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PubMed1985

Expulsions in immediate postpartum insertions of Lippes Loop D and Copper T IUDs and their counterpart Delta devices--an epidemiological analysis.

In this paper, an epidemiological analysis was performed, using an international data set, exclusively on the expulsion problem associated with postpartum IUD insertions. The inserter's experience in postplacental insertions is probably an important determining factor for IUD expulsions. Immediate insertions (within 10 minutes after placental delivery) are possibly associated with lower expulsion rates than later insertions (eg. two to 72 hours after placental delivery) during the woman's postpartum hospitalization. No significant differences were detected between the standard Lippes Loop D and Copper T IUDs and their counterpart Delta devices specifically designed for postpartum use, between the two types of Delta device or between the hand and inserter methods. A case-control analysis also did not detect any significant association between IUD expulsions and mild complications occurring or management performed during the third stage of labor and delivery. The practical implications of these findings, the methodologic problems of this analysis and future research strategies are also discussed.

Adult↗
PubMed2001

Immediate post-partum insertion of intrauterine devices.

OBJECTIVES: To assess the efficacy and feasibility of IUD insertion immediately after expulsion of the placenta. Our a priori hypothesis was that this practice is safe but associated with higher expulsion rates than interval IUD insertion. SEARCH STRATEGY: We used MEDLINE, Popline, EMBASE, and Cochrane Controlled Trials Register computer searches, supplemented by review articles and contact with investigators. SELECTION CRITERIA: We sought all randomized controlled trials that had at least one treatment arm that involved immediate post-partum (within ten minutes of placental expulsion) insertion of an IUD. Comparisons could include different IUDs, different insertion techniques, immediate vs. delayed post-partum insertion, or immediate vs. interval insertion (unrelated to pregnancy). Studies could include either vaginal or cesarean deliveries. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and sought to identify duplicate reporting of data from multicenter trials. We abstracted data onto data collection forms. Principal outcome measures included pregnancy, expulsion, and continuation rates. Because the trials did not have uniform interventions, we were unable to aggregate them in a meta-analysis. MAIN RESULTS: We found no randomized controlled trials that directly compared immediate post-partum insertion with either delayed post-partum or interval insertion. Modifications of existing devices, such as adding absorbable sutures or additional appendages, did not appear beneficial. Most studies showed no important differences between insertions done by hand or by instruments. Lippes Loops and Progestasert devices did not perform as well as did copper devices. REVIEWER'S CONCLUSIONS: Immediate post-partum insertion of IUDs appeared safe and effective, though direct comparisons with other insertion times were lacking. Advantages of immediate post-partum insertion include high motivation, assurance that the woman is not pregnant, and convenience. However, expulsion rates appear to be higher than with interval insertion. The popularity of immediate post-partum IUD insertion in countries as diverse as China, Mexico, and Egypt support the feasibility of this approach. Early follow-up may be important in identifying spontaneous IUD expulsions.

Feasibility Studies↗
PubMed1994

The pathology of intra-uterine contraceptive devices.

The IUCD is a simple and effective way of producing contraception without the need for patient compliance. It is not rendered ineffective by other drugs, as may be steroid contraceptives, and its side-effects, for carefully selected patients, are considered by most practitioners to be acceptably low (Van Kets et al. 1989).

Cervix Uteri↗
PubMed1997

[Expulsion proof intrauterine devices].

The author of this paper presents own new generation of IUDs, named "Antigrav", patented, and used for 14 years. Proper construction of these IUDs prevents expulsion by the uterus, and protects the uterus against injuries. This report comprise 7 year od study performed in two periods. Four size of the antigravs were used during the study. In the first period od study when applied only two sizes of antigravs-size 2, and 3 in parous women, very great different of Pearl index was obtained. In the case of the bigger size 3 of the antigravs-0.5, and for smaller size 2 of the antigravs-2.5. On the base of such differences results, the author of this paper came to the conclusion that efficacy of an IUD depend on paper selection od IUD to the dimension of the uterine cavity. For fulfill such condition the author performed measurements of the uteri cavities in vivo with a uterometer, and revealed great differences in their dimensions. Consequently the uteri were divided into four groups depending on inner length (depth), and four sizes of antigravs were used. Owing to such action in the second period of study was applied 4 size of antigravs selected to the dimension of the uterine cavity, what decreased Pearl index to 0.8. During 7 years of study none of the antigravs fell out of the uterus. Excluding pregnancies, 4 personal, and two clinical reasons requiring removal of antigravs, no others complications were record.

