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PubMed2001

Contraceptive practices of women after abortion in Turkey.

OBJECTIVES: The aim ofthis study was to determine the postabortion contraception choices of women and the subsequent reduction in pregnancy rate. The changes in method of contraception during the 1-year follow-up period were also assessed. METHODS: Ninety women decided to practice family planning methods following an abortion procedure. The family planning choices of the postabortion family planning group were determined by active immediate family planning counselling. The control group, which consisted of 23 women who had had an abortion and wanted to become pregnant again, were followed-up for 1 year to determine their pregnancy rate. The pregnancy rates and methods used were determined during a 12-month follow-up period. RESULTS: Following counselling, 79.64% of the patients signed for immediate family planning practice. In the postabortion family planning group, one out of 90 patients (1.1%, Pearl index 1.29) practising contraception with a condom became pregnant. However, ten out of 23 (43.5%, Pearl index 54.2) patients in the control group became pregnant during the 1-year follow-up period (p < 0.05). In the postabortion family planning group, intrauterine devices (IUDs) (n = 43), injectable monthly contraceptives (n = 24) and tubal ligation (n = 9) were the most commonly preferred methods, with 47%, 27% and 10% of the women using these methods, respectively. At the end of the 12-month period, the drop-out rate among women using the injectable monthly contraceptives was significantly higher (13 patients, 54%) compared to other methods (p < 0.05). In one case out of 43 using an IUD (2.38%), the IUD was expelled during follow-up. CONCLUSION: The use of postabortion family planning significantly decreased the postabortion pregnancy rate. The use of an IUD was the preferred immediate method of choice. Use of injectable monthly contraceptives was the method with the highest drop-out rate. The expulsion rate of postabortion IUDs was acceptable in our practice. The pregnancy rate in the control group was lower than the physiological fecundity would predict. This may suggest that, although couples plan to get pregnant, they do not concentrate on the ideal conditions for conception or they do, in fact, practice some form of family planning.

Abortion, Induced↗

PubMed1998

Non-physician insertion of IUDs: clinical outcomes among TCu380A insertions in three developing-country clinics.

Insertion of IUDs by trained non-physicians is increasing. This secondary analysis of TCu380A IUD acceptors collected at clinics in Nigeria, Turkey and Mexico involved 367 women; 193 insertions were performed by physicians and 174 by non-physicians. Women having their IUD inserted by a non-physician were more likely to experience a pain-free insertion, but also likelier to have the IUD removed for bleeding and pain or to experience an expulsion than women who had their IUD inserted by a physician. Early discontinuation rates were similar between the two groups. Overall continuation rates were statistically higher for IUDs inserted by physicians only at the Mexico site. Trained non-physicians can probably safely insert the TCu380A IUD. Appropriate competency-based training is required to limit the number of expulsions and removals for bleeding and pain by non-physicians.

Adult↗

PubMed1988

[Evaluation from various viewpoints of the Lippes Loop, Multiload Cu 250 and Nova T].

In the present study, our experience at the family planning unit Ankara Military Hospital with intrauterine devices Lippes Loop, multiload Cu 250 and Nova T are presented. 595 women were included in the study between march 31, 1984 with a follow up of 12 months. Out of 595 women 547 (92%) reported no complaints at all. From the remaining 48 women 8 wished to have the device removed, 8 had spontaneous expulsions and in 31 IUD was removed for medical purposes.

Adult↗

PubMed1979

Complications associated with IUD use in a family practice setting.

