A prospective cohort study comparing expulsion after postplacental insertion: the levonorgestrel versus the copper intrauterine device

The CHOICE study was a prospective cohort study of 7486 women in St. Louis, Missouri. The participants underwent standard, scripted contraceptive counseling and were provided with their choice of contraception at no cost. Primary outcomes were contraceptive failure and pregnancy rates in 2 age groups: women over 21 and less than 21 years old. Participants who chose long-acting reversible contraception (LARC) such as an intrauterine device or the contraceptive implant were less likely to experience a contraceptive failure compared to contraceptive pill, patch, ring (PPR) users (p = 0.001). Participants using PPR were 22 times more likely to have an unintended pregnancy than those using LARC. Among women less than 21 years old who used non-LARC methods, the risk of pregnancy was nearly twice as high than older women. LARC are highly-effective and safe for women of all ages and should be considered first-line methods of contraception for most patients.

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Rates of continuation and satisfaction of immediate intrauterine device insertion following first- or second-trimester surgical abortion: a French prospective cohort study

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2013.04.006 ◽

2013 ◽

Vol 169 (2) ◽

pp. 268-274 ◽

Cited By ~ 8

Author(s):

Aurélie Flamant ◽

Lobna Ouldamer ◽

Gilles Body ◽

Nathalie Trignol-Viguier

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Intrauterine Device ◽

Second Trimester ◽

Surgical Abortion

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Pelvic pain and early IUD discontinuation: a prospective cohort study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190850 ◽

2019 ◽

Vol 8 (3) ◽

pp. 792

Author(s):

Sharon R. Gerber ◽

Noah Natell ◽

Nora Doty ◽

Xiaoyu Liu ◽

Jessica R. Overbey ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Prospective Cohort Study ◽

Pelvic Pain ◽

Prospective Cohort ◽

Intrauterine Device ◽

Significant Difference ◽

History Of ◽

One Year

Background: The aim of the study is to assess if pelvic pain is a risk factor for intrauterine device (IUD) discontinuation within one year of placement.Methods: This is a prospective cohort study of women who had IUDs inserted at a family planning office for the primary intent of contraception. Baseline pelvic pain characteristics were assessed using a validated pelvic pain questionnaire. Women were contacted at 1 year to assess IUD continuation.Results: From February 1, 2014 to August 11, 2015 authors enrolled a sample of 179 women. Of the 179 enrolled,163 participants completed the questionnaire, 98 reported a history of baseline pelvic pain and 65 reported no history of baseline pelvic pain. 20 participants were lost to follow-up. 86 women in the pelvic pain and 57 in the no pelvic pain group were included in the final analysis. Discontinuation rates at one year follow up were 25.6% (22) and 35.1% (20) respectively. There was no significant difference in those with and without pelvic pain discontinuing IUDs at one year (p = 0.22).Conclusions: Baseline generalized pelvic pain may not be a risk factor for IUD discontinuation within one year of placement.

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Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study

Contraception and Reproductive Medicine ◽

10.1186/s40834-021-00153-w ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Joy Muhumuza ◽

Richard Migisha ◽

Joseph Ngonzi ◽

Musa Kayondo ◽

Godfrey Mugyenyi

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Intrauterine Device ◽

Significant Risk ◽

Tertiary Hospital ◽

Limiting Factor ◽

Expulsion Rate ◽

Postpartum Family Planning

Abstract Background Postpartum intrauterine device (PPIUD) use refers to intrauterine device (IUD) insertion after delivery but within 48 h of birth. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception. An important limiting factor to increased uptake of immediate postpartum IUD insertion may be its expulsion rates which vary widely. There is minimal documentation PPIUD expulsion rates and factors associated with PPIUD expulsion during puerperium in Uganda. Objective We aimed to determine the proportion of TCu380A (copper) intrauterine devices expelled by 6 weeks postpartum, and identify risk factors for expulsion among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods We conducted a prospective cohort study from September 1, 2014 to January 31, 2015 at MRRH. We administered a structured questionnaire to all participants, to capture data on their baseline demographic, clinical and obstetric characteristics. We followed up women who accepted the PPIUD insertions at 6 weeks post insertion for any IUD expulsion. We fit multivariable log binomial regression models to identify risk factors for IUD expulsion. Results We enrolled 167 women who had PPIUDs inserted. Of the144 women who returned at 6 weeks for follow up, 13 (9%; 95%CI:4.9–15%) of them had the IUDs expelled. In the multivariable model, the significant risk factors for PPIUD expulsion were: IUD insertion more than 10 min post-delivery (aRR 8.1, 95%CI 1.26–51.98, p = 0.027) and bloody lochia flow of ≥15 days (aRR 8.5, 95%CI 1.47–48.47, p = 0.017). Conclusion The cumulative expulsion rate of postpartum IUDs among women delivering at MRRH was low and comparable to expulsion rates in interval insertions. Longer duration from delivery to IUD insertions and longer duration of bloody lochia flow were key risk factors for postpartum IUD expulsion. More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates.

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