Postplacental placement of intrauterine devices: A randomized clinical trial

Laporte, Montas; Marangoni, Marcos; Surita, Fernanda Garanhani; Juliato, Cássia Teatin; Miadaira, Mariana; Bahamondes, Luís

doi:10.1016/j.contraception.2019.12.006

Cited by 13 publications

(15 citation statements)

References 19 publications

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“…We have published a short follow up that showed that most of the expulsions occurred within the first 42 days after childbirth. 11 The present manuscript confirms the previous publication now with the complete follow up.…”

Section: Discussionsupporting

confidence: 91%

“…In addition, we could also hypothesize that there is an LNG effect or a biomechanical difference between LNG IUS and Cu-IUD that explains the different expulsion rates. 11 We also found that the 1-year continuation rate was higher in cases of IUD/IUS placement at cesarean delivery, and it occurred independently of the type of IUD when compared with women with a vaginal delivery. However, IUD placement in women with vaginal delivery was described as a risk factor for expulsion in several publications with an odds ratio of 9.87, [8][9][10]15,16 which agreed with our findings; the matter is still under debate.…”

Section: Discussionsupporting

confidence: 53%

“…Expulsions after vaginal delivery are more common than cesarean delivery, which could explain the higher number of expulsions in the TCu380A IUD group. In addition, we could also hypothesize that there is an LNG effect or a biomechanical difference between LNG IUS and Cu‐IUD that explains the different expulsion rates 11 …”

Section: Discussionmentioning

confidence: 99%

“…The inserter tube or forceps was then slowly removed. We cut the IUD or IUS strings 11 . Before maternity discharge, the women were counseled about possible complications, such as infection, pain and hemorrhage, and were instructed to return 42, 90 days and 1 year after delivery for follow up.…”

Section: Methodsmentioning

confidence: 99%

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One‐year follow up on post‐placental IUD insertion: A randomized clinical trial

Marangoni

Laporte

Surita

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Our objectives were to compare the 1‐year follow‐up clinical performance of the TCu380A intrauterine device (TCu380A‐IUD) and levonorgestrel (LNG) 52‐mg intrauterine system (IUS) inserted at post‐placental period. Material and methods We conducted an open‐label, parallel‐group, randomized clinical trial, 1:1 with pregnant women admitted for childbirth independently of the mode of birth. Our primary outcome was expulsion up to 1 year after device placement by type of IUD and mode of delivery. During the follow up (42, 90 and 365 days (±7 days) after device placement), an ultrasound was performed to evaluate the device position. Kaplan–Meier with log‐rank test was used to compare the survival curves of the TCu380A IUD and the LNG IUS. Couple‐Years of Protection after insertion of both devices was calculated. Results One hundred and forty women were randomized to the TCu380A IUD (n = 70) or the LNG IUS (n = 70). By the end of the first year after device placement, 38 women experienced device expulsion (27.1%), most of them (33/38; 86.8%) within the first 42 days after delivery. The expulsions were significantly higher among users of TCu380A IUD (39.4%) than among users of the LNG IUS (22.2%; P = .039), and among those with vaginal delivery (43.8%) than among women with cesarean delivery (15%; P = .003). The 1‐year cumulative continuation rate was 64.2%, significantly higher for LNG IUS (73.1%) than for TCu380A IUD (54.4%; P = .03), and among women with cesarean delivery (77.6%) than for vaginal delivery (52%; P = .00). The post‐placental IUD insertion provided 356.4 Couple‐Years of Protection. Conclusions Two‐thirds of women who accepted a post‐placental IUD placement still used the device 1 year after childbirth. However, expulsion was the most prevalent reason for discontinuation, mainly within 42 days after device placement. The expulsion rate was significantly higher among TCu380A IUD users and among women with vaginal delivery.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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One‐year follow up on post‐placental IUD insertion: A randomized clinical trial

Marangoni

Laporte

Surita

et al. 2021

Acta Obstet Gynecol Scand

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“…Identifying risk factors for postpartum IUD expulsion is challenging because of small sample sizes, and inconsistent study designs and definitions. Postpartum IUD expulsion risk can be affected by features related to the insertion process, such as delivery mode, IUD type, placement timing, and provider experience 4,5 …”

Section: Introductionmentioning

confidence: 99%

Factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices

Nóbrega

Pitangui

Vieira

2021

Intl J Gynecology & Obste

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Objective To identify clinical and demographic factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices (TCu380A IUD). Methods This is a secondary analysis of an implementation study. We followed participants who had a postplacental TCu380A IUD insertion, at two postpartum visits: 45–90 days (visit 1) and 6–9 months (visit 2). We used multiple log‐binomial regression models to evaluate the demographic and clinical variables associated with missing strings and with IUD expulsion. Results We included 705 participants who had a postplacental IUD insertion. We observed missing strings in 275 (47.9%) participants at visit 1, and in 127 (34.2%) participants at visit 2. We identified 61 expulsions (8.9%) by visit 2. In the multiple regression models, only the delivery type was associated with missing strings and expulsion. Compared with vaginal delivery, cesarean delivery increased the risk of missing strings (adjusted relative risk [aRR] 6.21; 95% confidence interval [CI] 4.29–8.99) but reduced the risk of IUD expulsion (aRR 0.24; 95% CI 0.13–0.43). Conclusion The delivery mode was the only factor associated with missing strings and expulsion after postplacental IUD insertion. Cesarean section was associated with an increased risk of missing strings but decreased risk of expulsion after postplacental TCu380A IUD insertion.

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