savings were generated by the Impact 2 tool. Results are presented first for the program as evaluated, and second, based on a hypothetical national scale-up scenario. One-way sensitivity analyses were conducted. RESULTS Compared to standard practice, the PPIUD program resulted in an incremental cost-effectiveness ratio (ICER) of US$14.60 per CYP and US$91.13 per DALY averted in Bangladesh, and US$54.57 per CYP and US$67.67 per DALY averted in Tanzania. When incorporating estimated direct health care costs saved, the results for Bangladesh were dominant (PPIUD is cheaper and more effective versus standard practice). For Tanzania, the PPIUD initiative was highly cost-effective, with the ICER (incorporating direct health care costs saved) estimated at US$15.20 per CYP and US$18.90 per DALY averted compared to standard practice. For the national scale-up model, the results were dominant in both countries.Conclusions/implications: The PPIUD initiative was highly cost-effective in Bangladesh and Tanzania, and national scale-up of PPIUD could produce long-term savings in direct health care costs in both countries. These analyses provide a compelling case for national governments and international donors to invest in PPIUD as part of their family planning strategies.
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Affiliation(s)
- Gillian Eva
- Independent consultant, Washington, DC, USA.
| | - Judy Gold
- Independent consultant, Melbourne, Australia
| | - Anita Makins
- International Federation of Gynecology and Obstetrics, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department Women's and Reproductive Health, Oxford University, Oxford, UK
| | - Suzanna Bright
- International Federation of Gynecology and Obstetrics, London, UK
| | - Katherine Dean
- International Federation of Gynecology and Obstetrics, London, UK
| | | | - Parveen Fatima
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | - Afroja Yesmin
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | | | | | - Kim Dalziel
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Marangoni M, Laporte M, Surita F, Kraft MB, Bahamondes L, Juliato CRT. One-year follow up on post-placental IUD insertion: A randomized clinical trial. Acta Obstet Gynecol Scand 2021; 100:596-603. [PMID: 33421091 DOI: 10.1111/aogs.14081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Our objectives were to compare the 1-year follow-up clinical performance of the TCu380A intrauterine device (TCu380A-IUD) and levonorgestrel (LNG) 52-mg intrauterine system (IUS) inserted at post-placental period. MATERIAL AND METHODS We conducted an open-label, parallel-group, randomized clinical trial, 1:1 with pregnant women admitted for childbirth independently of the mode of birth. Our primary outcome was expulsion up to 1 year after device placement by type of IUD and mode of delivery. During the follow up (42, 90 and 365 days (±7 days) after device placement), an ultrasound was performed to evaluate the device position. Kaplan-Meier with log-rank test was used to compare the survival curves of the TCu380A IUD and the LNG IUS. Couple-Years of Protection after insertion of both devices was calculated. RESULTS One hundred and forty women were randomized to the TCu380A IUD (n = 70) or the LNG IUS (n = 70). By the end of the first year after device placement, 38 women experienced device expulsion (27.1%), most of them (33/38; 86.8%) within the first 42 days after delivery. The expulsions were significantly higher among users of TCu380A IUD (39.4%) than among users of the LNG IUS (22.2%; P = .039), and among those with vaginal delivery (43.8%) than among women with cesarean delivery (15%; P = .003). The 1-year cumulative continuation rate was 64.2%, significantly higher for LNG IUS (73.1%) than for TCu380A IUD (54.4%; P = .03), and among women with cesarean delivery (77.6%) than for vaginal delivery (52%; P = .00). The post-placental IUD insertion provided 356.4 Couple-Years of Protection. CONCLUSIONS Two-thirds of women who accepted a post-placental IUD placement still used the device 1 year after childbirth. However, expulsion was the most prevalent reason for discontinuation, mainly within 42 days after device placement. The expulsion rate was significantly higher among TCu380A IUD users and among women with vaginal delivery.
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Affiliation(s)
- Marcos Marangoni
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Montas Laporte
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernanda Surita
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Maria B Kraft
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
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Gilliam ML, Jensen JT, Eisenberg DL, Thomas MA, Olariu A, Creinin MD. Relationship of parity and prior cesarean delivery to levonorgestrel 52 mg intrauterine system expulsion over 6 years. Contraception 2021; 103:444-449. [PMID: 33651995 DOI: 10.1016/j.contraception.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assess the relationship between parity and prior route of delivery to levonorgestrel 52 mg intrauterine system (IUS) expulsion during the first 72 months of use. STUDY DESIGN We evaluated women enrolled in the ACCESS IUS multicenter, Phase 3, open-label clinical trial of the Liletta levonorgestrel 52 mg IUS. Investigators evaluated IUS presence at 3 and 6 months after placement and then every 6 months and during unscheduled visits. We included women with successful placement and at least one follow-up assessment. We evaluated expulsion rates based on obstetric history; for prior delivery method subanalyses, we excluded 12 participants with missing delivery data. We determined predictors of expulsion using multivariable regression analyses. RESULTS Of 1714 women with IUS placement, 1710 had at least one follow-up assessment. The total population included 986 (57.7%) nulliparous women. Sixty-five (3.8%) women experienced expulsion within 72 months, 50 (76.9%) within the first 12 months. Expulsion rates among nulliparous women (22/986 [2.2%]) or parous women with any pregnancy ending with a Cesarean delivery (6/195 [3.1%]) differed from parous women who only experienced vaginal deliveries (37/517 [7.2%]) (p < 0.001). In multivariable regression, obesity (adjusted odds ratio [aOR] 2.2, 95% confidence interval [CI] 1.3-3.7), parity (aOR 2.2, 95% CI 1.2-4.1), and non-white race (aOR 1.8, 95% CI 1.1-3.2) predicted expulsion. Among parous women, obesity (aOR 2.2, 95% CI 1.2-4.2) increased the odds and having ever had a cesarean delivery (aOR 0.4, 95% CI 0.1-0.9) decreased the odds of expulsion. CONCLUSION IUS expulsion occurs in less than 4% of users over the first 6 years of use and occurs mostly during the first year. Expulsion is more likely among obese and parous women. IMPLICATIONS Levonorgestrel 52 mg intrauterine system expulsion occured more commonly in parous than nulliparous women; the increase in parous women is primarily in women who had vaginal deliveries only. The association between obesity, delivery route, and IUS expulsion needs further elucidation.
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Affiliation(s)
- Melissa L Gilliam
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, United States
| | - David L Eisenberg
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, United States
| | - Michael A Thomas
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States.
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Ausstoßungsrisiko nach postpartaler Spiraleneinlage. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/a-1225-0785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Makins A, Arulkumaran S. The negative impact of COVID-19 on contraception and sexual and reproductive health: Could immediate postpartum LARCs be the solution? Int J Gynaecol Obstet 2020; 150:141-143. [PMID: 32449192 PMCID: PMC9087606 DOI: 10.1002/ijgo.13237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Anita Makins
- FIGO-International Federation of Gynecology and Obstetrics, London, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Sabaratnam Arulkumaran
- FIGO-International Federation of Gynecology and Obstetrics, London, UK.,St George's, University of London, London, UK
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