scholarly journals Intrauterine Device Insertion during Cesarean Section in Women without Prenatal Contraception Counseling: Lessons from a Country with High Cesarean Rates

2019 ◽  
Vol 41 (08) ◽  
pp. 485-492
Author(s):  
Alberto Moreno Zaconeta ◽  
Ana Carolina Oliveira ◽  
Flavielly Souza Estrela ◽  
Thalia Maia Vasconcelos ◽  
Paulo Sergio França ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cesarean Section ◽  
Removal Rate ◽  
Intrauterine Device ◽  
Uterine Perforation ◽  
Cesarean Sections ◽  
Trial Of Labor ◽  
The Moment ◽  
Contraception Counseling

Objective The moment of admission for delivery may be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections. Methods This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans. Results Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections. Conclusion Two thirds of the women who continued with IUD at 6 months had undergone 2 or more cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.

scholarly journals Predictors of success of trial of labor after cesarean section: A nested case–control study at public hospitals in Eastern Ethiopia

2021 ◽  
Vol 17 ◽  
pp. 174550652110619
Author(s):  
Maleda Tefera ◽  
Nega Assefa ◽  
Kedir Teji Roba ◽  
Letta Gedefa
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Vaginal Birth ◽  
Public Hospitals ◽  
Vaginal Birth After Cesarean ◽  
Eastern Ethiopia ◽  
Trial Of Labor ◽  
History Of ◽  
Nested Case Control

Background: One of the primary reasons for an increase in cesarean sections is obstetricians’ uncertainty about labor trial safety following a previous cesarean section. The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%. However, to the best of our knowledge, there is a scarcity of information on the determinants of vaginal birth after cesarean delivery in the study area. As a result, the purpose of this study was to identify predictors of successful vaginal birth after cesarean delivery in public hospitals in Eastern Ethiopia. Methods: A nested case–control study design was used within a prospective follow-up study conducted from June to October 2020. A total of 220 women who tried vaginal birth after cesarean delivery was included, 110 cases and 110 controls. Cases were women with one previous cesarean section scar and successfully proceed with vaginal delivery. The controls were those with an earlier cesarean section scar and delivered by emergency cesarean section after trial of labor. A pre-tested structured questionnaire was used to gather the information. Multiple logistic regression is used to identify the determinants for the success of vaginal birth after cesarean section; odds ratio with its 95% CI are used to report the findings. Results: We found that living in rural areas (AOR = 2.28; 95% CI (1.85, 12.41)), having a current antenatal care follow-up (AOR = 3.20; 95% CI (1.15, 8.87)) and partograph monitoring of labor (AOR = 4.26; 95% CI (1.90, 9.57)) had a positive association with successful vaginal birth after cesarean section. In contrast, the presence of meconium-stained amniotic liquor (AOR = 0.10; 95% CI (0.01, 0.75)) and history of stillbirth (AOR = 0.07; 95% CI (0.02, 0.53)) reducing the chance of success of the trial. Conclusion: Past obstetric history, such as stillbirth, history of labor trial after primary cesarean section, and prior vaginal birth, were significant predictors for achieving vaginal birth after cesarean section. Antenatal care visit, and partograph follow-up were the current obstetric characteristics positively associated with the trial of labor.

Trial of Labor After Two Cesarean Sections Versus Repeat Cesarean Section

2020 ◽  
Vol 135 ◽  
pp. 177S
Author(s):  
Rebecca Horgan ◽  
Saif Hossain ◽  
Adriana Fulginiti ◽  
Robert Massaro ◽  
Robert Graebe
Keyword(s):  
Cesarean Section ◽  
Cesarean Sections ◽  
Trial Of Labor ◽  
Repeat Cesarean Section

scholarly journals A follow up study of postpartum intrauterine device insertion in a tertiary health care centre

2017 ◽  
Vol 6 (7) ◽  
pp. 2800
Author(s):  
. Ranjana ◽  
Anita Verma ◽  
Indu Chawla
Keyword(s):  
Family Planning ◽  
Removal Rate ◽  
Post Partum ◽  
Intrauterine Device ◽  
Uterine Cavity ◽  
P Value ◽  
Expulsion Rate ◽  
Follow Up Study ◽  
Uterine Anomalies

