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Aim: To determine the safety and efficacy of immediate postpartum intrauterine contraceptive devices insertion after vaginal and caesarean and vaginal deliveries. Study Design: Retrospective study Place & Duration: Conducted at Gyne & Obs Department, Shahida Islam Teaching Hospital Lodhran, during from 1-06-2020 to 30-06-2021. Methods: In this study 120 patients were included in this study. Patients’ ages were ranging from 20 to 45 years. Patients’ detailed medical history including age, residence and socioeconomic status were examined after taking written consent. All the patients divided into two groups, 60 caesarean, 60 vaginal. IPPIUCDs were inserted in all the patients. Outcomes were examined at follow-up and compared between both groups. Data was analyzed by SPSS 24.0. P-value more...

Objectives More than 60,000 hysteroscopies are performed every year in the UK for common reasons such as heavy menstrual bleeding (HMB) or postmenopausal bleeding. A significant number of women requiring hysteroscopy receive oral anticoagulants and there is often a reluctance to perform these procedures due to bleeding concerns. Study Design We are presenting the first proof of concept cohort of patients undergoing minor hysteroscopic procedures while on anticoagulant or antiplatelet medication. A variety of minor procedures such as cervical dilatation, targeted endometrial biopsies, Pipelle endometrial biopsies and insertion or removal of intrauterine contraceptive devices were performed alongside hysteroscopy. Results Completion of planned procedures was feasible in all women due to minimal bleeding despite the ongoing anticoagulation or anti-platelet treatment. Conclusion More research is needed to establish the safety of performing diagnostic and operative hysteroscopies without bridging or interrupting anticoagulation or antiplatelet treatment. more...

BACKGROUND: Intrauterine contraceptive devices (IUCDs) have been used by women in India for decades for spacing pregnancies. The increased institutional deliveries are an opportunity to provide women easy access to immediate PPIUCD services. Hence, we planned a study to evaluate the role of a novel dedicated inserter technique to improve compliance in postpartum women. MATERIALS AND METHODS: A prospective case–control study was conducted on postpartum women who underwent vaginal delivery. Cases were selected and divided randomly into two groups: the long inserter (n = 292) and control groups (n = 301 using conventional method of insertion). PPIUD was inserted by trained providers, followed by ultrasound within 48 hours of insertion to assess location and fundal placement of the IUD. Follow-up was done at 2 weeks, 6 weeks and 3 months post-insertion, and ultrasound assessment was done for IUD location at each visit. Final statistical analysis was done by using Chi-square test. RESULTS: There were fewer complications like pain and irregular bleeding in the long inserter group as compared to the control group. None of the cases reported missing thread in the long inserter group. Expulsion was seen in only one case from the long inserter group and five cases in the control group. Client satisfaction was good (98.4%) in the long inserter group, and with each follow-up, satisfaction level also improved in the control group (96.6%, p value− 0.03). CONCLUSION: The long inserter PPIUD insertion is a safe and convenient method. It has better ease of insertion, high fundal placement and good thread visibility and has reduced risk of infections as compared to the conventional PPIUD insertion technique. more...

Introduction. Integrated use of postpartum intrauterine contraceptive devices with delivery service during the immediate postpartum period is ideal for both women and health-care providers. However, utilization of intrauterine contraceptive devices during the postpartum period was rare and in Ethiopia, with information regarding uptake of postpartum intrauterine contraceptive devices limited. Objective. Identify determinants of postpartum intrauterine contraceptive devices uptake among women delivering in public hospitals of South Gondar zone, Northwest Ethiopia, 2019. Methods. An unmatched case-control study was conducted in public hospitals of South Gondar, Ethiopia, from August 1, 2019, to November 10, 2019. A total of 140 cases and 280 controls have actively participated in the study. Five hospitals were selected by simple random sampling. Cases were selected consecutively, whereas two controls for each case were recruited by the lottery method. Pretested questionnaires were used to collect data and it was entered into Epidata version 4.4.2. Logistic regression analysis was used to identify variables associated with the use of outcome and adjusted odds ratio with a 95% confidence interval was used to determine the association between independent and outcome variables. Results. Completing secondary education (AOR = 4.5, 95%CI 2.3–8.85), having a total number of children of 3–4 (AOR = 3.6, 95%CI 1.25–10.2), having ≥ 5 (AOR = 4.7, 95%CI 1.5–15.3), attending 3 antenatal care (AOR = 2.8, 95%CI 1.44–5.6), ever hearing about postpartum IUCD (AOR = 6.6, 95%CI 2.7–16.1), and having counseling from health-care provider about a postpartum intrauterine contraceptive device (AOR = 6.2, 95%CI 2.99–12.8) were significantly associated with uptake of the postpartum intrauterine contraceptive. Conclusion and Recommendation. Completing secondary education, having 3–4 and ≥5 children, attending three antenatal care, ever hearing about postpartum IUCD, and having counseling from health-care providers about the postpartum intrauterine contraceptive device among women were significantly associated with uptake of an intrauterine contraceptive device after birth. Therefore, it is better to advise women to strictly follow their antenatal care, access to information, and provide counseling. more...

Intrauterine contraceptive device (IUCD) is convenient, a one-time procedure, OP procedure, long-acting, cheap, having less side effects and reversal of fertility is soon after removal, makes it suitable temporary contraception. To improve its usage and to improve the Nation's economy by uplifting family health is by creating awareness among women. This can be achieved by counselling, health talks, educating them. These targets can be met during their visit to hospitals for general ailment or by public awareness programs. The objective of this study is to evaluate knowledge, awareness towards the IUCD among Indian women in the reproductive age group (18 to 45 years) in a tertiary care teaching hospital. A Cross-Sectional Mixed Research from January 2019 to June 2019 was done among patients in the age group of 18-45 years attending the outpatient department of a tertiary care teaching hospital. The analysed results showed only 63% of participants were aware about the need for birth spacing and limiting child birth. 47% of participants interviewed knew that the device is used to prevent pregnancy while the rest didn't even know what an IUCD is. This survey concludes poor awareness about the IUCD among women in the study group. We have to improve the awareness and usage of IUD with proper health education and counselling. more...

