Top PDF Evaluation of safety, efficacy and expulsion of post placental insertion of intrauterine contraceptive device

Evaluation of safety, efficacy and expulsion of post placental insertion of intrauterine contraceptive device

Evaluation of safety, efficacy and expulsion of post placental insertion of intrauterine contraceptive device

I Dr. USHA RANI. N solemnly declare that the dissertation titled “EVALUATION OF SAFETY, EFFICACY AND EXPULSION OF POST PLACENTAL INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICE” has been prepared by me. I also declare that this bonafide work or a part of this work was not submitted by me or anyother for any award, degree, diploma to any other University board either in India or abroad. This is submitted to The Tamilnadu Dr. M. G. R. Medical University, Chennai in partial fulfillment of the rules and regulation for the award of M.S degree Branch – II ( Obstetrics & Gynecology) to be held in May 2018.
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Prospective study on outcomes of postpartum intrauterine contraceptive device including safety, efficacy and expulsion at GMERS Medical College, Dharpur Patan, Gujarat, India

Prospective study on outcomes of postpartum intrauterine contraceptive device including safety, efficacy and expulsion at GMERS Medical College, Dharpur Patan, Gujarat, India

The symptom of irregular bleeding per vaginum was not influenced by route of insertion. The women mainly complained of excessive bleeding and were treated adequately with Nonsteroidal Anti- Inflammatory Drugs (NSAIDs) and haematinics. Shukla et al indicated a higher incidence of Menorrhagia (27.2%) with use of CuT 200 in postpartum women. 15 Gupta et al observed

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Evaluation of acceptability, safety and expulsion rate of PPIUCD

Evaluation of acceptability, safety and expulsion rate of PPIUCD

Background: The modern intrauterine contraceptive device (IUCD) is highly effective, safe, private, long acting, coitus independent, rapidly reversible, cost effective and can be used by women who are breastfeeding. This study was conducted to evaluate factors associated with acceptability, safety and expulsion rates of PPIUCD among clients in the Department of Obstetrics and Gynecology, N. S. C. B Medical College, Jabalpur.

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Original Article Evaluation of Safety, Efficacy and Continuation Rates of Postpartum Intrauterine Contraceptive Devices (PPIUCD) (Cu-T 380 A)

Original Article Evaluation of Safety, Efficacy and Continuation Rates of Postpartum Intrauterine Contraceptive Devices (PPIUCD) (Cu-T 380 A)

In the present study, 13% expulsion rate was observed over one year. Similar rates have been reported by previously published studies. 13 Risk factors for expulsion include nulliparity, menorrhagia, severe dysmenorrhea, prior expulsion and age less than 20 years. 13 A multi- centric trial in which women were followed up for 7 years found that the cumulative discontinuation rate due to expulsion was 1.8 per 100 women- years of use. 14 Additionally, expulsion rates are highest when IUDs are placed during menses and delaying IUD insertion until day 6 of the cycle can reduce expulsions in the first 3 months by 30%– 50%. 15 Rare complications can occur with IUD placement. Perforation occurs in about 1 in 1000 cases. 16 Risk factors include inexperienced clinician, an immobile uterus, a retroverted uterus, and the presence of a myometrial defect. Ultrasound is used to determine the location of a perforated IUD and once identified treating the woman with antibiotics as for pelvic inflammatory disease is recommended. 17
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A comparative evaluation of post placental intrauterine contraceptive device (IUCD) insertion between normal delivery and caesarean section

A comparative evaluation of post placental intrauterine contraceptive device (IUCD) insertion between normal delivery and caesarean section

of IUCD respectively. In this study there is higher rate of expulsion i.e. 18.2% following vaginal delivery compared to those with intracaesarean insertion i.e. 3.8%, probably because the post placental insertion of IUCD was conducted by the post graduate trainees and intracaesarean insertion was conducted by consultants. In my study Expulsion was detected by history, clinical examination and pelvic ultrasonography. These women were informed about IUCD expulsion and were advised to use alternative method of contraception. According to Chi et al, expulsion rate of PPIUCD at 4 weeks interval was 9.5-12.5%. 11 In this study, 8 (7.6%) removed for
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Prospective study on outcome of post partum intrauterine contraceptive device insertion at tertiary level rural health institute of Gujarat, India

Prospective study on outcome of post partum intrauterine contraceptive device insertion at tertiary level rural health institute of Gujarat, India

Results: The study shows that PPIUCD is an effective intervention in both caesarean and vaginal delivery with non- significant differences in safety and efficacy depending on the route of insertion. There was no case of perforation and no significant risk of infection in either caesareans or delivery. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the caesarean group compared to vaginal insertion.

