Clinical Correlation of Position of Copper T 380a As Determined By Ultrasonography Following Its Insertion In The Immediate Postpartum Period With Subsequent Complication-Observational Study
DOI:
https://doi.org/10.70284/njirm.v9i3.2347Keywords:
PPIUCD, Ultrasonography, Position of Copper t 380A, Subsequence Complication.Abstract
Background & Objectives: The postpartum insertion of an IUCD provides a convenient opportunity for the woman to receive IUCD services. This is particularly important for women who have limited access to medical care. The postpartum period is potentially an ideal time to begin contraception as women are more strongly motivated to do so at this time, which also has the advantage of being convenient for both patients and health-care providers. Objectives: To determine the rates of expulsion, pelvic infection, lost strings/ displacement, Menstrual irregularity, abdominal pain and uterine perforation following PPIUCD insertion among parturients at 6 weeks and 6 months of post partum. Method: Total of 203 patients were included. Study was conducted from March 2015 to March 2016.Women who accepted the PPIUCD during their postpartum care were inserted with the device before discharge (within 48 hours).These women were followed up at 6 weeks and 6 months for complications. Menstrual irregularity (24.2%) followed by pain in lower abdomen (13.7%),vaginal discharge (5.8%) and expulsion (4.7%).No case of perforation or pregnancy was reported. Statistical analysis was done using Chi-square test. Results: The common complications at six weeks and six months. In total 92 (45.3%) women having complication after PPIUCD. which are more (32.5%) in malposition of PPIUCD. Position of PPIUCD are decided by sonography after PPIUCD insertion. Expulsion, Menstrual irregularity and Abdominal Pain were more significantly with malposition (p < 0.05). Interpretation & Conclusion: The clinical examination has its limitations in the assesement of the IUCD position especially in postpartum IUCDs as the threads remain coiled inside the uterus in post-ceserean state. Thus, sonography can be used as an adjunct to clinical examination to examine the position of the IUCD. The removal and re-insertion can be offered in patients with malpositioned IUCDs. Alternatively, these patients coulds be closely followed up for early detection and prompt management of any complication. [M Patel, Natl J Integr Res Med, 2018; 9(3):26-33]
References
2. Speroff, L, Darney, P. A Clinical Guide for Contraception, 3rd ed, Lippincott Williams Wilkins, Philadelphia 2001.
3. Hostynek JJ; Maibach HI. Copper hypersensitivity: dermatologic aspects.DermatolTher 2004;17(4):328-33.
4. WHO Report. Mechanism of action, safety and efficacy of intrauterinedevices. World Health Organ Tech Rep Ser 1987; 753:1.
5. Alvarez F, Brache V, Fernandez E, Guerrero B, Guiloff E, Hess R,Salvatierra AM. New insights on the mode of action of intrauterinecontraceptive devices in women.FertilSteril 1988; 49(5):768-73.
6. Ortiz ME, Croxatto HB, Bardin CW. Mechanisms of action of intrauterine devices. ObstetGynecolSurv 1996;51(12):S42.
7. ACQUIRE Project, Engender Health 2008. The postpartum intrauterinedevice handbook.
8. Thiery, Michel(March 1997)."Pioneers of the intrauterine device" (PDF). European Journal of Contraception and Reproductive Health Care 2 (1):15– 23.doi:10.1080/13625189709049930. PMID 9678105. Archived from the original (PDF)on August 13, 2006.
9. Thiery M (June 2000), "Intrauterine contraception: from silver ring to intrauterine contraceptive implant", Eur. J. Obstet. Gynecol.Reprod. Biol. 90 (2):145–52,doi:10.1016/s0301-2115(00)00262-1, PMID 10825633.
10. Thiery, M. (March 1997). "Pioneers of the Intrauterine Device" (PDF). The European Journal of Contraception and Reproductive Health Care (The Parthenon Publishing Group)2 (1). Archived from the original (PDF) on 20 August 2006. Retrieved 24 March 2016.
11. Reed, James (1984). The Birth Control Movement and American Society: From Private Vice to Public Virtue. Princeton University Press.p. 306. ISBN 9781400856596.