Background: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective and long-term contraception such as intrauterine device (IUCD) in post-partum women. This study was done to determine the efficacy and safety of Post-Partum Intrauterine Device (PPIUCD) and to compare the outcomes of PPIUCD insertion after vaginal delivery and caesarean section.Methods: This follow up study was carried out in the department of Obstetrics and Gynecology, Dr. R.M.L Hospital, PGIMER, New Delhi over a period of 7 month from January 2016 to July 2016. PPIUCD (cu T- 380 A) insertions were done in 136 women who fulfilled the inclusion criteria. Women having haemoglobin less than 8 gm%, rupture of membranes more than 18 hours, obstructed labour, Uterine anomalies, distorted uterine cavity by fibroid, significant postpartum haemorrhage, coagulation disorders, fever or clinical symptoms of infection during labour were excluded from the study. Post insertion counselling was done, and these women were advised to follow up at 6 weeks and then after 6 months postpartum in the family planning O.P.D. At the follow-up visit, the women were asked for any symptoms of unusual vaginal discharge, irregular or heavy bleeding per vagina, and any expulsions if noticed.Results: Total number of cases that reported for follow up in family planning OPD was 118. Therefore, 18 patients were lost in the follow up. In 58.47% women, there was no complaint. Heavy menstrual bleeding was found in 17.79% women and pelvic pain in 16.10% women. The expulsion rate was 5.08% and IUCD removal was done in 12.71% women. Though, the incidence of expulsion and removal rate was more in vaginal insertions than in caesarean insertions but this difference was not statistically significant, while the incidence of missing threads were found more in intra caesarean insertion (28% vs. 11.76% with p value <0.05). Continuation rate at 6 month was 82.20%.Conclusions: PPIUCD insertion is a safe, convenient and effective method of contraception. Although the expulsion rate and removal rate was more in vaginal PPIUCD insertions, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in our country where most of the women do not come for contraceptive advice after delivery.

scholarly journals Pelvic pain and early IUD discontinuation: a prospective cohort study

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.

scholarly journals Spontaneous Rupture of an Unscarred Gravid Uterus in a Primigravid Woman at 32 Weeks of Gestation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Etsuko Mizutamari ◽  
Tomoko Honda ◽  
Takashi Ohba ◽  
Hidetaka Katabuchi
Keyword(s):  
Cesarean Section ◽  
Uterine Rupture ◽  
Spontaneous Rupture ◽  
Gravid Uterus ◽  
Uterine Perforation ◽  
Primigravid Woman ◽  
Scarred Uterus ◽  
Operative Findings ◽  
The Right

Uterine rupture usually occurs in a scarred uterus, especially secondary to prior cesarean section. Antepartum uterine rupture in an unscarred uterus is extremely rare. We report a case of spontaneous rupture of an unscarred gravid uterus at 32 weeks of gestation in a primigravid woman. Ultrasonography and magnetic resonance imaging showed a bulging cystic lesion communicating with the intrauterine cavity. Operative findings during emergent cesarean section revealed uterine perforation in the right cornual area and a prolapsed, nonbleeding amniotic sac. The left cornual area was also focally thin. An arcuate uterus was suspected based on follow-up hysterosalpingography. Antepartum uterine rupture tends to occur in the uterine cornual area. In this case, Müllerian duct anomalies may have been associated with focal myometrial defects.

scholarly journals Acute intrauterine device migration appendicitis with cecal appendix obstruction: Case report and literature review

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Oscar Mauricio Poveda Ortiz
Keyword(s):  
Case Report ◽  
Iliac Fossa ◽  
Intrauterine Device ◽  
Abdominal Cavity ◽  
Uterine Perforation ◽  
Uterine Anomalies ◽  
Surgical Extraction ◽  
And Migration ◽  
The Moment ◽  
The Right

Introduction The intrauterine device is a planning method widely used in the world, however, it is not without complications, one of these is uterine perforation and migration of the IUD to the abdominal cavity, which although it is rare, has serious clinical repercussions and its study has been studied. relationship with the adequate or not insertion of the device, the size and configuration of the uterus, uterine anomalies or surgeries and the moment of insertion after delivery. Case report We present the case of a 36-year-old female patient with a 12-hour history of pain in the mesogastrium that radiates to the right iliac fossa of 9/10 weight intensity, associated with fever measured at 38.9º. He underwent diagnostic laparoscopy with a finding of acute appendicitis secondary to lumen obstruction by the IUD, so an appendectomy was performed. Conclusions The appropriate treatment when this complication occurs is surgical extraction either laparoscopically or laparotomy to reduce the risk of associated complications.

scholarly journals Comparison of Postoperative Pain between Patients who underwent Primary and Repeated Caesarean Section: A Prospective Cohort Study

2019 ◽  
Author(s):  
Guangyou Duan ◽  
Guiying Yang ◽  
Jing Peng ◽  
Zhenxin Duan ◽  
Jie Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Pain ◽  
Cesarean Section ◽  
Visceral Pain ◽  
Postoperative Patient ◽  
Cesarean Deliveries ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Intravenous Analgesia