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ACCEPTANCE OF POST PLACENTAL INTRAUTERINE CONTRACEPTIVE DEVICE: RECENT INCREASE IN TREND

ACCEPTANCE OF POST PLACENTAL INTRAUTERINE CONTRACEPTIVE DEVICE: RECENT INCREASE IN TREND

period itself. Most of the patients are referred and their consent is recorded in the antenatal case record. The coverage rate was low in the first year compared to second and third year of the study period. Continuous motivation was provided and their works were supervised by checking the PPIUCD insertion compared to the number of deliveries on day to day basis instead of weekly review. This showed more than double fold increase in acceptance of PPIUCD approximately. Vidyarama et al. [1] in her experience at a tertiary care centre as a LARC showed an acceptance rate from 2 to 15% which varied according to age, parity, literacy. Our study showed higher acceptance in primi para which correlated with their study. They also share that there is need to strengthen our counseling services and motivate trained personnel to improve the acceptance rate which is very well correlated with our study. Mishrasujnanendra et al [2] in her study on evaluation of safety, efficacy, and expulsion of post-placenta and intracaesarean insertion of intrauterine contraceptive devices (PPIUCD) stated the importance to arrange training on PPIUCD in order to increase knowledge and skills among healthcare providers. This will also further promote PPIUCD use and aid in reduction of the expulsion rates. Cash incentives to the acceptor, motivator and of course provider would bring about a substantial progress in the PPIUCD use in developing countries like India and also stated that most of the PPIUCD acceptors were in the (20-29) age group, most of them literate, most of them Hindu followed by Christian and Muslim, acceptance with primi (64.5%) was higher than multi para women. Our study showed most of the PPIUCD acceptance were in the (20-24) age group followed by (25-29) age group
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Evaluation of post partum intrauterine contraceptive device versus interval intrauterine contraceptive device insertion

Evaluation of post partum intrauterine contraceptive device versus interval intrauterine contraceptive device insertion

Methods: This was a prospective observational cohort study, done in the department of Obstetrics and Gynecology, GMERS Medical College, Sola, Ahmedabad, from August 2015 to April 2017 was taken for evaluation. 80 women in each group who were inserted IUCD after delivery and in the interval period were studied. Outcome was measured by expulsion rate, continuation rate, and incidence of dysfunctional uterine bleeding (DUB), Pelvic inflammatory disease (PID), failure rate and effect on puerperium.

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Comparative study of post partum intrauterine contraceptive device in vaginal and intra caesarean insertion

Comparative study of post partum intrauterine contraceptive device in vaginal and intra caesarean insertion

The cases were followed up to 9 months post delivery. 2 women in vaginal group came early before the scheduled follow up, due to spontaneous and partial expulsion. Out of 100 cases in vaginal group, 70 were followed up in our hospital and 15 were contacted over phone. They had examination at nearby peripheral health services and private hospitals. In cesarean group 72 cases visited our institute whereas 20 cases got examined at private and peripheral hospitals. Overall 85% cases in vaginal group and 92% cases in cesarean group returned for follow up. 15% cases in post placental group were lost in follow up which was slightly higher as compared to intra cesarean group (8%). This may be because of cesarean patients paid more attention to follow up visits as compared to vaginally delivered. “Insert and report and then forget” that must be replaced by “counsel and report, insert and report and follow up and report” and of course provide service at every visit. Few patients reported before the scheduled visit, mainly with complaints of protrusion of tail at introitus or due to spontaneous expulsion of IUCD. Similar to present study, Katheit G et al also found that 83.4% cases returned for follow up and 16.12% of cases were lost to follow-up. 7 Mishra S et al observed that
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Immediate postplacental insertion of intrauterine contraceptive device (copper 375) and its complications in term of expulsion, infection and perforation

Immediate postplacental insertion of intrauterine contraceptive device (copper 375) and its complications in term of expulsion, infection and perforation