This study compares the complication rate of intrauterine contraceptive devices (IUD) with other contraceptive measures in a residency practice. The study population included 220 randomly selected women who had IUDs inserted by residents over a five-year period. One hundred similarly selected women started on birth control pills (BCP) were used as a control group. Of the IUD patients, 8.6 percent developed pelvic inflammatory disease vs 2 percent of the BCP patients. The incidence of gonorrhea was not significantly different between the two groups: 8.2 percent for the IUD groups vs 7 percent for the BCP group. Discontinuation of IUDs for reasons other than desiring pregnancy was significantly higher than discontinuation of BCPs: 41 percent vs 12 percent. Of the total IUD insertions, there were 21 expulsions (10 percent) and one uterine perforation (0.4 percent). Five pregnancies occurred in the IUD group, yielding a pregnancy rate of 1.7 per 100 women-years. There was a four percent rate of gynecologic hospitalizations in the IUD group as contrasted with one percent rate in BCP group. IUD use in the family practice setting under study is associated with comparatively poor long-term acceptance and a relatively high rate of complications.

Adolescent↗

PubMed2002

Immediate post-partum insertion of intrauterine devices: a Cochrane review.

BACKGROUND: Insertion of an intrauterine device (IUD) immediately after delivery is appealing for several reasons. The woman is known not to be pregnant, her motivation for contraception may be high and the setting may be convenient for both the woman and her provider. However, the risk of spontaneous expulsion may be unacceptably high. The objective of this study was 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. METHODS: We used Medline, Popline, Embase, and Cochrane Controlled Trials Register computer searches, supplemented by review articles and contact with investigators. We sought all randomized controlled trials that had at least one treatment arm that involved immediate post-partum (within 10 min of placental expulsion) insertion of an IUD. Comparisons could include different IUDs, different insertion techniques, immediate versus delayed post-partum insertion, or immediate versus interval insertion (unrelated to pregnancy). Studies could include either vaginal or Caesarean deliveries. We evaluated the methodological quality of each report and sought to identify duplicate reporting of data from multicentre 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. 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 copper devices. 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.

Female↗

PubMed1996

Immediate postplacental insertion of GYNE-T 380 and GYNE-T 380 postpartum intrauterine contraceptive devices: randomized study.

OBJECTIVE: The purpose of the investigation was to compare the 1-year expulsion and efficacy rates of the GYNE-T 380 and the GYNE-T 380 Postpartum intrauterine contraceptive devices when inserted within 10 minutes after expulsion of the placenta in a term pregnancy. The two intrauterine contraceptive devices were identical, except that one was inserted by means of a temporary fundal suspension system and the other was placed directly into the uterine cavity. STUDY DESIGN: The study was a multicenter, randomized trial of intrauterine contraceptive devices in which 300 subjects accepted the GYNE-T 380 IUD and 292 subjects the GYNE-T 380 Postpartum IUD in clinics with adequate follow-up. RESULTS: At 1 year the gross cumulative expulsion rate was 13.2 per 100 cases (39 expulsions) with the GYNE-T 380 intrauterine contraceptive device and 16.2 per 100 cases (46 expulsions) with the GYNE-T 380 Postpartum device. There was no significant difference in the rate of expulsion between the two devices at any time during the year. There was one first-year intrauterine pregnancy, which occurred in a subject using the GYNE-T 380 device. The continuation rate for each device was above 80 per 100. CONCLUSION: The results indicate that both the GYNE-T 380 Postpartum and the standard GYNE-T 380 intrauterine contraceptive devices are safe and effective when inserted immediately after delivery of the placenta.

Female↗

PubMed1991

The effect of adding copper onto Lippes Loop IUDs: results from a ten-year study in Yugoslavia.

