المؤلفون: Jans L; Department of Women's Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Brynhildsen J; Department of Women's Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Cherif E; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Tenerz L; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Bergengren L; Department of Women's Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

المصدر: The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception [Eur J Contracept Reprod Health Care] 2024 Jun; Vol. 29 (3), pp. 109-114. Date of Electronic Publication: 2024 Apr 26.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Informa Healthcare Country of Publication: England NLM ID: 9712127 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1473-0782 (Electronic) Linking ISSN: 13625187 NLM ISO Abbreviation: Eur J Contracept Reprod Health Care Subsets: MEDLINE

مواضيع طبية MeSH: Papillomavirus Infections*/epidemiology , Uterine Cervical Dysplasia*/epidemiology , Intrauterine Devices*/adverse effects , Intrauterine Devices*/statistics & numerical data, Humans ; Female ; Cross-Sectional Studies ; Adult ; Middle Aged ; Prevalence ; Sweden/epidemiology ; Levonorgestrel ; Intrauterine Devices, Copper/adverse effects ; Intrauterine Devices, Copper/statistics & numerical data ; Uterine Cervical Neoplasms/epidemiology ; Contraception/statistics & numerical data ; Contraception/methods ; Intrauterine Devices, Medicated/adverse effects

مستخلص: Objective: To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods.
Methods: A cross-sectional register-based study including 16,181 women aged 30-49 years participating in the screening programme for cervical cancer in a Swedish County in 2017-2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test.
Results: There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04-1.41, and aOR 1.41; 95% CI 1.22-1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02-2.06, and aOR 1.56; 95% CI 1.13-2.16, respectively). No significant differences were found in HPV clearance rates.
Conclusions: Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception.

المؤلفون: Oliveira JA; Department of Women`s Health, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address: julianaoliveira_md@outlook.com., Eskandar K; Department of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil., Chagas J; Department of Gynecology and obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil., do Nascimento LLO; Department of Gynecology and obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil., Ribeiro DD; Department of Hematology, Federal University of Minas Gerais, Belo Horizonte, Brazil., Rocha ALL; Department of Gynecology and obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil., de Oliveira FR; Department of Gynecology and obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.

المصدر: Contraception [Contraception] 2024 Jul; Vol. 135, pp. 110450. Date of Electronic Publication: 2024 Apr 11.

نوع المنشور: Journal Article; Meta-Analysis; Systematic Review

بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 0234361 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0518 (Electronic) Linking ISSN: 00107824 NLM ISO Abbreviation: Contraception Subsets: MEDLINE

مواضيع طبية MeSH: Intrauterine Devices, Medicated*/adverse effects , Levonorgestrel*/administration & dosage , Menorrhagia*/drug therapy, Female ; Humans ; Amenorrhea ; Blood Coagulation Disorders, Inherited/complications ; Contraceptive Agents, Female/administration & dosage ; Contraceptive Agents, Hormonal/administration & dosage ; Ferritins/blood ; Hemoglobins/analysis ; Intrauterine Device Expulsion ; Quality of Life

مستخلص: Objectives: Inherited bleeding disorders may cause heavy menstrual bleeding in women, impacting quality of life and impairing daily and social activities. The levonorgestrel-releasing intrauterine system is a potential treatment for these women, which might reduce menstrual blood loss.
Study Design: We performed a systematic review and single-arm meta-analysis to examine the levonorgestrel-releasing intrauterine system in women with inherited bleeding disorders and heavy menstrual bleeding.
Results: A systematic search on PubMed, Embase and Cochrane yielded 583 results, of which six observational studies (n = 156) met inclusion criteria. Levonorgestrel-releasing intrauterine system use in patients with inherited bleeding disorders and heavy menstrual bleeding was associated with amenorrhea in 60% of patients and a significant increase of 1.40 g/dL in hemoglobin and of 19.75 ng/mL in ferritin levels when comparing post- and pre-treatment levels. The post-treatment mean hemoglobin was 13.32 g/dL and the mean ferritin was 43.22 ng/dL. The rate of intrauterine device expulsion or removal due to mal position was low (13%), as was the need for intrauterine device removal due to lack of efficacy (14%).
Conclusion: The levonorgestrel-releasing intrauterine system may improve bleeding patterns and quality of life in patients with inherited bleeding disorders and heavy menstrual bleeding.
Implications: Women with inherited bleeding disorders could benefit from levonorgestrel-releasing intrauterine system, so its use should be an option for this women.
(Copyright © 2024 Elsevier Inc. All rights reserved.)

