IMPLEMENTASI R-SHINY UNTUK ANALISIS BIPLOT KOMPONEN UTAMA (Studi Kasus: Penggunaan Alat Kontrasepsi pada Peserta Aktif KB di Provinsi Jawa Tengah Tahun 2019)

The population problem is a fairly complex and complicated problem. Therefore, Indonesia seeks to control the birth rate with the Family Planning program. The implementation of this program can be evaluated through statistical data. The statistical analysis used is biplot principal component analysis to see the relationship between districts/cities in choosing the contraceptive device/method used, the variance of each contraceptive device/method, the correlation between contraceptive devices/methods, and the superiority value of the contraceptive device/method in the population. each district/city. The problem with performing the analysis is the limitations of easy-to-use open source software. As with R, users must understand writing code to perform data analysis. Therefore, to perform a biplot analysis of the principal components, an RShiny application has been created using RStudio. The R-Shiny that has been made has many advantages, including complete results which include data display, data transformation, SVD matrix, to graphs along with plot graph interpretation. The results of the principal component biplot analysis using R-Shiny with α =1 have the advantage of a good principal component biplot, which is 95.63%. This shows that the biplot interpretation of the main components produced can be explained well the relationship between the district/city and the contraceptive methods/devices used.

Assessment of a Novel Fixation Method of a Frameless Intrauterine Contraceptive Device Inserted during Cesarean Delivery as a Means of Preventing Displacements and Expulsions: A Prospective Observational Study

The primary objective of this study was to assess the novel fixation method of a frameless copper-releasing intrauterine device inserted following placental delivery during cesarean section and analyze its impact in reducing device displacement and expulsion during and after uterine involution. We hypothesized that the dual-anchoring technique could reduce the risk of intrauterine device displacement and expulsion during and after the uterine involution. The study was conducted at the Gazi University Medicine Faculty Hospital in Ankara, Turkey. Twenty-one pregnant women were enrolled. Insertion was performed following placental removal. To confirm the proper placement and good retention of the device, the distance between the fundal serosa (S) and device anchor knot (A) was measured (S–A) during follow-ups, by ultrasound. There were significant differences in the S–A, as observed by ultrasound at discharge and at 6 weeks post-delivery, which is consistent with the tissue contractions associated with uterine involution. Notwithstanding the uterine involution, no device displacements or expulsions occurred, which indicated a good retention of the frameless device. This innovative retention method of the frameless intrauterine device ensures a well-tolerated, long-term contraception, allowing for immediate contraception and proper pregnancy spacing for cesarean scar healing, and overcomes the issue of expulsion encountered with conventional intrauterine systems.

Clinical outcome of post placental IUD CuT380 insertion in terms of expulsion

Background: Insertion of an intrauterine contraceptive device (IUD) immediately after delivery has been recommended by the World Health Organization (WHO), as one of the safe and effective methods of temporary contraception. In the immediate post delivery period the women are highly motivated and need an effective method for contraception so that the child can be brought up with a relaxed mind without the worry of unintended pregnancy. This approach is more applicable to our country where delivery may be the only time when a healthy woman comes in contact with health care personnel. However, immediate post-partum IUD insertion may have disadvantages as well. The risk of spontaneous expulsion may be unacceptably high.Methods: After taking approval from hospital ethical committee, all women planning vaginal delivery desiring IUD, admitted through OPD and emergency were evaluated in detailed on design Performa Performa include patient’s identity, age, parity, gestational age, no of alive children, outcome and timings of insertion. Informed consent was obtained. With aseptic precautions IUD was inserted with kellys forceps in the uterine cavity up to the fundus, then cervix was examined for thread (that should not be visible at cervix if proper insertion done). The procedure was performed by myself. Patients were followed at 6week by examining the threat of IUD. All the information was recorded by myself. Follow up was done by taking patients contact number.Results: In our study, out of 300 cases, 63.67% (n=191) were between 18-30 years of age while 36.33% (n=109) were between 31-40 years of age, mean+sd was calculated as 29.49+4.62 years, mean gestational age was calculated as 38.53+0.94 weeks, mean parity was calculated as 3.49+1.06 paras. Frequency of expulsion in post placental intra uterine device cuT 380 insertions reveals in 8.67% (n=26).Conclusions: We concluded that the frequency of expulsion in post placental intra uterine device cuT 380 insertions is not significantly higher and appears to be safe and effective method of contraception.