Adult↗
PubMed1995

The frameless GyneFix intrauterine implant: a major improvement in efficacy, expulsion and tolerance.

The CuFix (GyneFix), conceived in 1985, was developed to minimize three major problems frequently associated with discontinuation of IUD use: expulsion, bleeding and pain. Since the initial clinical investigations, over 10,000 woman years of experience and up to 8 years of follow-up in international multicenter, non-comparative and comparative clinical trials, including a large proportion of nulligravid/nulliparous women, have been collected. Based on new clinical information about the GyneFix from a long-term multicenter clinical trial, conducted in young nulligravid/nulliparous and parous women, the importance of this new contraceptive is discussed. The following conclusions were reached: The unique design characteristics of the GyneFix (frameless, flexible and fixed to the fundus of the uterus) have resulted in optimal tolerance and almost complete absence of expulsion. The result is enhanced effectiveness (comparable to OCs and male/female sterilization) and a high rate of continued use. The GyneFix reduces the IUD failure rate to a minimum and is, therefore, a welcome reversible alternative to OCs and female surgical contraception. Framelessness and flexibility explain the absence of side-effects and adverse events caused by dimensional incompatibility between the frame of conventional IUDs and the uterine cavity and may also explain the absence of PID and ectopic pregnancies in any of the clinical studies. The GyneFix is a promising new, highly effective and safe, contraceptive option for parous women and an equally effective and well-accepted method for nulliparous women.

Adolescent↗
PubMed1995

Performance of copper intrauterine devices when inserted after an expulsion.

A total of 124 women who re-inserted a TCu-200B intrauterine device (IUD) following an expulsion were followed up for 1 year after the IUD re-insertion. The cumulative expulsion rate at 6 months was 21.7 and 31.4 per 100 women at the end of the first year. Women who expelled the first IUD within the first 3 months of use had a significantly higher expulsion rate with the second IUD. Our conclusion is that women who expelled a copper IUD are at a significantly higher risk of expelling the re-inserted IUD than the first IUD. Health workers must also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.

Adolescent↗
PubMedDate not supplied

Missing IUD strings: diagnosis and management at Ilorin.

BACKGROUND: Intrauterine contraceptive device (IUD) is a widely accepted method of contraception. One of the complications reported with IUD use is missing IUD. METHODS: This retrospective study was carried out on a total of forty-two women who had missing IUDs over a three-year period (January 1992-December 1994). Socio-demographic data, type of previous contraception, timing of insertion, service provider of IUD, diagnostic and management methods of these cases were reviewed. Epiinfo statistical software package was used for analysis and the level of significance was at p<0.001. RESULTS: The total missing IUDs for the years under review accounted for 0.25% of total IUD continuous users or 0.89% of total new IUD acceptors. There was a slight decline over the study period in the percentage of missing IUDs. Majority (85.71%) presented more than 6 months postpartum for insertion while insertions during menses was common (71.43%). Expulsions of IUDs was recorded in 21 (50%) clients. Pelvic examination with uterine sound and abdominopelvic ultrasound were the diagnostic methods commonly used. Trainees at the family planning unit inserted most of the missing IUDs while most clients (71.43%) missed their IUDs especially within the first three months of use. Retrieval loop alone (64.29%) and with dilatation (11.91%) and uterine sounding alone (16.67%) were commonly employed in the management of missing IUDs. About a third had no associated complications. CONCLUSIONS: Prevalence of missing IUDs is low in this centre occurring mostly within 3 months of insertion. Good selection of women using IUDs will result in less reported cases of missing IUDs. Counselling will motivate the IUD user to present early when any complication arise. The trainees need closer supervision and should be taught appropriate insertion techniques.