Objective To compare TCu380Ag and TCu380A intrauterine contraceptive devices after 1 year of use. Methods A prospective randomized controlled trial was conducted among healthy married women aged 20-35 years who attended the family planning clinics of three tertiary centers in India between August 1, 2015, to March 31, 2018. The TCu380Ag group (n=300) received one of three sizes of this device depending on uterocervical length: maxi (8.0-9.0 cm), normal (7.0-8.5 cm), or mini (6.0-7.5 cm). The remaining 300 participants received TCu380A. Follow-up was conducted at 3-monthly intervals to assess continuation rate, acceptability, efficacy, adverse effects, and complications. Results The TCu380Ag group had a higher continuation rate than the TCu380A group at 1 year (84.0% vs 75.8%; P=0.01), with an efficacy of 99.6% versus 100.0% (P>0.05). Overall estimated continuation rates were 94.5% (95% confidence interval [CI] 91.7%-96.4%) and 88.4% (95% CI 83.2%-91.5%), respectively (P=0.026). Use of TCu380Ag was associated with fewer adverse effects (heavy menstrual bleeding, abdominal pain, or expulsion) when compared with TCu380A (P>0.05 for all comparisons). Discontinuation rates owing to adverse effects were 6.59% for TCu380Ag versus 13.26% for TCu380A (P=0.01). Conclusions Varying sizes of TCu380Ag could provide an alternative to TCu380A. more...

Intrauterine contraceptive devices (IUCDs) are a popular treatment choice for contraception. We report a case of a woman in her forties who presented to a urology clinic with visible haematuria. Flexible cystoscopy revealed a bladder lesion, suspicious for a tumour. However, subsequent imaging determined that this was in fact the arm of an IUCD, sited 7 years previously, which had migrated into the bladder. The patient underwent an uneventful robotic-assisted laparoscopic removal of the device. IUCD-related complications are infrequent and can present atypically, warranting a broad diagnostic approach. Robotic-assisted laparoscopic removal of devices migrating into pelvic structures offers all the advantages of minimally invasive surgery, with the added benefits of three-dimensional views and endowrist movement facilitating tasks such as intracorporeal suturing. We report the first documented case of utilizing the da Vinci robotic system in safely assisting the removal of a migrated IUCD. more...

Introduction Intrauterine contraceptive devices (IUCD) are a commonly used, reversible, contraceptive method. Complications from insertion rarely include migration into the bladder. We report on two cases of intravesical migrated IUCD and present an algorithm for management based on recently published data. Materials and Methods The case records of two patients who underwent surgical procedures for migrated IUCD into the bladder were reviewed. A Pubmed search was performed to identify similar studies. A total of 25 papers met the criteria for inclusion. Results Both cases were managed with laparotomy and partial cystectomy. A review of literature suggests recently reported cases of IUCD migration are rising, with most cases having been reported in the last decade. Bladder calculus developing over the migrated IUCD is the most common presentation. Most cases have been managed using endourological techniques. A small number of cases have required open vesicolithotomy or laparoscopic surgery. Rarely, laparotomy has been required. Discussion IUCD migration into the bladder remains rare, however, recently the number of reported cases has risen. A thorough physical examination and radiological evaluation are warranted. Management is surgical in all cases. Most cases can be managed with endourological techniques. A treatment algorithm has been suggested in this paper based on recent data. Conclusion With the rising use of contraception worldwide, the incidence of IUCD migration is possibly going to increase. Treating doctors need to be aware of the possible complications that may arise from a migrated IUCD, including bladder calculi. more...

Background: Radiology plays a vital role in the diagnosis of intrauterine contraceptive device (IUCD) migration. Ultrasound (US) is used for initial evaluation. It is inexpensive and widely available. The X-ray is required for the diagnosis of (IUCD) expulsion as all (IUCDs) are radiopaque and rarely computed tomography (CT) is used. Aim of the study: Evaluation of the role of different radiological modalities in the assessment of mal-positioned (IUCDs). Subjects and methods: A Cross-sectional study in the radiology department at Al Ahrar teaching hospital. Fifty patients were included with suspected misplaced (IUCD) over one year. Results: (US) was able to detect (IUCD) position in 88%, while in 12% (IUCD) could not be localized. X-ray was performed for 42 % and could confirm (US) result and exclude (IUCD) expulsion. (CT) was performed for 18% and could detect (IUCD) location when not seen in (US) and detect the associated complications. There was a significant agreement between the three diagnostic techniques and intraoperative findings. Conclusion: (US) is the first modality used in the diagnostic workup of the misplaced (IUCD), but it is not reliable if the omentum and bowel loops surround the device. The X-ray can help confirm (US) result and exclude expulsion. Rarely (CT) is used for (IUCD) localization. However, (CT) is the best for the evaluation of complications associated with intra-abdominal (IUCDs) and has a role in determining the proper method of removal. more...

Background: The use of intrauterine contraceptive device (IUCD) generally has been known to be safe and effective but tends to have some side effects. Reproductive tract infection is one of the major complications caused by prolonged usage of an IUCD. Cervical smears have shown an increase in inflammation, inflammatory epithelial changes, or metaplastic cells among the IUCD users as compared to nonusers. There is also a predisposition to higher rate of infections such as Actinomyces, atypical squamous cells of undetermined significance, and low-grade squamous intraepithelial lesion. Aims and Objectives: The aim of this study was to study changes in cervical cytology in IUCD users and to assess the risk of epithelial cell abnormalities among IUCD users compared to nonusers. Materials and Methods: A 2-year cross-sectional study was carried out to screen Papanicolaou (Pap) smears in women of the reproductive age group who were categorized as IUCD and non-IUCD users. Results and Observations: A total of 1100 (550 + 550) Pap smears from IUCD and non-IUCD users were analyzed. Among IUCD users, 544 cases (98.90%) were adequate for reporting including 533 cases (97.98%) showing negative for intraepithelial lesion or malignancy (NILM) and 11 cases (2.02%) showing epithelial cell abnormality (ECA). In non-IUCD users, 541 cases (98.36%) were adequate for reporting. Among these, 538 cases (99.44%) showed NILM and 3 cases (0.56%) showed ECA. Conclusion: In IUCD users, the prevalence of infections and ECA is higher than non-IUCD users. more...