The present study is the first randomized ten-year comparison of the standard, non-medicated Lippes Loop D and the same device with the addition of 200 mm2 of copper in the form of copper sleeves. The devices were randomly inserted immediately after first trimester medical termination of pregnancy. Out of 400 postabortal IUD insertions, 371 were followed for up to ten years. Gross cumulative life-table accidental pregnancy rates after one year of use were 0.56 for the copper-bearing Lippes Loop and 4.63 for the standard Lippes Loop. After two, four and ten years, these rates were 1.24, 2.70 and 3.62 and 6.03, 7.58 and 14.94, respectively (in all comparisons, rates were significantly different at the 0.05 level or lower). At each time interval, expulsion/displacement rates were 4.49, 4.49, 5.23 and 6.32 for the copper-bearing Lippes Loop and 12.61, 13.29, 15.46 and 19.79 for the standard Lippes Loop (rates were significantly different at the 0.01 level or lower). Differences in removal rates for bleeding and/or pain were not significantly different at any of the follow-up intervals. The lower event rates for copper-bearing Lippes Loop D users indicates that the addition of copper to the Lippes Loop IUD may result in better long-term efficacy profiles for this device among postabortal women. The results also suggest that large, medicated IUDs may be more efficacious for women with larger uteri who often experience higher failure rates due to expulsion or displacement of smaller IUDs into the lower uterine segment.

Adolescent↗

PubMed1979

Experience with two different medicated intrauterine devices: a comparative study of the Progestasert and Nova-T.

A comparative study of the Progestasert (UPS) and the Nova-T in 326 randomly selected women was carried out. The observation period was 1 year. The over-all continuation rates for the two types of intrauterine devices (IUDs) were similar. The expulsion rate for the Nova-T (9.2%) was considerably higher (P = 0.001) than that for the UPS (1.2%). Medical removals for bleeding/pain were more frequent (P = 0.028) for the UPS (15.4%) as compared with the Nova-T (6.1%). The pregnancy rate for the UPS (Pearl index = 4.8) was insignificantly higher than that for the Nova-T (Pearl index = 2.8). Two of the pregnancies in the UPS group were ectopic. No significant changes in the reactive immunoglobulins (IgA, IgG, or IgM) were observed in either of the groups. Our results indicate that neither of these two IUDs is preferable to the already existing medicated IUDs, such as the Copper T or the Copper 7.

Adult↗

PubMed1987

Immediate postpartum insertion: performance of the Nova-T-PP and randomized comparison with the Nova-T.

Clinical evaluation of the Postpartum Nova-T or Nova-T-PP (a Nova-T IUD adapted for postpartum insertion) was based on 412 insertions and showed that this model--besides being effective and safe--had a low expulsion rate (7.2% at 1 year). To prove that the Nova-T-PP's low expulsion rate is indeed the result of its special design, a randomized trial was conducted to compare the Nova-T-PP with the parent model (Nova-T) when inserted within 10 minutes of delivery of the placenta. The result of this study (408 insertions, 203 of them Nova-T) indicate that there is no significant difference in expulsion rate between the two IUD models, suggesting that the addition of two extra arms to the original Nova-T model does not improve the retention of the adapted IUD model.

Adult↗

PubMed1977

Six-year continuation rates for CU-T-200 users.

The long-term (six years) contraceptive effectiveness of the Cu-T-200 is evaluated based on 833 first insertions performed by physicians and nurse-midwives. IUD event rates (pregnancy, expulsion, pain/bleeding removal or removal for medical reasons) did not increase with increasing duration of use. The results of the study indicate that the Cu-T-200 is a safe and effective contraceptive for at least six years after insertion.

Adult↗

PubMed2004

Immediate postabortal insertion of intrauterine devices.