المؤلفون: Jin Y; Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Riyue Avenue, Chengdu, Sichuan, China., Wu T; Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Riyue Avenue, Chengdu, Sichuan, China., Liao J; Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Riyue Avenue, Chengdu, Sichuan, China., Liu Y; Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Riyue Avenue, Chengdu, Sichuan, China., Gan X; Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Riyue Avenue, Chengdu, Sichuan, China. Amandine2021@163.com.

المصدر: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2024 Jul; Vol. 310 (1), pp. 607-608. Date of Electronic Publication: 2024 Mar 16.

نوع المنشور: Case Reports; Letter; Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 8710213 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0711 (Electronic) Linking ISSN: 09320067 NLM ISO Abbreviation: Arch Gynecol Obstet Subsets: MEDLINE

مواضيع طبية MeSH: Postmenopause* , Intrauterine Device Migration*/adverse effects, Humans ; Female ; Device Removal/methods ; Minimally Invasive Surgical Procedures/methods ; Middle Aged ; Hysteroscopy ; Intrauterine Devices/adverse effects

المؤلفون: Wise MK; University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota. Electronic address: mwise@umn.edu., Okuyemi O; University of Minnesota Medical School, Minneapolis, Minnesota., Flint M; University of Minnesota Medical School, Minneapolis, Minnesota., Biscaye EM; University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota., Martins SL; University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota., Tessier KM; University of Minnesota Masonic Cancer Center, Biostatistics Core, Minneapolis, Minnesota., Traxler SA; Planned Parenthood North Central States, St. Paul, Minnesota., Boraas CM; University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota.

المصدر: Journal of pediatric and adolescent gynecology [J Pediatr Adolesc Gynecol] 2024 Apr; Vol. 37 (2), pp. 160-164. Date of Electronic Publication: 2023 Dec 10.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Elsevier Science Country of Publication: United States NLM ID: 9610774 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4332 (Electronic) Linking ISSN: 10833188 NLM ISO Abbreviation: J Pediatr Adolesc Gynecol Subsets: MEDLINE

مواضيع طبية MeSH: Reproductive Health* , Intrauterine Devices*, Pregnancy ; Female ; Humans ; Young Adult ; Adolescent ; Adult ; Intrauterine Device Expulsion ; Retrospective Studies ; Delivery, Obstetric

مستخلص: Background: Despite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYAs) by leading professional organizations and demonstrated acceptance and desirability by AYAs, clinicians may worry about the procedural difficulty of IUD device placement in younger patients.
Objective: The aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history.
Study Design: We performed a retrospective cohort study of patients under 25 years old at reproductive health clinics with an IUD placement attempt between January 1 and August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first-attempt IUD placement by VD history. We also assessed the frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications.
Results: We included 1325 participants (median age = 21.3 years), including 42 (3.2%) with a previous VD. Nearly all IUD placements were successful on the first attempt (n = 1301, 98.2%) and performed by advanced practice clinicians (n = 1314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (P > .999). Ancillary measures other than nonsteroidal anti-inflammatory drugs were used infrequently (n = 16, 3.6%). Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within 6 months of placement were rare (n = 29) and mostly comprised expulsions (n = 27, 93.1%).
Conclusion: IUD placement success among AYAs at community-based reproductive health clinics is high and is not associated with a history of VD.
Competing Interests: Conflicts of Interest CMB reports participation in a speaker's bureau for Organon, Inc. The other authors have no disclosures or conflicts of interest to report.
(Copyright © 2023. Published by Elsevier Inc.)

المؤلفون: Free LL; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States. Electronic address: leanne.free@unlv.edu., Brown BP; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States. Electronic address: benjamin_brown@brown.edu., Matteson KA; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States. Electronic address: kristen.matteson@umassmemorial.org., Cronin B; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States. Electronic address: bcronin@kentri.org., Has P; Lifespan Biostatistics, Epidemiology and Research Design Core, Rhode Island Hospital, Providence, RI, United States. Electronic address: PHas1@Lifespan.org., Zeyl V; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States. Electronic address: zeyl0001@umn.edu., Allen RH; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States. Electronic address: rhallen@kentri.org.