Background The postpartum intrauterine contraceptive devices (PPIUCD) is the only family planning method for couples requesting highly effective, reliable, inexpensive, non-hormonal, immediately reversible, and long-acting contraceptive that can be initiated during the immediate postpartum period and it has no a negative effect on lactation. Despite these benefit, the acceptance and utilization of immediate PPIUCD were very low and the reasons for rejecting immediate PPIUCD usage have not been characterized in Southeast Ethiopia. Therefore, this study determined the level of acceptability and factors associated with immediate PPIUCD use among women who gave birth at Bale zone health facilities, Southeast Ethiopia. Methods A facility based cross-sectional study was conducted from March to July 2017 in Bale zone health facilities. Four hundred twenty-nine women were successfully interviewed using structured and pre-tested questionnaire. Health facilities were selected by lottery method. Study participants were selected systematically. Data were entered into Epi data version 3.1 and exported into SPSS version 21 for analysis. Logistic regression analyses were done. A significant association was declared at a p-value less than 0.05. Results The acceptance of immediate PPIUCD usage was 12.4%. Non-acceptors reported their reasons for rejecting PPIUCD use; concern and fears of complications (24.8%), religious beliefs (19.8%), and husband refusal (17.7%). Respondents who had completed secondary education were more likely to accept PPIUCD usage than those who had no formal education (AOR = 3, CI = 11.81, 53.91). In addition, the odds of accepting PPIUCD insertion was higher among women who attended 3 antenatal care visits than those who did not attend antenatal care visits for the current birth (AOR = 1.81, CI = 0.34, 0.85). Conclusions The acceptance of immediate PPIUCD usage was still low. This might be attributed to the low achievement of education, perceived concern and fears of complications towards IUCD insertion. The male partner’s refusal and religious beliefs also have a role in the usage of postpartum IUCD. Due attention should be given to enhancing educational level of women and effective IUCDs counseling should be given during antenatal care visits to correct misconceptions and fears of complication about PPIUCD insertion. Electronic supplementary material The online version of this article (10.1186/s40834-018-0071-z) contains supplementary material, which is available to authorized users. more...

Background: Intrauterine contraceptive devices (IUCDs) are the most frequently used method of reversible female contraception worldwide, but their utilization varies considerably in different countries. Objectives: The objective of this study is to determine the pattern of use of IUCD, sources of referral, its associated complications and reasons for its discontinuation over a 10-year period. Materials and Methods: This was a retrospective study of all the women who sought contraceptive services at the Family Planning Clinic of the Lagos University Teaching Hospital over a 10-year period (January 1, 2006, to December 31, 2015). The case notes of these women were retrieved and relevant data extracted. Descriptive statistics were computed for the data, and results were presented in simple tables and charts. Results: A total of 1726 women accessed contraceptive services during the period under review with 521 (30.2%) choosing IUCD as their preferred method. A majority of the clients were aged between 30 and 34 years (34.5%) and multiparous (92.3%). The largest proportion of the studied clients (71.9%) had up to the tertiary level of education with the majority of the referrals coming from nurses (39.5%) and doctors (20.0%). The most common undesirable effect reported by the clients was abnormal vaginal discharge (40.8%) while 40.7% of the women discontinued the use of the IUCD prematurely. The most common reason for discontinuing the use of IUCD was the occurrence of an undesirable effect (44.8%). Conclusions: Our study revealed a modest decline in the uptake of IUCD among contraceptive users in Lagos. Health-care providers still appear to be the best source of information and referral as they play a crucial role in influencing women's acceptability of these services. more...

Contraception is a new topic gaining attention in country like India and a new proposed area of research. Intrauterine contraceptive devices (IUCDs) are one contraceptive method requiring less efforts and having more efficacy. ‘Misplaced IUCD’ is one of the rare and the most dreadful complication of IUCD insertion. Clinically, it can present as having pain, bleeding, recurrent pregnancy loss or can be asymptomatic. This is a case report of a 40 year old P4A1L4 female who presented to us with suspicion of misplaced IUCD without clinical symptoms. Clinical examination and radiological investigations made a diagnosis of misplaced IUCD and laparoscopy confirmed it. Laparoscopically misplaced IUCD was removed. more...

The various relationships between hysteroscopy and contraception are discussed, including hysteroscopic sterilisation, hysteroscopic placement of long-acting reversible contraception (LARC) devices, and hysteroscopic methods of solving problems related to contraceptive devices (sterilisation and intrauterine contraceptive devices). more...

Intrauterine Contraceptive Devices are among the safest and most effective reversible contraceptives used worldwide. It is also the most effective emergency contraception and particularly suitable for women in developing countries as they are affordable, convenient and do not require frequent visits to the clinic. To review the profile and prevalence of intra uterine contraceptive device acceptors at the Rivers State University Teaching Hospital (RSUTH). A 10 year retrospective review of all 814 clients’ records that accepted intrauterine contraceptive device in the family planning clinic of the hospital from 1stJanuary 2008 - 31stDecember 2017. Data was extracted, coded and analyzed using the statistical package for social sciences (SPSS) IBM version 25.0 (Armonk, NY).There were 1893 contraceptive acceptors during the study period, out of which 814 (43%) accepted the IUCD, which was the highest compared to other contraceptives. Majority of the clients 762 (93.6%) were between the age range of 25-44 years, married 779 (96%), multiparous 512 (62.9%), Christians 779 (96%) and 805 (98.9%) had formal education with secondary level of education being the highest, 610 (74.9%). Clinical personnel were the commonest source of information, accounting for 634 (77.9%). Though the uptake rate of IUCD was the highest among the contraceptives in the family planning clinic during the study period, there is still need to improve on its uptake by creating more awareness including on its effectiveness as an emergency contraception. more...