The postpartum period is potentially an ideal time to begin contraception as women are more motivated to do so at this time, which also has the advantage of being convenient for both patients and health care providers [8]. A descriptive study from Turkey reported expulsions in 235 women who had immediate post placental insertion of IUCD following either vaginal or caesarean delivery, combined expulsion rates were 5.1%, 7.0% and 12.3% at 1.5, 6 and 12 months respectively [9]. One case control study at JPMC Karachi examined 100 women who had post placental IUCD insertion. Follow up study was done at 1 week, 6 weeks and 6 months. Wound was infected in 10%, heavy lochia in 2%, at 6 months thread was visible in 92% and no perforation seen [10]. Another retrospective study from India in 300 women with immediate IUCD insertion reported lower abdominal pain (11.5%), menorrhagia (6.6%) dislodgment of IUCD (3.3%) and expulsion (6.6%) [11].
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Post partum intrauterine contraceptive device: acceptability and safety

Post partum intrauterine contraceptive device: acceptability and safety

long term reversible method and may be an alternative to tubectomy. Its efficacy, compliance is high does not require daily self-administration and thus women can effectively avoid unintended pregnancies. Post-insertion symptoms are masked by the normal postpartum cramping and lochia. Postpartum insertion is convenient both for the women and the provider. Follow up can be scheduled along with immunization visits. A study on PPIUCD therefore, was done with the aim of future scope of the method, reasons for its acceptability, denial and associated complaints and complications.
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Enhancing contraceptive usage by immediate postpartum intra uterine contraceptive device insertion with evaluation of safety, acceptability and expulsion

Enhancing contraceptive usage by immediate postpartum intra uterine contraceptive device insertion with evaluation of safety, acceptability and expulsion

In present study expulsion rates were low compared to other studies may be attributed to skill and training of the person inserting IUCD and also use of Kelly’s placental forceps which is 32cms long which ensures high fundal placement of IUCD and insertion of PPIUCD by an adequately trained provider. There was no misplaced IUCD in present study. In one study done by Sofat et al in India 4.3 per cent of cases had IUD slid in cervical canal. 12 O’Hanley Huber et al in his study has suggested

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Factors affecting the behavior outcomes on post partum intrauterine contraceptive device uptake and continuation in Nepal: a qualitative study

Factors affecting the behavior outcomes on post partum intrauterine contraceptive device uptake and continuation in Nepal: a qualitative study

LMICs in South Asia such as Nepal are no exception to the challenge of low uptake and continuation of IUDs including the ones used in the immediate post-partum period [5]. Post-partum intrauterine contraceptive device (PPIUD) is an effective and affordable long-acting post-partum family planning (PPFP) method which can be used immediately after childbirth within 48 h of post-partum period. It is known to be safe and has broad eligibility criteria for post-partum mothers [6, 7]. PPFP such as PPIUD was first introduced in Nepal between 2008 and 2009 [8]. Despite the decade-long effort, the country still lacks nationally representative data on the usage of PPIUD separately. Moreover, the overall usage of IUD remains as low as 1.4% in the country [9].
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Use and discontinuation of intrauterine contraceptive device in the Greater Accra Region of Ghana

Use and discontinuation of intrauterine contraceptive device in the Greater Accra Region of Ghana

Women’s reasons for using the IUD varied slightly among current and ever users. Among current IUD users, preventing unwanted pregnancy emerged as the most important motivating factor, whilst the desire for a long acting FP was mentioned most often among ever IUD users. Although the ever IUD users would have loved to continue using the IUD, unbearable side effects of heavy menses and cramps lead to discontinuation. A further probe on this assertion shows that the type of IUD being referred to is the Cupper T 380 A . There were few reported instance were clients opted for LNG-IUS but was not available in the facility. Perhaps, the avail- ability of LNG-IUS (hormonal IUD) in facilities would have been preferred over Copper-T 380A which might have increased IUD usage in the study area. This sug- gests that among ever IUD users, there is an unmet need for LNG-IUS (hormonal IUD) which calls for program- ming and contraceptive security. The observation that IUDs have shown no or minimal reported side effects is an opportunity to use such satisfied clients for public education on IUDs to ensure continuity and increasing patronage since clients will really choose an IUD due to their understanding on the duration and perceived bene- fits over other methods.
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Colposcopic and Cytological changes in intrauterine contraceptive device users: A Prospective study

Colposcopic and Cytological changes in intrauterine contraceptive device users: A Prospective study

Pain is usually due to uterine cramp, it subsides within a week and is mostly relieved by analgesic and NSAIDS. Persistent pelvic pain may be due to abnormal position of the IUD, uterine Perforation, the beginning of the expulsion of the IUD, disparity between IUD size and cavity size, associated PID or ectopic pregnancy. Hence persistent pain should be investigated and often needs removal of the IUD 2.