المصدر: Contraception [Contraception] 2024 Apr; Vol. 132, pp. 110362. Date of Electronic Publication: 2024 Jan 07.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 0234361 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0518 (Electronic) Linking ISSN: 00107824 NLM ISO Abbreviation: Contraception Subsets: MEDLINE

مواضيع طبية MeSH: Internship and Residency* , Intrauterine Devices*, Female ; Humans ; Levonorgestrel ; Retrospective Studies ; Intrauterine Device Expulsion

مستخلص: Objective: To evaluate expulsion rates in the first 3 years of an academic postplacental levonorgestrel intrauterine device (LNG-IUD) insertion program.
Study Design: Retrospective case series, January 2016 to December 2018. We measured LNG-IUD expulsion rates by 12 weeks postpartum.
Results: Of 235 LNG-IUD insertions, in years 1, 2, and 3, expulsion rates were 11/39 (28%), 9/94 (10%), and 15/102 (15%) (p = 0.03). After vaginal delivery, manual insertion was associated with a higher expulsion rate than ring-forceps (10/28 [36%] vs 17/105 [16%], p = 0.04).
Conclusions: LNG-IUD expulsion rates decreased after program year 1, suggesting program maturity may be associated with a lower expulsion risk.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

المؤلفون: El-Sayed YY; Dr. El-Sayed is from the Department of Obstetrics & Gynecology in the Center for Academic Medicine at the Stanford University School of Medicine, Palo Alto, California; yasser.el-sayed@stanford.edu.

المصدر: Obstetrics and gynecology [Obstet Gynecol] 2023 Nov 01; Vol. 142 (5), pp. 998-999.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401101 Publication Model: Print Cited Medium: Internet ISSN: 1873-233X (Electronic) Linking ISSN: 00297844 NLM ISO Abbreviation: Obstet Gynecol Subsets: MEDLINE

مواضيع طبية MeSH: Postpartum Hemorrhage*/prevention & control , Intrauterine Devices*, Pregnancy ; Female ; Humans ; Postpartum Period ; Intrauterine Device Expulsion

مستخلص: Competing Interests: Financial Disclosure The author did not report any potential conflicts of interest.

المؤلفون: Fassett MJ; Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, the Department of Clinical Science and the Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, and the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, and the Division of Research, Kaiser Permanente Northern California, Oakland, California; the Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington; RTI Health Solutions, Research Triangle Park, North Carolina; Bayer AG, Berlin, Germany; Bayer AG and Bayer OY, Espoo, Finland; Bayer Pharmaceuticals, Whippany, New Jersey, and the Department of Obstetrics and Gynecology, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, Indiana., Reed SD, Rothman KJ, Pisa F, Schoendorf J, Wahdan Y, Peipert JF, Gatz J, Ritchey ME, Armstrong MA, Raine-Bennett T, Postlethwaite D, Getahun D, Shi JM, Xie F, Chiu VY, Im TM, Takhar HS, Wang J, Anthony MS

المصدر: Obstetrics and gynecology [Obstet Gynecol] 2023 Sep 01; Vol. 142 (3), pp. 641-651. Date of Electronic Publication: 2023 Aug 03.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401101 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-233X (Electronic) Linking ISSN: 00297844 NLM ISO Abbreviation: Obstet Gynecol Subsets: MEDLINE

مواضيع طبية MeSH: Intrauterine Devices*/adverse effects , Intrauterine Devices, Copper*/adverse effects , Menorrhagia*/etiology , Uterine Perforation*/epidemiology , Uterine Perforation*/etiology, Female ; Humans ; Intrauterine Device Expulsion/etiology ; Levonorgestrel ; Retrospective Studies ; Middle Aged