Background: To investigate the hypothesis that increased uptake of long-acting reversible contraception (LARC) by women played a role in the declining abortion rates observed in New Zealand between... more...

Objective: Studying sub endometrial vascularity and blood flow in cases using intrauterine contraceptive devices for contraception with and without menorrhagia compared to cases not using intrauterine contraceptive devices. Methods: Three hundred and fifteen women attending gynecology and family planning outpatient clinics in the maternity hospital, Ain Shams University were included in the study. They were classified into three groups, 105 women using IUCD with menorrhagia (group I), 105 women using IUCD without menorrhagia (group II), and 105 normal controls not using IUCD (group III). After excluding local causes for bleeding, blood disease or any medical disorders, transvaginal ultrasound including three dimensional power Doppler (3DPD) ultrasound was done for all women. Right and left uterine artery pulsatility index (PI) and resistance index (RI) were calculated, subednometrial blood flow RI and PI were obtained then 3DPD Vascular indices (VI, FI and VFI) of subendometrial blood flow were obtained for all cases. Statistical analysis was done to compare between the three groups. Results: A significant statistical difference was found as regards subendometrial vascularity indices, while there was no difference as regards bilateral uterine arteries Doppler indices in the three groups. Conclusion: Subendometrial vascularity in cases of menorrhagia with IUCD was markedly higher than in cases without menorrhagia and cases with no IUCD. 3DPD may be used for selection of cases prior to insertion of IUCD. more...

Objective: India is first to introduce family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). To assess the acceptability and safety of Postpartum Intrauterine Contraceptive Device insertion among women on bases of two key outcomes of PPIUCD insertions — expulsion and infection,who delivered at Rajkiya Mahila Chikitsalya J.L.N. Medical College and Hospital. Method: this is a prospective interventional analytical study. The postpartum family planning services offered are in the form of health education in group counseling session at the postnatal ward. Results: Total women counseled 1000, accepted 312, declined 688, lost to follow up 56, followed up 256, complications 82 (Expulsion 8, Bleeding 21, String problem 32, Removal 8, continuation 231) Interpretation and conclusions: Immediate post-partum IUCD insertion provides highly effective contraception immediately after delivery. Although the expulsion rate for immediate post-partum is higher than for interval insertion particularly in country where women have limited access to medical care. The government needs to develop strategies to increase public awareness of the PPIUCD through different media sources. It is also important to arrange training on PPIUCD in order to increase knowledge and skills among health care providers. This will also further promote PPIUCD use and aid in reduction of expulsion rates. Case incentives to the acceptor, motivator and provider will bring about substantial progress in the PPIUCD use in developing countries like India. more...

Objective As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertions — expulsion and infection — for physicians and nurses/midwives to generate evidence for task sharing. Study design We analyzed secondary data from the PPIUCD program in seven states using a case–control study design. We included facilities where both doctors and nurses/midwives performed PPIUCD insertions and where five or more cases of expulsion and/or infection were reported during the study period (January–December 2013). For each case of expulsion and infection, we identified a time-matched control who received a PPIUCD at the same facility and had no complaints. We performed a multiple logistic regression analysis focusing on provider cadre while controlling for potential confounding factors. Results In 137 facilities, 792 expulsion and 382 infection cases were matched with 1041 controls. Provider type was not significantly associated with either expulsion [odds ratio (OR) 1.84; 95% confidence interval (CI): 0.82–4.12] or infection (OR 0.73; 95% CI: 0.39–1.37). Compared with centralized training, odds of expulsion were higher for onsite (OR 2.32, 95% CI: 1.86–2.89) and on-the-job training (OR 1.23, 95% CI: 1.11–1.36), but odds of infection were lower for onsite (OR 0.45, 95% CI: 0.27–0.75) and on-the-job training (OR 0.31, 95% CI: 0.25–0.37). Conclusion Trained nurses and midwives who conduct deliveries at public health facilities can perform PPIUCD insertions as safely as physicians. Implications Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services. more...

Background: Post-partum period is defined to be an ideal time for family planning counselling. Being a second largest populated country, India has a high rate of unintended pregnancy especially in post- partum women. There is a need for accessible, reliable contraception like post-partum intra uterine contraceptive device (PPIUCD) in our country. The present study is an attempt to evaluate the safety and efficacy of intra- uterine devices in post-partum women.Methods: The study population included all the women who delivered vaginally who were counselled for PPIUCD insertion in prenatal period, early labour and within 48 hours of delivery and were willing to participate in the study. Participants were interviewed prior to discharge after receiving a PPIUCD and then six, ten, fourteen weeks and 6 months or earlier when necessary. Institutional ethical approval and informed consent were taken.Results: A total of 1625 deliveries took place out of which only 888 were inserted PPIUCD. So, the total acceptance rate was 54.6%. Majority of cases were between the age group of 21-25 (46.4%) and most of them were primipara (39.8%). 34.8% came for routine follow up in OPD at 6 weeks, 14% at 6 months and 6.1% at 1 year.Conclusions: The IUCD insertion has been proved to be a safe and effective method of contraceptive with very few side effects and no major complications. To increase the knowledge and skills among health care providers, it is necessary to arrange training on PPIUCD. more...

OBJECTIVE To assess the effects of strengthening family planning capacity on the uptake of long acting reversible contraceptive (LARC) methods at two primary health centers. METHODS Between April 2016 and March 2017, the Society of Gynecologists and Obstetricians of Burkina Faso (SOGOB) increased the capacity of two primary health centers in Ouagadougou, Burkina Faso, to offer LARC methods by training staff and providing family planning equipment and commodities. Uptake of LARC methods was compared between the year preceding the intervention and the year during the intervention. RESULTS Within a year, the number of new users of family planning increased 2.8-fold from 2936 new users before the intervention to 8267 during it. The rate of new users of contraception increased 1.9-fold (14.9% vs 28.1%; P more...