Abstract Background: The presences of differences in post-operative pain are unclear between the primipara who underwent a primary cesarean section and multipara who underwent first repeat cesarean section. The study aimed to explore the possible difference in postoperative pain between primipara and multipara. Methods: Women who underwent cesarean deliveries under spinal anesthesia were included, and postoperative patient-controlled intravenous analgesia was performed. Postoperative incision and visceral pain within 48 hours after the surgery were evaluated. Serum leukocyte and neutrophil counts before and 24 hours after the surgery were retrospective collected. Additionally, the patients’ pain statuses on postoperative week 1 and week 4 were also assessed during follow-up via telephone. Results: A total of 168 patients (67 primipara and 101 multipara) were included. The multipara showed less risk for experiencing moderate to severe incision pain during the 48 hours after the surgery than the primipara (15.8%vs.37.3%; P=0.001). In patients under 30 years old, inadequate treatment of the visceral pain in the multipara was higher than that of the primipara (22.7%vs.6.4%; P=0.026). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multipara and primipara (33.7%vs.40.2%, P=0.381). Additionally, a significantly higher incidence of pain at 4 weeks after the surgery was noted in the primipara compared to the multipara (55.4%vs.36.1%, P=0.015). Conclusions: Individual differences between the primipara and multipara should be considered in the management of postoperative analgesia for those who have undergone Cesarean deliveries.

scholarly journals Labor patterns in Chinese women in Fuzhou attempting vaginal birth after previous cesarean delivery: a retrospective cohort study

2019 ◽  
Vol 47 (12) ◽  
pp. 6091-6099
Author(s):  
Lianghui Zheng ◽  
Qinjian Zhang ◽  
Qiuping Liao ◽  
Rongxin Chen ◽  
Rongli Xu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cesarean Section ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chinese Women ◽  
Vaginal Birth ◽  
Previous Cesarean Section ◽  
Cervical Dilation ◽  
Trial Of Labor ◽  
Previous Cesarean

Objective To investigate the characteristics of labor in Chinese women who successfully have vaginal birth after cesarean section (VBAC). Methods A retrospective cohort study was conducted in a hospital with 1000 beds between January 1 2015 and December 31 2017. A total 657 parturients with VBAC were selected. Women were divided into two groups according to previous cesarean section with or without trial of labor. Labor curves were analyzed and interval-censored regression was used to estimate the duration of labor. Results The 95th percentile for the first stage of labor in VBAC was 13.03 hours, and labor accelerated after 4 cm of cervical dilation in both groups. The dilation rate in the trial of labor group was superior to that in the non-trial of labor group at 6–10 cm of dilation. After 6 cm, labor accelerated much faster in the trial of labor group than in the non-trial of labor group. Conclusions Management of labor in parturients with VBAC whose cervical dilation is >6 cm should be treated differently according to previous cesarean section with or without trial of labor. If there is trial of labor in a previous delivery, the duration of labor should be shortened.

scholarly journals Emergency Contraception Counseling in California Community Pharmacies: A Mystery Caller Study

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 38 ◽  
Author(s):  
Ditmars ◽  
Rafie ◽  
Kashou ◽  
Cleland ◽  
Bayer ◽  
...  
Keyword(s):  
San Francisco ◽  
Emergency Contraception ◽  
San Diego ◽  
Intrauterine Device ◽  
Community Pharmacists ◽  
Community Pharmacies ◽  
Ulipristal Acetate ◽  
Contraception Counseling ◽  
Copper Intrauterine Device

This study was conducted to determine which emergency contraception (EC) methods are offered by community pharmacists in response to patient calls. Female mystery callers called all community pharmacies in two California cities using standardized scripts. The callers inquired about options available to prevent pregnancy after sex and whether that method was available at the pharmacy, using follow-up probes if necessary. A total of 239 calls were completed in San Diego (n = 127, 53%) and San Francisco (n = 112, 47%). Pharmacists indicated availability at most sites (n = 220, 92%) with option(s) reported as levonorgestrel only (LNG; n = 211, 88.3%), both ulipristal acetate (UPA) and LNG (n = 4, 1.6%), UPA only (n = 1, 0.4%), or non-specific EC (n = 4, 1.7%). Nineteen pharmacies (7.9%) did not have EC available on the day of the call. Following additional probing, some pharmacists discussed UPA (n = 49, 20.5%) or the copper intrauterine device (n = 1, 0.4%) as EC options. LNG EC products were available same-day in 90.1% of pharmacies, whereas UPA was available same-day in 9.6% of pharmacies. The majority of pharmacies called in this study offered and stocked at least one EC option, but the focus of discussions was on LNG and matched what was in stock and available.

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