12. Smith (pseudonym), Sydney (March 8, 2003). "Contraceptive Concerns". medpundit: Commentary on medical news by a practicing physician. Retrieved 2006-07-16.
13. http://newsandinsight.thomsonreuters.com/Legal/News/2013/05_-_May/Judge calls for_ female lawyers on plaintiffs committee in MirenaMDL.
14. WHO, UNICEF, UNFPA, The World Bank, and the United Nations Population Division. Trends in Maternal Mortality: 1990 to 2015.Geneva, World Health Organization, 2015.
15. ACQUIRE Project, Engender Health 2008. The postpartum intrauterine device Handbook.
16. Safwat A, Mohamed Momen A, Kamel Omar M, Shaaban HT, Salem. Acceptability for the Use of Postpartum Intrauterine Contraceptive Devices: Assuit Experience, Medical Principles and Practice 2003; 12: 170 -175.
17. Rosenberg MJ, Waugh MS, Long S. Unintended pregnancies and use, misuse and discontinuation of oral contraceptives. Journal of Reproductive Medicine.1995; 40: 355-360.
18. Chi I-c, Farr G. Review article: Postpartum IUD contraception -- a review of an international experience. Adv Contraception 1989;5(3):127-46.
19. O'Hanley K, Huber DH. Postpartum IUDS: keys for success. Contraception 1992; 45 (4): 351-61.
20. Grimes DA, Lopez LM, Schulz KF, Van Vliet HAAM, Stanwood NLet. Inserting an IUD right after childbirth versus a later time, Cochrane library: survey 2010.
21. Maternal and Child Health Integrated Program and PPFP activities, WHO Report. 2015.
22. Morrison C. Waszak C, Katz K. Clinical outcomes of two postpartum IUD insertion programs in Africa. Contraception. 1996;53(1):17-21.
23. Shelton J. Risk of clinical pelvic inflammatory disease attributable to an intrauterine device. Lancet, 2001; 357(9254): 443.
24. IUCD reference manual for medical doctors by Family Planning Division, Ministry of Health and Family Welfare,Government of India,Nov- 2010.
25. RimmerE,Jamieson MA, James P.Malposition and expulsion of the levonorgestrel intrauterine system among women with inherited bleeding disorders, 2013;19:933-8.
26. Braaten KP, Benson CB, Maurer R,et al. Malpositioned intrauterine contraceptive devices: risk factor, outcome, and future pregnancies. Obstet Gynecol. 2011;118:1014-20.
27. Boortz HE Margolis DJA, Ragavendra N, et al. Migration of intrauterinedevices: radiological finding and implications for Patient care. Radiogr Rev PublRadiolSoc North Am Inc. 2012;32:335-52.
28. Celen S, Moroy p, Sucak A, et al. Clinical outcome of early postplacental Insertion of intrauterine contraceptive devices.contraception.2004;69:279-82.
29. Eroglu K, Akkuzu G, Vural G, et al. Comparison of efficacy and complication of IUD insertion in immediate postplacental/earlypostpartum period with interval period: 1 year follow-up. Contraception.2006;74:376-81.
30. CelenS,Sucak A, Yildiz Y, et al. Immediate post-placental insertion of an intrauterine contraceptive device during caesarean section.Contraception.2011; 84:240-3.
31. Gupta S, Malik S,Sinha R, et al. Position of cu-T 380A by sonography Following its insertion in immediate postpartum period with the subsequent complication.2014;64(5):349-353.
32. Chi I-C, Bardin CW, Mishell DR. Postpartum IUD insertion: Timing, route, lactation and uterine perforation. Proceedings from the Fourth International Conference on IUDs.1994; 219-27.
33. Sivin I, Greenslade F, Schmdt F. The Copper T 380 Intrauterine Device: A Summary of Scientific Data. New York: The Population Council, 1992; 15.
34. Mishra S, et al. Evalution of safety, Efficacy and Expulsion of Post-Placental and Intra-Cesarean Insertion of Intrauterine contraceptive Devices (PPIUCD); 64(5):337-343.