Intrauterine contraception (IUC) is one of the more effective contraceptive methods for women at highest risk of unintended pregnancy. This includes younger, often nulliparous, women; however, uptake has been relatively low in this group.In February 2017 we conducted a systematic review of randomised controlled trials, prospective and retrospective observational studies to identify barriers to IUC use in nulliparous women.Study quality was poor. No differences in rates of infection or expulsions between nulliparous and parous were seen. Fertility rates following removal appeared no different from the general population. Higher rates insertion difficulty, insertion failure and pain during insertion were observed in nulliparous women.A long-acting reversible contraceptive method such as IUC reduces the risk of unintended pregnancy since user failure is minimised. Evidence-based information about the advantages and disadvantages of IUC is required to inform decision-making and dispel any myths and misperceptions. Potential barriers to IUC use in nulliparous women, particularly concerns around infection, significantly higher rates of device expulsion and adverse effects on fertility, do not appear to be justified. IUC is appropriate for all medically-eligible women, including nulliparous women, and should be included in the range of contraceptive options discussed during counselling. more...

Although many complications have been reported with intrauterine contraceptive devices (IUDs), vesicovaginal fistula with secondary vaginal stones is rare. We report the case of a 46-year-old woman who presented with a vaginal discharge lasting 2 months. Two years previously, she had undergone cystoscopic lithotripsy and surgery to remove an IUD, after pelvic radiography had revealed a fractured Chinese stainless steel ring IUD with secondary vesical stones that had been the cause of her urinary tract symptoms. When she again complained of vaginal discharge, vaginal stones and a vesicovaginal fistula were found on physical examination and CT urography. The patient underwent stone removal and concurrent vesicovaginal fistula repair. IUD fragments were found in the vesicovaginal and rectovaginal spaces. No abnormalities were found at follow-up 6 months after surgery.In any woman undergoing surgery to remove a migrated IUD, complete exposure and removal of the IUD are necessary to avoid fracturing of the IUD, secondary breakage and residue. more...

BACKGROUND: In spite of many advantages intrauterine contraception (IUC) is underutilised in Australia: only 5% of Australian women using contraceptive methods in 2011 were using IUC. AIMS: In 2012 Family Planning New South Wales (FPNSW) commenced training registered nurses (RNs) to insert IUC. This article reports outcomes of insertion attempts by the first four trained RNs and suggests strategies for increasing IUC utilisation in Australia. MATERIALS AND METHODS: Data regarding client characteristics and outcomes of insertion attempts including relevant adverse events that occurred during a 6-month follow-up period after the IUC insertions were retrospectively extracted from the FPNSW clinical record system and analysed in SPSS. RESULTS: Of 207 insertion attempts by RNs 91% were successful without Medical Officer (MO) assistance. The likelihood of insertion attempts being successful did not differ significantly between nulliparous and parous clients. Incidence of a postinsertion adverse event was equal to or less than rates in previous studies. All adverse events involved parous clients. CONCLUSIONS: We have shown that RNs who undertook competency-based IUC insertion training had a high rate of successful insertions and a low rate of adverse outcomes. Utilisation of IUC in Australia could be increased by engaging RNs as inserters and it is timely to review the barriers that make it difficult for private medical services to employ RNs to insert IUC. more...

Objectives To assess the prevalence of anemia and VulvoVaginal Candidiasis (VVC) in women before and 3 months after copper Intra Uterine Device (IUD) insertion. Methods Longitudinal prospective study was performed with 101 women aged 15–45 year who wanted to use the IUD at six health centers in Tehran, Iran from November 2011 to August 2012. The pattern of bleeding, Hemoglobin and Hematocirt levels, and Candida colony count/cultures in the women were assessed before and after 3 months of IUD insertion. Data analysis was performed by descriptive and analytical statistics using the SPSS software for Windows. Results At the end of 3 months, a significant increase in menstrual blood loss and a significant decrease of Hb and HCT ( P = 0.047 and 0.001, respectively) were reported. Moreover, no difference in the prevalence of anemia before and after IUD insertion was observed. The mean ± SD Candida colony counts significantly increased ( P = 0.001), but positive Candida cultures were not significantly different before and 3 months after IUD insertion. Also, no clinical VVC was reported 3 months after IUD insertion. While BMI ≥ 29 had a positive relationship with Candida colony counts, the results remained unchanged after adjusting for potential risk factors. Conclusions Despite an increase in bleeding and Candida colony counts in copper IUD users in this study, clinical VVC or anemia cases were not increased, which indicates relative safety of this contraception method. The study findings can be helpful to healthcare professionals and midwives to counsel women who want to start using IUD and also current users who are contemplating IUD removal due to its complications. more...

Background. One of the strategies to reduce maternal mortality includes accessible and appropriate contraceptive services to all women. The intrauterine contraceptive device (IUCD) has been identified as a cheap and effective means of contraception by the South African National Department of Health.Objective. To explore knowledge about the IUCD among women using the public health sector and identify any misconceptions.Methods. A sample of 150 women attending antenatal/postnatal clinics were interviewed using a structured questionnaire.Results. Forty-six percent (n=69) had some experience with the injectable form of contraception, and 2.7% (n=4) had used the IUCD; 70.7% (n=106) knew that the device does not prevent HIV transmission, 40.7% (n=61) knew that HIV-positive women can use the IUCD, 75.3% (n=113) believed that the IUCD causes heavy bleeding, 36.7% (n=55) knew that the device does not stop fertility indefinitely, 33.3% (n=50) knew that the IUCD can be inserted in the immediate postpartum period, and 26.7% (n=40) knew that the duration of use is 10 years. In terms of attitudes, 40.0% (n=60) expressed concern about the pain during insertion, 33.3% (n=50) believed the IUCD can cause cancer, and 32.0% (n=48) believed that the device interferes with normal sexual activities. Most participants 77.3% (n=116) acquired the information they had about the IUCD from the clinic during teaching and counselling sessions.Conclusion. This survey documented poor knowledge about the IUCD among women using the public health sector. However, the fact that there are few misconceptions and that clients rely on the clinic information should be seen as an opportunity to improve the situation. more...