مستخلص: Objective: The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD) insertion, breastfeeding, heavy menstrual bleeding, and IUD type (levonorgestrel-releasing vs copper) with risks of uterine perforation and IUD expulsion in usual clinical practice. We summarize the clinically important findings to inform counseling and shared decision making.
Methods: APEX-IUD was a real-world (using U.S. health care data) retrospective cohort study of individuals aged 50 years and younger with IUD insertions between 2001 and 2018 and with electronic health record data. Cumulative incidences of uterine perforation and IUD expulsion were calculated. Adjusted hazard ratios (aHRs) and 95% CIs were estimated from proportional hazards models with control of confounding.
Results: Among the study population of 326,658, absolute risk of uterine perforation was low overall (cumulative incidence, 0.21% [95% CI 0.19-0.23%] at 1 year and 0.61% [95% CI 0.56-0.66% at 5 years]) but was elevated for IUDs inserted during time intervals within 1 year postpartum, particularly among those between 4 days and 6 weeks postpartum (aHR 6.71, 95% CI 4.80-9.38), relative to nonpostpartum insertions. Among postpartum insertions, IUD expulsion risk was greatest for insertions in the immediate postpartum period (0-3 days after delivery) compared with nonpostpartum (aHR 5.34, 95% CI 4.47-6.39). Postpartum individuals who were breastfeeding had a slightly elevated risk of perforation and lowered risk of expulsion than those not breastfeeding. Among nonpostpartum individuals, those with a heavy menstrual bleeding diagnosis were at greater risk of expulsion than those without (aHR 2.84, 95% CI 2.66-3.03); heavy menstrual bleeding also was associated with a slightly elevated perforation risk. There was a slightly elevated perforation risk and slightly lower expulsion risk associated with levonorgestrel-releasing IUDs compared with copper IUDs.
Conclusion: Absolute risk of adverse outcomes with IUD insertion is low. Clinicians should be aware of the differences in risks of uterine perforation and expulsion associated with IUD insertion during specific postpartum time periods and with a heavy menstrual bleeding diagnosis. This information should be incorporated into counseling and decision making for patients considering IUD insertion.
Funding Source: Bayer AG.
Clinical Trial Registration: EU PAS register, EUPAS33461.
Competing Interests: Financial Disclosure Susan Reed has received funding from the National Institutes of Health (NIH) and Bayer, as well as royalties from UpToDate on chapters related to endometrial hyperplasia. Jeffrey F. Peipert receives research support from Bayer, Merck, and CooperSurgical, and has served on advisory boards for Bayer, CooperSurgical, and OCON. Darios Getahun receives research support from NIH, NIEH, DHHS, NICHD, Patient-Centered Outcomes Research Institute, Garfield Memorial Fund, Bayer AG, and HOLOGIC, Inc. Jennifer Gatz disclosed money was paid to her institution from Cook, Lily, and Janssen. Michael J. Fassett receives research support from Garfield Memorial Fund, Bayer AG, and HOLOGIC, Inc. Federica Pisa, Juliane Schoendorf, and Yesmean Wahdan are employees of Bayer, the marketing authorization holder for 3 IUD brands, among others, that were included in this study. Jinyi Wang and Mary S. Anthony are employed at RTI Health Solutions, and Mary E. Ritchey was employed at RTI Health Solutions at the time the analysis was conducted. This organization worked under contract with Bayer to conduct the analyses. No payment or support of any kind was received for drafting or review of this manuscript. Tina Raine-Bennett, an employee of KPNC during the conduct of the study, is currently an employee of Medicines360, a marketing authorization holder for one of the IUD brands included in this study. The other authors did not report any potential conflicts of interest.
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

المؤلفون: Saputra AND; Department of Obstetrics and Gynecology, Universitas Gadjah Mada, Yogyakarta, Indonesia., Permatasari NUI; Department of Obstetrics and Gynecology, Universitas Gadjah Mada, Yogyakarta, Indonesia nisauip@gmail.com.

المصدر: BMJ case reports [BMJ Case Rep] 2023 Oct 24; Vol. 16 (10). Date of Electronic Publication: 2023 Oct 24.

نوع المنشور: Case Reports; Journal Article

بيانات الدورية: Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101526291 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-790X (Electronic) Linking ISSN: 1757790X NLM ISO Abbreviation: BMJ Case Rep Subsets: MEDLINE

مواضيع طبية MeSH: Intrauterine Device Migration*/adverse effects , Urinary Bladder Calculi*/diagnostic imaging , Urinary Bladder Calculi*/etiology , Urinary Bladder Calculi*/surgery, Adult ; Female ; Humans ; Cystoscopy/adverse effects ; Intrauterine Devices ; Urinary Bladder/injuries

مستخلص: An intrauterine device (IUD) is a popular method of contraception mainly used in developing countries. Perforation is one of the most serious but a rare complication secondary to the insertion of an IUD, while perforation into the intravesical organs such as the bladder is even more rare. A 30-year-old multipara in early 30s, with two previous caesarean sections (CS) and one curettage, was found to have her IUD puncturing the bladder during a cystoscopy procedure to remove her bladder stones. Transvesical migration of an IUD is an uncommon complication with a high rate of calculi formation, which is thought to be caused by the IUD's lithogenic potential. Imaging approaches such as ultrasound and pelvic X-rays are considered imperative in the accurate diagnosis. Any migrated IUD should be removed regardless of location. Prompt and continual monitoring of women using an IUD is essential and in a case where the IUD has migrated, the removal using the endoscopic approach is a safe and effective method.
Competing Interests: Competing interests: None declared.
(© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

