Among 52 women who delivered by cesarean section in a medical center in Beijing, China and had either a Delta Loop or Delta T intrauterine device (IUD) inserted manually through the incision wound, the expulsion rates were significantly lower than among a comparable group of 147 women who both delivered and had the IUD inserted vaginally (4.1 versus 20.5 per 100 women at six months post-insertion). Since the cesarean delivery rate is increasing worldwide, we deem this preliminary finding important for postpartum contraception programs and urge further studies. (Am J
A newer generation of IUDs that includes the Copper T-380A/Ag (TCu-380A/Ag) IUDs and the Multiload Copper-375 (MLCu375) IUDs has been developed and marketed. The high efficacy of these IUDs in preventing accidental pregnancies has been equated to that of oral contraceptives and even sterilization. However, the reduction of two other IUD-related pertinent events, namely, expulsion and medical removal due to bleeding and/or pain, has been less impressive. Therefore, efforts are continuing to develop new IUDs. In this paper, the authors review the physical structures of six new IUDs: the CU-SAFE, Cu-Fix, Ombrelle, Fincoid, and Multiload Mark II IUDs, and the intracervical fixing device (ICFD). The clinical performance of the first four devices is also evaluated. Independent, noncomparative studies suggest that all of the four new IUDs may perform as well as, or even better than, the TCu-380A IUD in terms of expulsions and medical removals attributable to bleeding and/or pain. However, we deem these results tentative, and emphasize the need for multi-center, randomized comparative clinical trials with larger sample sizes and long-term follow-up.
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