Background: The objective of the study was to evaluate the safety and efficacy of immediate postpartum intrauterine contraceptive device (PPIUCD) insertion in women delivering vaginally or by cesarean section. Methods: This prospective study was carried out at General Hospital [Tertiary care] from August 2014 to September 2015. All antenatal patients admitted for delivery to our hospital were counseled for PPIUCD. Also consent was taken from those who opted for PPIUCD insertion. Results: A total of 2016 women were counseled for PPIUCD adoption. Out of this, 1312 women accepted this method. Total number of deliveries during the study period was 2835. Total acceptance rate was 46.27%. The expulsion rate was 10.63% while removal rate was 7.74%. Out of 555 women who came for follow up, 453 women continued PPIUCD. Thus, continuation rate was 81.62%. Conclusions: PPIUCD is easily accessible, reversible and cost effective contraceptive method for most postpartum women specially lactating women. more...

Background A wide variety of complications due to the extrauterine migration of intrauterine contraceptive devices have been reported in the literature. Here we describe the case of a large bladder stone formed around a migrated Copper T380A device that was neglected and detected 15 years after insertion. Case presentation A 48-year-old Sri Lankan woman underwent a workup for lower urinary tract symptoms and recurrent urinary tract infections over the previous 6 months. The radiographs showed a large bladder stone with an imprint of an intrauterine contraceptive device in the center of it. The device had been inserted 15 years previously. Two years after the insertion, it was considered to be missing, but our patient did not comply with the recommended follow-up. She had been completely asymptomatic until she developed lower urinary tract symptoms. After confirming the location of the stone via ultrasonography, a vesicolithotomy was performed, revealing a stone with three limbs corresponding to the shape of the Copper T380A device. The device and the threads were fully covered with the stone material. Our patient was asymptomatic following the surgery. Conclusions A migrated intrauterine contraceptive device can act as the nidus for the formation of a secondary bladder stone. The detailed imprint of the device inside the stone and the laminated appearance of the stone material were characteristic of a secondary bladder stone formed around an intrauterine contraceptive device. Radiography and ultrasonography are adequate for the diagnosis of intravesical migration of intrauterine contraceptive devices. more...

Background and objectiveIntrauterine contraceptive devices (IUDs) are an important method to reduce unmet need for family planning and for prevention of unintended pregnancy. However, IUD use in Malaysia is still low. Doctors play a major role in influencing IUD uptake among women. This study was designed to evaluate doctors’ knowledge, attitudes and perceptions towards IUDs and factors associated with their current practice.MethodsA questionnaire was mailed to public and private contraceptive providers who practise in Kuala Lumpur, Malaysia.ResultsA total of 400 doctors were invited and 240 (60%) of them responded to the survey. Of the respondents, 161 (65.9%) were from the public or government sector and 89 (34.1%) were from the private sector. The knowledge score of doctors was classed as ’average', and correlated well with their previous training level, working position, number of patients seen in a week and number of contraceptive methods available in their facilities. The age, gender, working duration, availability of IUDs in the premises and number of IUD insertions in a month were not statistically associated with the providers’ knowledge. The use of IUDs was low, especially among private doctors, and was significantly related to their knowledge of the method. Knowledge scores, perception and practice were significantly lower in the private sector. more...

Background: Providing quality contraceptive services to women is essential for achieving maternal and child health. Objective of this study was to evaluate the efficacy of intra-caesarean insertion of copper IUCDs as postpartum contraception. To study the side effects of intra caesarean copper device. To study the continuation rates of intra-caesarean copper IUCDs. To study the acceptability of intra-caesarean copper IUCD as immediate postpartum contraceptive.Methods: The prospective study was undertaken at Bhaskar medical college and general hospital, Yenkepally, Moinabad, Telangana, between January 2016 and March 2018 after ethical committee clearance. About 60 pregnant women were enrolled into the study after an informed written consent regarding the procedure, benefits and complications and the need for follow up for at least one year. Copper T 380A/multiload copper 375 was inserted into the uterine cavity after delivery of the placenta and membranes during caesarean section. Patients were followed up at 6 weeks, 6 months and one-year intervals for any complaints, visibility of threads and for ultrasound examination for position of copper IUCDs in the uterus. Data analysis was done using Microsoft excel 2016.Results: Nearly 48.33% continued intra-caesarean copper IUCDs for more than 1 year. 70% did not have any complaints. 86.67% came for more than one follow-up visit. 47% had copper IUD threads visible by one year. No case of perforation either during insertion or during continuation was noted. None conceived with copper IUCD in situ. Removal of copper IUCD was also easy and none required hysteroscopic removal.Conclusions: Intra-caesarean copper IUCD insertion is a safe and effective long acting reversible contraceptive method in the postpartum period. more...

Background: Immediate postpartum intrauterine contraceptive device (PPIUCD) is a lucrative postpartum family planning method which provide an effective reversible contraception for women in delivery settings. PPIUCD can be inserted post-placental, intra-caesarean and within 48 hours postpartum. We conducted this study to determine the outcome, satisfaction rate and continuation rate of PPIUCD. Materials and Method: This was a prospective observational study conducted in a tertiary care teaching institute. CuT 380A was inserted within 10 minutes of placental delivery in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications for PPIUCD. They were then followed up for 3 months. A Cohort of 260 vaginal and caesarean deliveries with PPIUCD in situ were studied over seven months period and follow-up results were compared between Vaginal and Caesarean groups. Result: Overall expulsion rate was 8.47%, removal rate was 14.83% and continuation rate was 76.7%. There was no significant difference in removal rate of two groups. Spontaneous expulsion occurred in 8.47% cases and were significantly higher in vaginal insertion group (p value 0.0017). Overall complication rate was low. No case of perforation or accidental pregnancy was reported. Conclusion: PPIUCD is a safe, highly effective, long acting, cost effective method of postpartum contraception, which can be used during institutional delivery visit and eliminates the need for a return visit to start contraception. PPIUCD is a strong weapon in the family planning armory and should be encouraged in both vaginal and caesarean deliveries. more...

