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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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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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Che Y, Hou GF, Zhang HP, Yang H, Lin SJ, Gan T, Yang WH, Shi CH, Ren WJ, Xu YQ, Yin BM, Chen TT, Gan YJ, Zhang Y, Zhang Y, Cheng LN. Effectiveness, safety, and acceptability of postplacental insertion of GyneFix postpartum intrauterine device among women undergoing cesarean section: A multicenter prospective cohort study in China. Contraception 2023; 122:109999. [PMID: 36849032 DOI: 10.1016/j.contraception.2023.109999] [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: 12/04/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To assess the effectiveness, safety, and acceptability of postplacental insertion of GyneFix postpartum intrauterine device (PPIUD) in women undergoing cesarean section (C-section). STUDY DESIGN We conducted a prospective cohort study at 14 hospitals in four eastern coastal provinces of China between September 2017 and November 2020. A total of 470 women who underwent C-section and consented to the postplacental insertion of GyneFix PPIUD were enrolled, and 400 completed the 12-month follow-up. Participants were interviewed in the wards after delivery and followed up at 42 days, and months 3, 6, and 12 after delivery. We used Pearl Index (PI) to measure the rate of contraceptive failure, life-table method to measure the rate of PPIUD discontinuation, including IUD expulsion, and Cox regression model to explore the risk factors associated with discontinuation of the device. RESULTS Nine pregnancies were detected during the first year after GyneFix PPIUD insertion: seven were due to device expulsion and two occurred with PPIUD in situ. The PIs for overall 1-year pregnancy rate and pregnancies with IUD in situ were 2.3 (95% CI: 1.1-4.4) and 0.5 (95% CI: 0.1-1.9), respectively. The 6- and 12-month cumulative expulsion rates for PPIUD expulsion were 6.3% and 7.6%, respectively. The overall 1-year continuation rate was 86.6% (95% CI: 83.3-89.8). We did not identify any patient with insertion failure, uterine perforation, pelvic infection, or excess bleeding due to GyneFix PPIUD insertion. Women's age, education, occupation, previous history of C-section, parity, and breastfeeding were not associated with removal of GyneFix PPIUD in the first year of use. CONCLUSIONS Postplacental insertion of GyneFix PPIUD is effective, safe, and acceptable for women undergoing C-section. Expulsion is the most common reason for GyneFix PPIUD discontinuation and pregnancy. The expulsion rate for GyneFix PPIUD is lower than that for framed IUDs, but more evidence is needed for a firm verdict.
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Affiliation(s)
- Yan Che
- NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China; Departiment of Family Planning, Weifang People's Hospital, Shandong, China.
| | - Gui-Fang Hou
- Department of Obstetrics, The Second People's Hospital of Huadu District, Guangzhou, China
| | - Hong-Ping Zhang
- Department of Obstetrics, Wenzhou People's Hospital, Wenzhou, China
| | - Heng Yang
- Department of Obstetrics, Shenzhen Luohu Maternal and Child Health Hospital, Shenzhen, China
| | - Shu-Juan Lin
- Department of Obstetrics, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, China
| | - Tao Gan
- Department of Obstetrics, Jun'an Hospital, Shunde Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Hua Yang
- Department of Obstetrics, University of Chinese Academy of Sciences - Shenzhen Hospital, Shenzhen, China
| | - Chun-Hui Shi
- Department of Obstetrics, Yuhuan Hospital of Traditional Chinese Medicine, Yuhuan, China
| | - Wei-Juan Ren
- Department of Obstetrics, Yangzhou Maternal and Child Health Hospital, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Ying-Qin Xu
- Department of Obstetrics, Laizhou Maternity and Child Healthcare Hospital, Laizhou, China
| | - Bao-Ming Yin
- Department of Obstetrics, Zhuhai Maternal and Child Health Hospital (Zhuhai Women and Children's Hospital), Zhuhai, China
| | - Ting-Ting Chen
- Department of Obstetrics, The First People's Hospital of Longwan District, Wenzhou, China
| | - Yu-Jie Gan
- Department of Obstetrics, Boai Hospital of Zhongshan, Zhongshan, China
| | - Yuan Zhang
- Department of Obstetrics, Yangjiang Maternal and Child Health Hospital, Yangjiang, China
| | - Yan Zhang
- NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China
| | - Li-Nan Cheng
- NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China
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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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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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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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de Albuquerque CU, Rios CEGF, Figueiredo ET, Bruno ZV, Feitosa FEDL, Peixoto RAC. Continuation and satisfaction with intrauterine copper device inserted during caesarean delivery. EUR J CONTRACEP REPR 2021; 26:486-490. [PMID: 34184603 DOI: 10.1080/13625187.2021.1943739] [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: 10/21/2022]
Abstract
PURPOSE The objective was to assess the continuation and satisfaction of women who had copper IUDs inserted during caesarean delivery, in addition to possible factors associated with device positioning. MATERIALS AND METHODS A prospective, observational study was carried out involving 158 women who underwent copper IUD insertion during caesarean delivery in Fortaleza, Brazil. The women were followed up 6 weeks and 6 months after insertion of the IUD, at which time they completed a satisfaction questionnaire. We performed speculum and ultrasound examination. RESULTS IUD continuation rates after 6 weeks and 6 months were 92% and 71.5%, respectively. Approximately 85% and 76% of the women were satisfied with the method after 6 weeks and 6 months, respectively. The rate of poor positioning on ultrasound was 5% and the rate of visible thread after 6 weeks was 29.1%, both without association with age, parity, gestational age or active labour. There were 2 cases of infection (1.3%) and no cases of perforation or pregnancy. CONCLUSIONS There was a good rate of continuation and satisfaction with the immediate post-caesarean IUD. There was no association between IUD malpositioning and age, parity, gestational age or active labour.
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Affiliation(s)
- Clarisse Uchoa de Albuquerque
- Master's Student of the Professional Master's in Women, Children and Adolescents' Health, Federal University of Ceará, Fortaleza, Brazil
| | | | - Elfie Tomaz Figueiredo
- Master's Student of the Professional Master's in Women, Children and Adolescents' Health, Federal University of Ceará, Fortaleza, Brazil
| | - Zenilda Vieira Bruno
- Department of Women's, Child and Adolescent Health at the Faculty of Medicine of the Federal University of Ceará, Fortaleza, Brazil
| | | | - Raquel Autran Coelho Peixoto
- Department of Women's, Child and Adolescent Health at the Faculty of Medicine of the Federal University of Ceará, Fortaleza, Brazil
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Barbieri MM, Juliato CRT, Surita FG. Provision and Guidance for Postpartum Contraception - Ensuring Reproductive Rights during Times of Crises. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:247-249. [PMID: 33979885 PMCID: PMC10183938 DOI: 10.1055/s-0041-1729985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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