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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

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.

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.

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.

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.

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.

Intrauterine Contraceptive Devices with multifaceted application potential is a need of an hour. Although, copper-based IUDs exert an effective contraceptive as well as anticancer effects in a long-term basis, but also results in multiple complications. In this regard, RISUG® a polymer based contraceptive device has been introduced as a suitable alternative. However, its potential to impart protective effects against development of endometrial cancer still remains unexplored. This article presents the hypothesis on this unexplored domain and provides scientific facts to support the hypothesis. The mechanism of anticancerous activity is hypothesized that RISUG® involves its lipid membrane destabilizing activity. This activity is modulated by both, the cellular microenvironment and lipid bilayer composition. Acidic environment along with the significantly higher fluidic nature of lipid bilayer of the cancerous cells make them more prone to lipid solubilisation effect of RISUG®. We here present an in-depth insight into the factors that would favour faster solubilisation of cancer cell membrane, thereby exerting an anticancer effect.

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.

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.

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.

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.

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.

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.

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.

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.

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...

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.

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.

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.

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.

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

В статье подчеркивается этиология, патогенез и осложнения течения воспалительных заболеваний органов малого таза при применении внутриматочных контрацептивов (ВМК). Риск возникновения воспаления выше в первые недели применения ВМК. Актуальность проблемы показана на примере случая из практики гинекологического отделения Худжандской областной клинической больницы., The article emphasizes the etiology, pathogenesis and complications of pelvic inflammatory diseases in the use of intrauterine contraceptives (IUD). The risk of inflammation is higher in the first weeks of the use of IUD. The urgency of the problem is shown by the example of the case from the practice of the gynecological department of Khujand regional clinical hospital.

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.

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.

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.