Original research articleIntraoperative placement of the Copper T-380 intrauterine devices in women undergoing elective cesarean delivery: a pilot study☆
Introduction
Immediate postpartum placement of intrauterine devices (IUDs) provides women effective, long-term and reversible contraception that is convenient at a time in their lives when they face considerable demands on their time, unusually high levels of stress and significant disruptions in their usual routines. Previous trials of IUD placement at the time of cesarean section have demonstrated high levels of device retention [1], [2], [3], [4] and low levels of complications [3], [4], [5], [6]. Much of this work has been done with tailless IUDs, with IUDs whose tailstrings were not visible in the vagina or in situations in which the status of the tailstrings was not reported [4], [7], [8]. A recent Cochrane review found that modification of existing devices, such as adding absorbable sutures or additional appendages, did not appear to be beneficial [9]. However, having access to tailstrings allows for more straightforward removal of the IUD in case of early complications.
In this pilot study, we tested a technique for intraoperative placement of the Copper T-380A IUD that was designed to minimize bacterial contamination and to ensure that the IUD strings would be visible in the vagina for easy removal when desired.
Section snippets
Methods and materials
The design of this study was approved by the Research Committee at the Los Angeles Biomedical Research Institution at Harbor-UCLA Medical Center (LA BioMed) in Torrance, CA. The patient informed consent was approved by the John F. Wolfe Human Subjects Committee at LA BioMed. Devices were donated under a grant from Duramed/Barr Pharmaceuticals. The study was registered with clinicaltrials.gov (number NCT00733278).
Women were invited to join the study during their third trimester of pregnancy if
Results
All seven women who had Copper T-380A IUDs placed through the uterine incision with tailstrings threaded through the os into the vagina as described above had follow-up for at least 6 weeks. There were no reports of excessive blood loss postpartum; neither were there any episodes of postpartum infection. At the 2- and 6-week follow-up visits, women had no complaints related to their IUDs. Tailstrings were present in the vaginas of all women at every visit. Chromic suture #2-0 was used as the
Discussion
Although there is extensive literature, particularly from China in the 1980s and 1990s, of intraoperative placement of IUDs at the time of cesarean delivery, more recent experience (especially in the United States) has been limited. A recent Cochrane analysis found that the risk of expulsion associated with IUD placed at the time of cesarean section was significantly lower than the expulsion rates seen with transvaginal placement of IUDs immediately following vaginal delivery of the fetus and
Acknowledgments
The authors would like to express their gratitude to Kathy Reape, M.D., and Barr/Duramed Pharmaceuticals for providing the Copper T-380A IUDs used in this study.
References (12)
- et al.
Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study
Contraception
(2005) - et al.
A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the Copper T-380A IUD in Shanghai, People's Republic of China
Contraception
(1996) - et al.
Clinical outcomes of two early postpartum IUD insertion programs in Africa
Contraception
(1996) - et al.
A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device
Contraception
(2007) - et al.
Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices
Contraception
(2004) - et al.
Intrauterine contraceptive device insertion with suture fixation at cesarean section
Chin Med J (Engl)
(1983)
Cited by (14)
Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis
2020, American Journal of Obstetrics and GynecologyCitation Excerpt :In all, 13 studies included IUDs placed in the interval time period as a comparison group,30-35,37,38,40–44 A total of 24 studies included only copper IUDs,24,26,28,29,32,34,41,45–61 14 studies included only LNG IUDs,25,30,33,35,36,39,40,42-44,62–65 and 10 studies included data on both types of IUDs.27,31,37,38,66–71 A total of 16 studies included only IUDs placed at cesarean delivery,29,31,40–42,45,48,52,54–56,60,62,63,65,69 14 studies included only IUDs placed at vaginal delivery,24,26,30,32–36,43,57,59,64,68,70 and 18 studies included data on both types of delivery.25,27,28,37–39,44,46,47,49–51,53,58,61,66,67,71 Follow up ranged from 4 weeks to 5 years, and study sample size ranged from 7 to 2733 women.
A randomized trial of levonorgestrel intrauterine system insertion 6 to 48 h compared to 6 weeks after vaginal delivery; Lessons learned
2015, ContraceptionCitation Excerpt :Immediate postpartum IUC placement can occur immediately after placenta delivery (postplacental), or up to 48 h postpartum [4–11]. An IUC can also be inserted right after cesarean birth, prior to closing the uterus [12–14]. Recent data from the United States indicate that immediate levonorgestrel-releasing intrauterine system (LNG-IUS) placement after vaginal birth is acceptable to women but is also associated with spontaneous expulsions occurring in 10%–38% of women by 6 months [6–8,15].
Expulsion of Nova-T380, Multiload 375, and Copper-T380A contraceptive devices inserted during cesarean delivery
2015, International Journal of Gynecology and ObstetricsCitation Excerpt :Further, the sloping surface and flexible horizontal arms of Nova-T380 could aggravate its downward displacement under the influence of uterine contractions and involutions during the puerperium. Despite a WHO-sponsored multicenter trial reporting that immediate postplacental insertion of IUCDs has “unacceptable high pregnancy and expulsion rates” [17], recent studies have reported an improved performance and reliability of this method [1,2,6,7,12,18]. The expulsion rate of Multiload 375 has been reported to be 15% after 6 months [5] and 10.4% after 1 year [8] in two studies including 300 and 157 women, respectively.
Trancesarean intra-uterine device. Pilot study performed at Dakar teaching hospital
2013, Journal de Gynecologie Obstetrique et Biologie de la ReproductionA review of intrauterine device placement during caesarean section at level two facilities in the Metro West, Cape Town
2021, Obstetrics and Gynaecology Forum
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Anita Nelson, M.D., declares that she has received honoraria from Barr/Duramed for speaker's bureau and for participation on its advisory board.