AIM: The aim of this study was to investigate the presence of biofilm formation around intrauterine contraceptive devices (IUCD) and to correlate the microbiological profile of the IUCD-associated genital infections to the microbiological profile of specimens retrieved from vaginal discharge. MATERIAL AND METHODS: Samples of the vaginal discharge in the posterior fornix were collected from 50 women attending the Family Planning Clinic in Ain Shams University Hospital using two high vaginal swabs. Swabs were immediately sent for Gram staining as well as microbiological culture. The IUCD was then removed. A 0.5-cm piece of the removed IUCD was cut and sent for culture. Growing colonies were tested for their abilities to form a biofilm (colorimetric method). Another 0.5-cm piece of the removed IUCD was examined by electron microscopy (EM) for detection of biofilm formation. RESULTS: Among the included 50 women 24 (48%) women showed biofilm formation (via colorimetric methods). EM scanning was able to detect biofilm formation in the prepared pieces of the removed IUCD of 48 (96%) women. There was no significant agreement between the isolated microorganisms on the removed IUCD and the vaginal swab (proportion of agreement was 14 [11.4%]; kappa = -0.089 P = 0.892). CONCLUSION: Scanning EM is a useful tool in detection of biofilm formation on removed IUCD. (c) 2014 The Authors. Journal of Obstetrics and Gynaecology Research (c) 2014 Japan Society of Obstetrics and Gynecology. more...

Intrauterine contraceptive devices (IUCD) are a safe and cost-effective contraceptive method for medically eligible women. Despite this, the utilisation rate for IUCDs is relatively low in many high-income countries, including Australia. Provision of education and training regarding IUCDs to healthcare providers, including nurses and midwives, is one approach to overcome some of the barriers that may prevent wider uptake of IUCDs. This study aims to explore the types and impact of IUCD insertion training for healthcare providers. A systematic review was undertaken in January 2017 to determine the effectiveness of IUCD training for healthcare providers in relation to provision of IUCDs to women. The databases MEDLINE, EMBASE, CINAHL, COCHRANE and SCOPUS were searched to identify studies from high-income countries relating to IUCD training for healthcare providers and relevant outcomes. A total of 30 studies were included in the review. IUCD training for healthcare providers contributed to increased knowledge and improved positive attitudes towards IUCDs, high rates of successful insertions, low complication rates, and increased provision of IUCDs. Successful insertions and low complication rates were similar across different healthcare provider types. No notable differences between provider types in terms of knowledge increase or insertion outcomes were observed. Different training programs for healthcare providers were found to be effective in improving knowledge and successful provision of IUCDs. Increasing the number of healthcare providers skilled in IUCD insertions in high-income countries, including nurses and midwives, will enhance access to this method of contraception and allow women greater contraceptive choice. more...

Intrauterine contraceptive devices (IUCD) are an effective way for contraception. Proper patient education at the time of placing the IUCD is important. Otherwise, they may not come for device removal at appropriate time, and it may be left in situ and forgotten, which can lead to complications at a later date. Here, we present a case of a 76-year-old lady who came with postmenopausal bleeding due to a forgotten IUCD leading to actinomycotic endometritis. The device was removed hysteroscopically under general anesthesia followed by appropriate antibiotics and the patient recovered well. more...

More than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. Objective: The study was conducted to assess the safety incidence of perforation/pain/bleeding/foul discharge and expulsion rates at 6 week follow-up and willingness to continue when Copper T 380A (Cu T 380A) inserted within 10 minutes of placental expulsion both in vaginal and C-section deliveries. Methods: This was an open label, prospective, and multicentric longitudinal study. The study was approved by the Ethics Committee of FOGSI. Results: The insertion of Intrauterine Contraceptive Devices (IUCD) was easy in 98.76 per cent of subjects after normal delivery, and 100 per cent in all subjects after assisted vaginal and c-section deliveries. The position of the Cu T was in situ in 97.61 per cent of subjects, ultra sonogram was used in 1 per cent to confirm location of IUCD and in 1 per cent of subjects the IUCD was in the cervix. There was no case of perforation in this series and no other major complications. Conclusion: Inserting Cu T 380A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus. more...

Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy but do not protect against sexually transmitted infection (STI). Recent efforts to improve access to intrauterine devices (IUDs) and implants have raised concerns about STI prevention and reduced condom use, particularly among teenagers and young women. We evaluated whether a provider-targeted intervention to increase LARC access negatively impacted dual method use and STI incidence among an at-risk patient population. We conducted a cluster randomized trial in 40 reproductive health centers across the United States from May 2011 to May 2013. After training providers at 20 intervention sites, we recruited 1500 sexually-active women aged 18-25years who did not desire pregnancy and followed them for one year. We assessed intervention effects on dual method use, condom use and STI incidence, modeling dual method use with generalized estimating equations and STI incidence with Cox proportional hazard regression models, accounting for clustering. We found no differences between intervention and control groups in dual method use (14.3% vs. 14.4%, aOR 1.03, 95% CI 0.74-1.44) or condom use (30% vs. 31%, aOR 1.03, 95% CI 0.79-1.35) at last sex at one year. STI incidence was 16.5 per 100 person-years and did not differ between intervention and control groups (aHR 1.20, 95% CI 0.88-1.64). A provider training intervention to increase LARC access neither compromised condom use nor increased STI incidence among young women. Dual method use was very low overall, highlighting the need to bolster STI prevention efforts among adolescents and young women. more...

Intrauterine contraceptive devices (IUD) are a popular method of birth control, typically with minimal side effects, and are used worldwide. Serious side effects such as uterine perforation are rare. Most often, a perforated IUD is found in the intraperitoneal space, although in rare instances, an IUD may perforate to the urinary bladder. In the case presented, a combination of 2D and 3D sonography was used to identify a missing IUD within the urinary bladder. The IUD was removed by cystoscopy without serious consequences to the patient. more...