BACKGROUND: Insertion of an intrauterine device (IUD) immediately after an abortion has several potential advantages. The woman is known not to be pregnant, a major concern for clinicians. For example, many clinicians refuse to insert an IUD in a woman who is not menstruating. After induced abortion, a woman's motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries potential risks as well. For example, the risk of spontaneous expulsion may be increased due to recent cervical dilation. OBJECTIVES: To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY: We used MEDLINE, Popline, and EMBASE computer searches, supplemented by review articles and contacts with investigators. SELECTION CRITERIA: We sought all randomized controlled trials that had at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 12 trials which described random assignment but excluded three from this review. Two of these revealed unethical research conduct, and one used alternate assignment to treatments. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and abstracted information onto a data collection form. We focused on gross discontinuation rates (single-decrement life table analysis) for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. We entered the data into RevMan 3.1 for analysis of Peto odds ratios. MAIN RESULTS: In large multicenter trials, the TCu 220C device proved superior to either the Lippes Loop D or the Copper 7 IUDs for immediate postabortal insertion. In single-center trials, the Nova T IUD had a significantly higher discontinuation rate for pregnancy than did the Multiload 250 (OR 4.5; 95% CI 1.0-19.8), while the Nova T had a significantly lower discontinuation rate for pregnancy than did the TCu 200 (OR 0.3; 95% CI 0.1-0.9). The levonorgestrel-releasing device was more effective in preventing pregnancy than was the Nova T. Only one trial compared immediate vs. delayed insertion. In this trial, the performance of the Copper 7 IUD inserted immediately after abortion was inferior to that after interval insertion (remote from pregnancy), although the differences were not statistically significant. REVIEWERS' CONCLUSIONS: Insertion of an IUD immediately after abortion is both safe and practical. IUD expulsion rates appear higher than after interval insertions.

Abortion, Induced↗

PubMed1994

Contraceptive efficacy of the Copper T 380A and Copper T 200 intrauterine devices: results from a comparative clinical trial in six developing countries.

The clinical performance of the Copper T 380A (TCu 380A) and the Copper T 200 (TCu 200) intrauterine devices (IUDs) was evaluated for 12 months in a group of women who had one of the two IUDs inserted. Results are from a multicenter randomized clinical trial at one site in each of six developing countries. The pregnancy rate with the TCu 380A IUD was significantly lower than the pregnancy rate with the TCu 200 IUD at 12 months (0.5 and 2.6 per 100 women, respectively, p < 0.01). No statistically significant differences between the two study IUDs were found with regards to expulsion or removals due to bleeding/pain, personal, medical, or planned pregnancy. The TCu 380A IUD did not have a disproportionately higher incidence of side effects such as intermenstrual bleeding or pain, inflammations or infections, or insertion-related events compared to the TCu 200 IUD. TCu 380A IUD users, however, were significantly more likely to report increased dysmenorrhea than were TCu 200 IUD users. The performance of the TCu 380A IUD in preventing pregnancy during this trial indicates that this IUD may be a better option than the TCu 200 IUD for women wishing to practice effective, long-term, reversible birth control without having to resort to hormonal methods.

Contraception↗

PubMed1990

[Comparative study of norplant-2 and levonorgestrel-releasing intrauterine devices].

Norplant-2 and Levonorgestrel-releasing IUD were studied in a randomized comparative trial for one year. Each group consisted of 100 healthy women among whom contraceptive efficacy and acceptability were studied. Only one woman with the LNG-IUD got pregnancy during the 12 months of use. Expulsion rate was 3.0 in the LNG-IUD. Removal rate for menstrual problems was 3.0 for both groups. The use-related discontinuation were 4.0 and 10.0 respectively. Irregular bleeding was the major side-effect with the two devices. Menstrual blood loss (MBL) and haemoglobin concentration were measured in thirty women at pre- and post-insertion periods. After the 1st, 6th, 12th month of use in Norplant-2 group, the mean MBL were all less than that of pre-insertion, but the differences were not significant. Among LNG-IUD users, the MBL decreased significantly after one year of use. Haemogloblin concentrations were slightly increased in both groups.

Adult↗

PubMed1993

What we have learned from recent IUD studies: a researcher's perspective.

