POSITIVE ADAPTIVE RESPONSE OF WOMEN IN LOW SOCIO-ECONOMIC CLASS FOR CHANGE OF CONTRACEPTIVE METHOD FROM COMBINED CONTRACEPTIVE PILLS TO COPPER INTRAUTERINE DEVICE

Objective: To ensure family spacing in our low socio-economic class. Study Design: Quasi-experimental study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2019. Methodology: Two hundred females using oral contraceptive pills for spacing of children coming to Pak Emirates Military Hospital were selected. The problems of using contraceptive pills were identified. Out of these 87 women agreed to choose an intrauterine copper device (IUCD). Results: Out of 200 women 87 converted from oral contraceptive pills to intrauterine copper device use. Most of them faced daily dosage problems 168 (84%). Nausea was encountered by 123 (61.5%) women and later settled in 89 (44.5%) women. About 31 (15.5%) were worried about the chances of uterine perforation and 56 (28%) were worried about lost intrauterine copper device resulting in laparotomy. About 65 (32.5%) were afraid of infection, backache and vaginal discharge. About 91 (45.5%) women thought to have gastric problems with the intrauterine copper device. About 71 (81%) agreed to have a spacing of children for about five years and removal whenever desired. Conclusion: Intrauterine contraception is a very safe and efficient method for contraception as compared to oral pills. If expertise is, available it should be used and couples should be fully educated for its safety.

THE RESURGENCE OF INTRAUTERINE CONTRACEPTION

The topic of intrauterine contraception remains relevant for a very long time. The active search for optimal and safe means of intrauterine contraception began in the last century and is gaining more and more momentum in the modern world. The importance of this issue is due to the continuing need of the population of reproductive age to control childbearing, the popularization of data on various methods of birth control and the desire to use safe, effective, environmentally friendly methods of contraception. The presented topic touches on the aspects of family planning and pre-gravidar training, so it is not only a significant medical, but also a social problem. This leads to the constant need to study new mechanisms of systemic and local effects of intrauterine contraceptives on the female body. This article discusses the use of intrauterine contraceptives, the features of their impact on the endometrium, the reproductive potential of women, as well as the positive and negative aspects of their use. There are also groups of women for whom intrauterine contraception is the method of choice for birth control. The indications for the extraction of an intrauterine contraceptive are described. Among them, there are menstrual disorders of the type of hypermenorrhea lasting more than 6 months in the absence of the effect of the use of non-steroidal anti-inflammatory drugs, the end of the period of use of an intrauterine contraceptive, the desire and need of a woman, the desired pregnancy, expulsions, the postmenopausal period. Knowledge of all aspects of intrauterine contraception allows the obstetrician-gynecologist to correctly select a certain type of IUD, to explain to the woman all the risks of its use, to diagnose and correct complications in a timely manner.

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

Background Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception. Methods We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle–Ottawa Scale to assess risk of bias and excluded studies with medium–high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis. Results Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium–high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC. Conclusions Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making. Systematic review registration PROSPERO [CRD42016038254].

Failure of intrauterine contraception in a multigravida lady with an undiagnosed uterus didelphys: a case report

Uterus didelphys remains one of the rarest uterine anomalies partly because; majority women experience no symptoms with an uneventful reproductive life. Despite the cost-effectiveness and efficacy paired with fewer side effects and convenience of using an intrauterine contraceptive device, it is most likely to prove futile in an unsuspected case of didelphic uterus resulting in an unintended pregnancy. Hence, intrauterine contraception is generally considered a contraindication in cases of uterine malformations. We present a case of a multigravida mother (G7 P3 L3 A3) with a history of three term vaginal deliveries, with an undiagnosed uterus didelphys, carrying a single live intrauterine pregnancy of approximately 6 weeks period of gestation, in the right uterine horn and a copper containing intrauterine contraceptive device in the left uterine horn, willing to undergo medical termination of pregnancy. A high index of suspicion, on the part of the gynaecologist as well as the radiologist, is required to investigate concurrent pregnancy with a history of an intrauterine contraceptive device insertion, in order to rule out rarer uterine malformations like uterus didelphys. Thorough history taking and clinical examination accompanied by improved imaging techniques should be performed at the time of first pregnancy in order to avoid an unsuitable placement of an intrauterine contraceptive device.