To compare the incidence of visible strings after postplacental intracesarean insertion of Cu375 and CuT380A intrauterine contraceptive devices (IUD).This was a prospective, randomized comparative study. A total of 100 women fulfilling the inclusion and exclusion criteria underwent postplacental intracesarean insertion of either Cu375 IUD or CuT380A IUD. Women were followed up at 1, 6 weeks and 3 months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualize the IUD strings. Data were analyzed by Chi-square test.At 6-week follow-up, 97.9% women in group A versus 41.7% women in group B had strings visible at the cervical os and at 3 months 100% women in group A versus only 47.9% women in group B (Both Cu375 and CuT380A IUD are safe postpartum method of contraception but Cu375 if used for intracesarean IUD insertion increases the incidence of visible IUD strings. Hence, it avoids radiological investigations and invasive procedures at follow-up visits required to locate the IUD when strings are not visible. more...

Background: More than 100 million women in developing countries would prefer to avoid a pregnancy; but they may not be using any form of contraception. The study was conducted to assess the safety, incidence of perforation /pain/bleeding/foul discharge and expulsion rates at 6 week follow-up and willingness to continue when Cu T 380 A inserted within ten minutes of placental expulsion both in vaginal and C-section deliveries. Methods: This was an open label, prospective, and longitudinal study. The study was approved by the ethics committee of FOGSI. Results: The insertion of Intrauterine Contraceptive Devices (IUCD) at KIMS, Hubli was easy in 99.52% of subjects after normal delivery and 100% in all subjects after assisted vaginal deliveries. The position of the CuT was in situ in 94.78% of subjects, ultra sonogram was used in 24.76 % to confirm location where threads were not visible in the vagina and in 6.19% of subjects the tip of IUCD was in the cervix which was pushed back into the uterus using artery forceps. It was expelled in 5.23% of patients. There was no case of perforation in this series and no other major complications. Conclusions: Inserting CuT 380 A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus. more...

OBJECTIVE: To evaluate the rate and pattern of complications associated with use of the Copper T 380A intrauterine device (IUD) among adolescents. METHODS: A prospective comparative study of women eligible for IUD insertion who attended the family planning clinic of Sohag University Hospital Egypt between July 1 2008 and December 31 2010. The participants were categorized as adolescents or adults. The Copper T 380A IUD was inserted in all participants and follow-up visits were scheduled at 1 3 and 6 months. Odds ratio and chi(2) square tests were used to compare the rates of complications at each visit. RESULTS: Of 1512 patients eligible for IUD insertion 852 met the inclusion criteria: 281 adolescents and 571 adults. The rates of pain bleeding displacement expulsion and removal of IUDs were significantly higher in adolescents (P more...

Background: The intrauterine contraceptive device (IUD) primarily in the form of copper T is used by more than 150 million women around the world making it the most widely used reversible method of contraception with a remarkably low failure rate of less than 1 per 100 women in the first year of use for cu T 380 A. It is more suitable for a country like India which is in urgent need of population control methods.Methods: A Prospective observational study was under taken where in a series of women who delivered either vaginally or through caesarean section during the period of November 2013 to October 2017 in the Department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli counseled for PPIUCD insertion were included in the study. Mothers who were suffered from Chorioamnionitis, Puerperal sepsis, Postpartum haemmorrhage, PROM more than 18 hours, extensive genital trauma, uterine abnormalities, Multiple sexual partners and obstructed labour were excluded from the study. Since it was a time bound study, a total of 16009 cases were enrolled in the study after counseling them.Results: A total of 16009 women were counseled to undergo PPIUCD, out which 5144 women accepted for PPIUD amounting to a total acceptance rate of 32.1%.Out of the 10865 women who did not accept device, the reason for non-acceptance preference another contraception 60%, family opposition was reason in 21% of women, while 08% of women had side effects from their previous use. 11% of women said that they were not desire to use contraception.Conclusions: Family planning and mother and child health services are supplied to the people free of cost in India. Use of an intrauterine device is simpler , less expensive, and immediately reversible. more...

This commentary describes a variety of tools and procedures available for retrieval of intrauterine contraceptive devices (IUCs) with missing strings. In addition it presents an algorithm for the management of the missing strings. Copyright © 2011 Elsevier Inc. All rights reserved. more...

Intrauterine contraceptive devices (IUCDs) are one of the most widely chosen contraceptive methods with high efficacy, less side effects, and low cost especially in a developing country like India. Although they have low side effect profile but they are also associated with serious complications like device migration into adjacent organs, uterine perforation and sepsis. Any patient presenting with loss of thread should be assessed for localization of the IUCD. Authors are thereby reporting a case of a 30-year-old lady who presented with 2 month amenorrhea with loss of IUCD thread. She was diagnosed with intrauterine pregnancy with migrated IUCD into distal sigmoid colon. The patient was explored, IUCD was removed, dilatation and evacuation were done. Authors concluded that IUCDs are safe only in experienced hands and an institutional training is must for family planning workers. Patient education regarding regular checkup for threads is also emphasized. more...

Purpose: This study was planned to answer the management of cases with translocated intrauterine devices (IUDs) into the abdomen or into the wall of the uterus. Materials and Methods: This study was a retrospective analysis of patients' records at the training and research hospital during the years 2001–2005, which required an admission to the hospital for the removal of an IUD that had translocated to the outside of the uterus. Thirteen (13) cases that were diagnosed and treated as migrated IUDs in our clinic were evaluated retrospectively. IUDs were inserted in 1788 patients at the hospital in which the study was performed during the study interval. Results: In 10 patients, removal of the IUDs at laparoscopy succeeded, whereas, in 1 case, laparotomy proved necessary, and 2 IUDs were removed via hysteroscopy. Three (3) IUDs were in the Douglas space, 7 of them were embedded in the omentum, 1 was inside the broad ligament, and 2 had perforated the wall of the uterus. In 6 cases, mild adhesion, an... more...

Intrauterine contraceptive devices (IUD) have been a form of birth control for many hundreds of years. Just as their composition and architectures have changed, so have their sonographic appearances and clinical implications. With the emergence of volume imaging brings the ability to consistently evaluate the uterus in the coronal plane, which brings an entirely different diagnostic perspective and thought process for the evaluation of an IUD. This article provides three examples of how volume imaging is extending the sonographic evaluation of patients with IUDs. more...