Many studies published on intrauterine devices (IUDs) during the last six years have consistently reported findings in favor of IUD use. Notable among these findings are: IUDs are not abortifacients; newly developed IUDs are highly effective and the efficacy is long-lasting; IUDs can be safely used by most lactating women, with lower removal rates attributable to bleeding and/or pain; and immediate postplacental IUD insertion reduces the risk of expulsion usually associated with postpartum insertion. Most importantly, in apparent contrast to results often reported in the late 1960s through the early 1980s, recent findings show that IUDs per se, especially the medicated ones, are not associated with an increased risk of pelvic inflammatory disease (PID), nor are they associated with an increased risk of ectopic pregnancy or subsequent infertility. There are still issues concerning IUD use that are controversial in spite of numerous studies. Should some of the contraindications currently listed for IUD use be modified according to the newer findings? Is the risk of uterine perforation increased when the IUD is inserted in lactating women? Do IUD tails increase the risk of PID? Does oral use of antibiotics at IUD insertion help prevent postinsertion PID? There are also issues that have not been sufficiently addressed and more information from empirical studies is needed. These include: the effect of the insertor's skill on IUD performance; IUD use in nulliparous as well as in older women; the relationship between IUD use and chlamydia infection; and long-term IUD use and safety, including actinomycosis, etc. Answers are also needed by administrators facing difficult programmatic decisions. For instance, should programs involving massive IUD removal be implemented as many IUD-wearing women are approaching or passing menopause? Similarly, are large programs to remove less-effective devices and replace them with newer and more effective IUDs advisable? This article reviews the state-of-the-art findings from recent IUD studies on the above issues.

Contraindications↗

PubMed1981

Interception by post-coital IUD insertion.

After the development of postcoital hormonal interception, the postcoital use of IUDs to prevent pregnancy was proposed by Tatum. The major advantage of this treatment is that it avoids the use of the usual massive dose of estrogens (a very effective postcoital method) which is associated with nausea and vomiting. This is the 1st method to be effective up to 5 days after exposure, 3 days more than the estrogen treatment. It may also provide long-term contraception in women who wish to continue using the IUD. A major disadvantage of postcoital IUD use is that IUD insertion can produce serious complications if a patient has a vaginal or venereal infection or an asymptomatic cervicitis or even pelvic inflammatory disease (PID). After proper physical examination, suitable patients are selected from those requesting postcoital treatment. Cases involving rape are mostly excluded from these services; but, if they present early, proper work up and treatment can be performed within the time span of 5 days available for this method and it will still be possible to fit a postcoital IUD. The potential risk of future infertility should be considered as PID rates in nulliparous IUD users are up to 7 times higher than in nonusers. Young nulliparous, sexually active women--especially of the lower socioeconomic strata--are identified as high-risk patients. Over 70% of women requesting interception are nulliparous. Clients asking for postcoital insertion should be informed of its potential risk, as women under 25 years of age are more prone to infection. The risk of septic abortion exists if an IUD is inserted into a gravid uterus due to pregnancy resulting from unreported previous sexual intercourse. Septic abortion is a life-threatening condition. Out of several series, no pregnancies are reported in the month of treatment. The IUD preferred is the Multiload copper IUD or the copper T; the highest expulsion rate proved the Copper-7 Gravigard (Cu-7) inefficient. In suitable circumstances, the IUD can be the 1st choice in postcoital interception.

Age Factors↗

PubMed2001

Post-partum bleeding and infection after post-placental IUD insertion.

The incidence of excessive bleeding and endometritis in 145 women who accepted post-placental insertion of a copper T380A intrauterine device (IUD) was compared with that of 157 subjects who did not accept the insertion of the IUD. The subjects delivered at the Maternidade da Encruzilhada, Recife, Brazil in the period from March 30, 1994, to December 15, 1995. A blood sample for hemoglobin was collected before placental expulsion and 10 days after labor. The IUD was inserted up to 10 min after the expulsion of the placenta. There was no difference between the groups in the incidence of excessive bleeding, neither regarding mean hemoglobin concentration before placental expulsion (t = 0.039; p = 0.83) nor at day 10 postpartum (t = 1.04; p = 0.29). There were 5 cases of clinically diagnosed endometritis among the 145 subjects with placental-IUD (3.4%) and 7 cases among the 157 women without IUD (4.6%) (p = 0.40). Post-placental insertion appears to be a convenient approach to IUD initiation, with no observed increase in the incidence of excessive bleeding or endometritis.