Safety and Efficacy of an Atraumatic Uterine Cervical Traction Device: A Pilot Study

Introduction: Alignment of the uterine cervix with the vaginal canal is often required during insertion of an intrauterine contraceptive device (IUD). Currently available instruments are traumatic tenacula, which can cause pain and bleeding and represent an obstacle for certain patients to pursue their medical follow-up. A novel investigational cervical vacuum tenaculum, enables atraumatic traction of the cervix using a semi-circular suction pad, designed to conform to the anatomical shape of the external cervical os. Suction is generated by manually pulling out a sliding tube in a vacuum chamber.Methods: We performed a single arm non-comparative pilot study to assess the safety and efficacy of the cervical vacuum tenaculum in 13 women receiving an IUD. Data on procedural efficacy, safety, patient-reported pain scores at specific time points during IUD insertion procedure and patient satisfaction were collected prospectively.Results: Insertion of IUD was successful with use of the study device in 7 of the 13 enrolled patients (54%). No bleeding or only limited ecchymosis were caused by the device. No adverse events were reported. Participants reported very little pain (mean Visual Analog Scale <10) when applying the device. Participants who achieved IUD insertion with the device reported strong overall satisfaction with the procedure.Conclusions: The suction-based atraumatic tenaculum can be used to manipulate the cervix during IUD insertion with satisfactory efficacy and safety. The results of this pilot study support further studies of this device in larger populations comparing with standard single-tooth tenaculum.Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT 04441333.

Role of diagnostic hysteroscopy in evaluating patients with abnormal uterine bleeding in a tertiary care centre

Background: Abnormal uterine bleeding is one of the commonest conditions amongst patients attending gynaecology OPD which also leads to significant disruption in a normal lifestyle. The causes of abnormal uterine bleeding are heterogeneous and complex. A systematic evaluation with detailed history and physical examination is foremost important in reaching diagnosis. Hysteroscopy is not only safe, quick and observes entire uterine cavity but also helps in precision in sampling and increases accuracy of diagnosis. It is also curative in conditions such as polyps, fibroids, uterine synechiae, menorrhagia and lost intrauterine contraceptive device. The aim of the study is to evaluate the role of hysteroscopy as a screening method in patients with AUB & compare to their USG findings and to the histopathological reports of the endometrial biopsy.Methods: This is a prospective observational study conducted at a tertiary healthcare centre over a period of 18 months, in 50 females belonging to pre, peri and post-menopausal age group. Sampling was done based on selection criteria after obtaining valid consent from the study group.Results: Hysteroscopy has a definitive role in evaluation of patients presenting with abnormal uterine bleeding with high sensitivity, specificity, PPV and NPV with immediate results.Conclusions: The above study concludes that the accuracy of diagnosing the cause of abnormal uterine bleeding is more with hysteroscopy followed by D and C then USG combined with D and C.

Intrauterine contraceptive device migration to the urinary bladder

Intravesical migration represent as uncommon complication of intrauterine device insertion. We present a case of an IUD that migrated to the urinary bladder and impacted in urinary bladder wall, causing significant urinary symptoms. A 44 years old woman presented with menorrhagia, lower abdominal pain and urinary symptoms since past 1 year. She reported an IUD insertion 10 years back. Imaging detected the presence of IUD in the urinary bladder wall with large fibroid in uterus. Under anaesthesia, total abdominal hysterectomy with bilateral salphingoophorectomy is performed and IUD was removed out of the bladder without any complications. In her follow-up evaluation after 2 week, she had no urinary symptoms. A regular follow-up of IUD for visible thread would help in earlier detection of misplaced IUD and prevent the complications such as intravesical migration.

Postpartum intrauterine contraceptive device use and its associated factors in Ethiopia: systematic review and meta-analysis

Background The intrauterine contraceptive device, a type of long-acting reversible contraception, is one of the most effective and safe contraceptive methods. In Ethiopia, intrauterine contraceptive device is little known and practised to delay pregnancy. Therefore, this study aimed to assess post-partum intrauterine contraceptive device utilisation and its associated factors among women in Ethiopia. Method In the current meta-analysis, variables were searched from different electronic database systems, including PubMed, Google Scholar, EMBASE, HINAR, Scopus, Web of Sciences, and Grey literature. Data were extracted using a standardised data collection measurement tool. The data were also analysed by using STATA 16 statistical software. I2 tests assessed heterogeneity between the studies. A random-effect model was used to forecast the pooled utilisation of postpartum intrauterine contraceptive device. Results Twelve full-article studies were included. The pooled prevalence of post-partum intrauterine contraceptive device among women in Ethiopia was 21.63%. Occupation (OR = 4.44, 95% CI, 2.24–8.81), educational level of college and above (OR = 5.93, 95% CI, 2.55–13.8), antenatal care (OR = 2.09, 95% CI, 1.4–3.12), age (OR = 4.8, 95% CI, 2.3–10.04), good knowledge (OR = 4.16, 95% CI, 1.65–10.49), counseling (OR = 3.05, 95%CI, 1.41–6.63), husband support (OR = 11.48, 95% CI, 6.05–21.79) and awareness about IUCD (OR = 3.86, 95% CI, 1.46–10.2) were positively associated with utilization of postpartum intrauterine contraception device. Conclusions Utilisation of post-partum intrauterine contraceptive device was significantly low. Scaling up women’s educational status and ANC use has paramount importance in increasing post-partum IUD use, which further improves maternal and child health in general. This finding may be useful in both reproductive health promotion at an individual level and policy-making regarding this issue.