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Central Venous Access Device Insertion and Post Insertion Care

Central Venous Access Device Insertion and Post Insertion Care

This Policy sets out the requirements for the safe insertion and post insertion care of CVADs in NSW Health facilities. Except where specified all instances of CVAD insertion must comply with this Policy regardless of the clinical setting. The Policy also sets out to minimise complications from the insertion, management and access of CVADs.

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Intrauterine lidocaine and naproxen for analgesia during intrauterine device insertion: randomized controlled trial

Intrauterine lidocaine and naproxen for analgesia during intrauterine device insertion: randomized controlled trial

Helsinki, they completed a demographics form to en- sure that they met inclusion criteria and had no ex- clusion criteria. Inclusion criteria included Defense Enrollment Eligibility Reporting System (DEERS)-eligible women aged 18 years and older desiring Copper T380A or levonorgestrel 52 mg intrauterine device insertion. DEERS eligibility would allow them to receive care at a Military Treatment Facility. Exclusion criteria were current pregnancy, history of cervical stenosis, severe medical illness, known allergy or sensitivity to lidocaine or naproxen, peptic ulcer disease, current pelvic inflamma- tory disease, patients with known renal insufficiency, and patients using chronic NSAIDs or on chronic pain medi- cation. Due to the infrequency of Skyla IUD use in our clinic and the non-availability of Liletta and Kyleena at the time of the study, women desiring these devices were also excluded.
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Study on post partum intrauterine contraceptive device practices and causes for discontinuation of PPIUCD at follow up in a tertiary hospital

Study on post partum intrauterine contraceptive device practices and causes for discontinuation of PPIUCD at follow up in a tertiary hospital

of the present study is that infection was based upon self- report and was not corroborated by medical records or microbiological confirmation. 39 women (72.2%), had their PPIUCD removed within the first six weeks of insertion. Women most commonly reported expected side effects of IUCDs as the reasons for the removal, including bleeding and abdominal pain. These findings suggest that there is room for strengthening PPIUCD counselling services, particularly regarding normal side effects and complications that arise from method use. CONCLUSION
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Migration of an intrauterine contraceptive device to the sigmoid colon: a case report

Migration of an intrauterine contraceptive device to the sigmoid colon: a case report

perforate through the uterine wall into the pelvic or abdominal cavity, or into adjacent organs. Numerous factors may affect perforation. IUD-related factors include the design and structural characteristics of the device, as well as the nature and rigidity or plasticity of the inserter. With regard to the patient, uterine size and position, inherent anatomic configuration and timing of the insertion relative to delivery or abortion are all important determinants of potential perforation. Although the incidence of uterine perforation varies with the type of IUD, the incidence of IUD perfora- tion has been estimated to be 0.87 per 1000 insertions 9 .
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A Study of 500 acceptors of intrauterine contraceptive device - Copper `T'

A Study of 500 acceptors of intrauterine contraceptive device - Copper `T'

The IUD can be inserted anytime in a woman’s cycle when she is not pregnant. White and co-workers demonstrate that expulsion rates for the first three postinsertion cycles were reduced by more than 30% when insertion was delayed until the end of menses. Theoretically, the optimal time for insertion is at the time of ovulation, when the cervical canal is maximally dilated and progesterone can quiet the myometrial contractions triggered by uterine manipulation. Insertion postpartum is best delayed until the uterus is completely involuted (usually, 4-6 weeks after delivery) to reduce the risk of perforation and expulsion. Nevertheless, international work suggests that insertion immediately postpartum (10-20 minutes after delivery of the placenta) is associated with low risks of uterine perforation and expulsion and may be a reasonable alternative for women who have limited access to the medical care system. Women who have miscarriages or other pregnancy terminations in the first trimester are candidates for immediate IUD insertion unless there is evidence of infection.
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