Abdomen↗
PubMed1994

[Multiload Cu250 intrauterine devices and VCu200 intrauterine devices for women with previous failure of stainless steel ring intrauterine devices: a 5-year randomized clinical trial].

Two hundred rural women with history of stainless steel ring (SSR) intrauterine devices (IUD) failure (i.e. expulsion or pregnancy with IUD-in-situ) were randomly allocated into Multiload Cu250 (MLCu250) or VCu200 group. The follow up rate was 97.5% at the end of 5-year. The 5-year gross cumulative continuation rates per 100 women for MLCu250 and VCu200 were 80.0 and 81.7 respectively. The 5-year cumulative expulsion rate was significantly lower in MLCu250 group (1.0) than that in VCu200 group (8.1) (P < 0.05), while the pregnancy rate was higher in MLCu group (12.0 vs. 4.1) but no statistical significant difference existed between the 2 groups. The removal for bleeding and (or) pain were similar (6.0 and 6.1). There was one ectopic pregnancy in each group and no removal for medical or personal reasons. The expulsion and pregnancy cases in the present study were not associated with their previous failures. It was concluded that both types of copper IUD were effective for women with previous failure of SSR. The study also showed that MLCu250 might be used as long as 5 years. Should surface area of copper be increased, further decreased pregnancy rate would be expected.

Adult↗
PubMed1996

[Intrauterine copper contraceptive implants].

GyneFix, conceived in 1985, was developed to minimize three major problems frequently associated with discontinuation of IUD use: expulsion, bleeding and pain. Since the initial clinical investigations, over 10,000 women years of experience and up to 8 years of follow-up in international, multicenter, non-comparative and comparative clinical trials, including a large proportion of nulligravid/nulliparous women, have been collected. The following conclusions were reached: 1. The unique design characteristics of GyneFix (frameless, flexible and fixed to the fundus of the uterus) have resulted in optimal tolerance and almost complete absence of expulsion. The result is enhanced effectiveness (comparable to OCs and male/female sterilization) and a high rate of continued use. GyneFix reduces the IUD-failure rate to a minimum and is, therefore, a welcome reversible alternative to OCs and female surgical contraception. 2. Frameless and flexibility explain the absence of side-effects and adverse events caused by dimensional incompatibility between the frame of conventional IUDs and the uterine cavity and may also explain the absence of PID and ectopic pregnancies in any of the clinical studies. 3. Insertion of GyneFix, with or without local anaesthesia, is easily accomplished in the office of a few minutes. Removal is easy, quick and painless. 4. GyneFix is an equally effective and well accepted method fro nulliparous women.

Equipment Design↗
PubMed1996

[Contraceptive use in women with heart disease].

PURPOSE: To analyse efficacy, tolerance and adverse events of reversible contraceptives in women with cardiac disease. METHODS: We studied prospectively during 24-39 (mean = 29) months, 89 women with heart disease with a mean age of 25.6 (16-42) years. Rheumatic heart disease was present in 73 (82%) cases, congenital heart disease in 11 (11%), coronary artery disease in 2 (2%) and cardiomyopathy in 3 (3%) case. The patients were divided in three groups: GCO--35 patients taking combined oral contraceptives (30 micrograms ethinyl estradiol and 75 micrograms gestodene--COs); GIT--27 using injectable progestagens (depot medroxyprogesterone acetate-DMPA) and GUID--27 with intrauterine device (IUD). RESULTS: In GCO occurred 4 (11.4%) cases of arterial hypertension, 1 (2.8%) of a transient cerebral isquemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amnorrhea e 1 (2.8%) pregnancy. Interruption of this method occurred in 4 (11.4%) cases due to hypertension (2), pregnancy (1) and amenorrhea (1). In group GIT there were 2 (7.4%) cases of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 (18.5%) due to amnorrhea (2), weight gain (2) and headache (1). In GUID there was 1 (3.7%) case of infeccion, 1 (3.7%) pregnancy and 1 (3.7%) spontaneous expulsion of IUD. Interruption of use took place in 3 (11.1%) cases due to infeccion, pregnancy and expulsion. The comparation between the groups demonstrated a difference in the incidence of amenorrhea (p < 0.005) and descontinuation of use of the method (p < 0.025). CONCLUSION: Use of reversible contraceptives in heart disease women was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups, however intolerance was more observed in GIT.