Adult↗

PubMed1990

Comparison of the clinical performance, contraceptive efficacy and acceptability of levonorgestrel-releasing IUD and Norplant-2 implants in China.

The levonorgestrel-releasing IUD (LNG-IUD, 20 micrograms/d) and the Norplant-2 implants were studied in a randomized comparative clinical trial with 200 women for one year. No pregnancy or expulsion occurred with the Norplant-2. In the LNG-IUD group, there was one pregnancy at the 12th month of use after an unnoticed expulsion. The net cumulative pregnancy and expulsion rates of LNG-IUD were 1.0 and 3.0. The removal rate due to menstrual disturbances in both LNG-IUD and Norplant-2 groups was 3.0. The use-related discontinuation rates were 9.0 and 3.0, and the continuation rates were 90.0 and 96.0, respectively. The differences were not statistically significant. Menstrual disturbance was the main side effect. It was improved after long time use, especially in the LNG-IUD group. After one year, the percentages of women with amenorrhea were 18.9 for the LNG-IUD and 8.3 for the Norplant-2. The menstrual blood loss was statistically significantly reduced in the LNG-IUD group, and blood haemoglobin concentration increased in both groups. The LNG-IUD and Norplant-2 are highly effective, safe, long-acting, and well accepted by the Chinese women.

Administration, Intravaginal↗

PubMed2000

Immediate post-abortal insertion of intrauterine devices.

OBJECTIVES: To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY: We used Medline, Popline, and EMBASE computer searches, supplemented by review articles and contacts with investigators. SELECTION CRITERIA: We sought all randomized controlled trials that had at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 12 trials which described random assignment but excluded three from this review. Two of these revealed unethical research conduct, and one used alternate assignment to treatments. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and abstracted information onto a data collection form. We focused on gross discontinuation rates (single-decrement life table analysis) for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. We entered the data into RevMan 3.1 for analysis of Peto odds ratios. MAIN RESULTS: In large multicenter trials, the TCu 220C device proved superior to either the Lippes Loop D or the Copper 7 IUDs for immediate post-abortal insertion. The Peto OR for discontinuation for pregnancy was 0.4 (95% CI 0.2-0.7) compared with the Lippes Loop D and 0.5 (95% CI 0.3-0.8) compared with the Copper 7. Expulsions were also significantly less common with the TCu 220C than with the other two IUDs. In single-center trials, the Nova T IUD had a signicantly higher discontinuation rate for pregnancy than did the Multiload 250 (OR 4.5; 95% CI 1.0-19.8), while the Nova T had a significantly lower discontinuation rate for pregnancy than did the TCu 200 (OR 0.3; 95% CI 0.1-0.9). Only one trial compared immediate vs. delayed insertion. In this trial, the performance of the Copper 7 IUD inserted immediately after abortion was inferior to that after interval insertion (remote from pregnancy), although the differences were not statistically significant. Addition of copper sleeves to a Lippes Loop D improved its performance, but addition of a topical hydrogel to a Spring Coil did not offer benefit. Overall, rates of perforation and pelvic inflammatory disease were low. REVIEWER'S CONCLUSIONS: Insertion of an IUD immediately after abortion is both safe and practical. This was true for both induced and reported "spontaneous" abortions, many of which may have been induced under clandestine circumstances. IUD expulsion rates were higher after second-trimester abortions than after earlier abortions, so delaying insertion may be advisable after later abortions. Although Copper 7 devices inserted unrelated to pregnancy may perform better than those inserted after abortion, many women who express interest in intrauterine contraception do not return for the scheduled insertion. These women may remain unprotected against unintended pregnancy. However, evidence is inadequate to compare the safety and efficacy of IUD insertion immediately after abortion vs. insertion some weeks later.

Abortion, Induced↗