المؤلفون: Che Y; 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. Electronic address: cheyan2004@163.com., Hou GF; Department of Obstetrics, The Second People's Hospital of Huadu District, Guangzhou, China., Zhang HP; Department of Obstetrics, Wenzhou People's Hospital, Wenzhou, China., Yang H; Department of Obstetrics, Shenzhen Luohu Maternal and Child Health Hospital, Shenzhen, China., Lin SJ; Department of Obstetrics, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, China., Gan T; Department of Obstetrics, Jun'an Hospital, Shunde Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China., Yang WH; Department of Obstetrics, University of Chinese Academy of Sciences - Shenzhen Hospital, Shenzhen, China., Shi CH; Department of Obstetrics, Yuhuan Hospital of Traditional Chinese Medicine, Yuhuan, China., Ren WJ; Department of Obstetrics, Yangzhou Maternal and Child Health Hospital, Affiliated Hospital of Yangzhou University, Yangzhou, China., Xu YQ; Department of Obstetrics, Laizhou Maternity and Child Healthcare Hospital, Laizhou, China., Yin BM; Department of Obstetrics, Zhuhai Maternal and Child Health Hospital (Zhuhai Women and Children's Hospital), Zhuhai, China., Chen TT; Department of Obstetrics, The First People's Hospital of Longwan District, Wenzhou, China., Gan YJ; Department of Obstetrics, Boai Hospital of Zhongshan, Zhongshan, China., Zhang Y; Department of Obstetrics, Yangjiang Maternal and Child Health Hospital, Yangjiang, China., Zhang Y; NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China., Cheng LN; NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China.

المصدر: Contraception [Contraception] 2023 Jun; Vol. 122, pp. 109999. Date of Electronic Publication: 2023 Feb 26.

نوع المنشور: Multicenter Study; Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 0234361 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0518 (Electronic) Linking ISSN: 00107824 NLM ISO Abbreviation: Contraception Subsets: MEDLINE

مواضيع طبية MeSH: Intrauterine Devices* , Intrauterine Devices, Copper*/adverse effects, Pregnancy ; Female ; Humans ; Cesarean Section ; Prospective Studies ; Postpartum Period ; Intrauterine Device Expulsion ; Parity ; China

مستخلص: 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.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

المؤلفون: Seleem M; Kasr Al-Ainy Maternity Hospital, Cairo University, Cairo, Egypt. mostafasaleem@kasralainy.edu.eg., Sedik MM; Kasr Al-Ainy Maternity Hospital, Cairo University, Cairo, Egypt., Megahed AMM; Kasr Al-Ainy Maternity Hospital, Cairo University, Cairo, Egypt., Nabil H; Kasr Al-Ainy Maternity Hospital, Cairo University, Cairo, Egypt.

المصدر: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2023 Jun 26; Vol. 23 (1), pp. 474. Date of Electronic Publication: 2023 Jun 26.

نوع المنشور: Randomized Controlled Trial; Journal Article

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE

مواضيع طبية MeSH: Intrauterine Devices* , Intrauterine Devices, Copper*, Female ; Pregnancy ; Humans ; Cesarean Section/methods ; Copper ; Placenta ; Postpartum Period ; Intrauterine Device Expulsion

مستخلص: Background: Inserting IUDs during cesarean section reduces the need for more manipulation and discomfort. The current conventional manual technique for IUD insertion during cesarean section is not standardized with many modifications and high rates of expulsion, displacement, missed threads, and discontinuation. This study aims to find a standard technique for IUD insertion during cesarean section with the least possible problems, especially displacement and missed threads.
Methods: A randomized controlled study was conducted at Kasr Al-Ainy Maternity Hospital, Cairo University, Egypt. The study was performed over 12 months, from September 2020 to September 2021. Two groups of patients were selected; each group included 420 patients with a desire for IUD insertion during cesarean section. Group (A) (Control group) was subjected to a post-placental intrauterine device (Copper T380) during cesarean section using a conventional manual method; Group (B) (Study group): the IUD (Copper T380) was placed at the top of the uterine fundus using a new technique (intra-cesarean post placental introducer withdrawal IUD insertion technique).
Results: There was a significant statistical difference between the two groups regarding displacement of the IUDs at the end of puerperium, at 6 months, non-visibility of IUD threads, and continuation of use with p-value < 0.05. There was no significant statistical difference in the term of duration of surgery.
Conclusion: The new technique of post-placental IUD insertion can be the standard technique of intra-cesarean section IUD insertion as it is associated with more favorable outcomes among the included women in the form of lower incidence of IUD displacement, non-visibility of IUD threads, and higher rates of continuation without increasing the duration of surgery as compared with the conventional manual technique.
Trial Registration: ClinicalTrial.gov ID: NCT05788354, registration date: 28/03/2023 (retrospectively registered).
(© 2023. The Author(s).)