Adolescent↗
PubMed1984

A comparative evaluation of three IUDs.

Private practice clinical experience with the insertion of 3 types of IUDs (Lippes loop, Dalkon shield, Cu 7) is evaluated. Life table analyses indicated similar pregnancy rates for the 3 IUDs. Lower expulsion rates were experienced with the Dalkon shield. Higher removal rates were experienced for pelvic inflammatory disease and pain and/or bleeding with the Cu 7. In part, the higher Cu 7 removal rates reflect a change to more liberal indications for IUD removal.

Adnexa Uteri↗
PubMed1987

Cervical dilatation in interval insertion of an IUD. Who requires it and does it lead to a high expulsion rate?

Cervical dilatation is occasionally performed to facilitate IUD insertions in difficult-to-insert cases. Patient characteristics associated with the need for dilation and whether dilation is associated with an increased risk of early expulsion of the IUD have rarely been studied. This analysis, using the extensive international IUD data base developed and maintained by Family Health International, is intended to answer these questions. This case-control analysis revealed that nulliparous women as well as women who had used oral contraceptives or an IUD in the previous month were more likely to require cervical dilatation at IUD insertion. Breastfeeding women, on the other hand, were less likely to require cervical dilatation to facilitate IUD insertion. Hypotheses are generated from this analysis that need to be tested in future studies. The six- and 12-month gross cumulative life-table expulsion rates and other pertinent termination event rates (e.g., accidental pregnancies and removals due to bleeding and pain) were not found to be higher for women with cervical dilatation than for women without.

Age Factors↗
PubMed2001

Emergency contraception with Multiload Cu-375 SL IUD: a multicenter clinical trial.

The objectives of the present study were to evaluate the efficacy and side effects and the benefits and limitations of inserting Multiload intrauterine device (IUD) for emergency contraception. A total of 1013 women requesting emergency contraception was recruited, among whom 843 were parous women and 170 nulliparous women. Multiload Cu-375 SL IUD was inserted within 120 h after unprotected intercourse. A urine test for pregnancy was performed before IUD insertion to rule out pregnancy. Participants were followed-up until 1 week after the expected day of the next menstruation. Pregnancy test or ultrasound scanning were performed if menstruation did not return. Efficacy of preventing unplanned pregnancy was calculated. Efficacy and side effects were compared between the parous and nulliparous groups. The results showed that there were two pregnancies, one in each group. The pregnancy rate was 0.2 per 100 women. The efficacy rate of preventing unwanted pregnancy in the parous group was 98.1% and in the nulliparous group 92.4%. The difference was not significant. Removal of IUD because of pain and bleeding was 2.5% in parous women, but was more in the nulliparous group (10.6%). After the return of menstruation, 95.7% of parous women and 80% of nulliparous women maintained the IUD for contraception. There were two complete expulsions and three partial expulsions of the IUD, but there was no significant changes in menstruation and bleeding pattern, nor was infection or trauma observed. It was concluded that IUD insertion is a safe and effective method for emergency contraception for both parous and nulliparous women. One of the advantages of using an IUD is its long-term contraceptive effect, if the women prefer to continue its use.

Contraceptives, Postcoital↗
PubMed1993

[The acceptability of current contraceptive methods to adolescents].

The authors analyze the admissibility of present-day contraception methods in 107 adolescent girls who used oral anteovin and trisiston and in 128 ones who used copper-containing IUDs. Analysis has not revealed noticeable differences in the incidence of side effects in adolescents and a control group of women of a reproductive age. Spontaneous menses recovery occurred in all young patients within 26 to 36 days after the drugs were discontinued, and basal temperature biphasic pattern recovered in 70.2% of girls by the third month after IUD contraception discontinuation. Short courses (up to 6-12 months) of hormonal contraception are advisable for adolescents. IUD contraception complications presenting as expulsions and menstrual cycle disorders were 1.5-2 times more incident in the adolescents than in control women despite the preventive measures taken.

Adolescent↗