Performance of a handheld point of care ultrasonography to assess IUD position compared to conventional transvaginal ultrasonography.

OBJECTIVE: To compare the performance of the abdominal handheld point-of-care ultrasonography (POCUS) Butterfly-iQ to gold standard transvaginal ultrasonography (US) in identifying the position of intrauterine devices (IUDs) in the hands of a medical doctor specialised in ultrasonography. METHODS: In this diagnostic accuracy study, a single operator conducted abdominal POCUS followed by conventional transvaginal US. Seventy patients utilising copper or hormonal IUDs were assessed between June 2021 and October 2022. IUDs were categorised as entirely within the uterine cavity or malpositioned. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for detecting malpositioned IUDs, with conventional US results serving as the reference standard. Concordance rate and Kappa coefficient were computed to assess the agreement between the two ultrasound modalities. RESULTS: Among the 70 patients, 46 (65.7%) used copper IUDs, and 24 (34.3%) used hormonal IUDs. Conventional transvaginal US showed IUDs entirely within the uterine cavity in 56 (80%) patients and 14 (20%) IUDs were malpositioned. Of the 14 malpositioned IUDs seen by conventional US, POCUS identified 13 demonstrating a sensitivity of 92.9% (66.1-99.8). Of the 56 IUDs entirely within the uterine cavity shown by conventional US, only two cases were considered malpositioned by POCUS demonstrating a specificity of 96.4% (87.7-99.6). The concordance rate was 95.7%, and the Kappa value was 0.87 in differentiating between IUDs entirely within the uterine cavity and those that were malpositioned. CONCLUSION: Abdominal POCUS using Butterfly-iQ, when administered by an imaging specialist, exhibited excellent performance in confirming IUDs entirely within the uterine cavity.

Through a smartphone-based handheld point-of-care ultrasonography it was possible to correctly evaluate the position of intrauterine devices (IUDs) in a sample of 70 patients (46 using copper and 24 using hormonal IUDs).

Clinical Assessment of 3 Intrauterine Devices in Adolescent Girls: A Randomized Clinical Trial.

STUDY OBJECTIVE: To assess clinical performance, bleeding pattern, dysmenorrhea, and satisfaction up to 1 year after placement of 3 types of intrauterine devices (IUDs) (TCu380A, levonorgestrel 52 mg, and levonorgestrel 19.5 mg) in adolescents METHODS: The study was a randomized trial with 318 adolescents allocated to the 3 IUDs. We assessed reasons for removal, continuation, menstrual patterns, dysmenorrhea, and satisfaction. RESULTS: Participants aged (mean ± SD) 17.9 ± 1.4 years, with 80.8% being nulligravidae. After 1 year, 265 (83.3%) continued using the IUD; however, the continuation rate of TCu380A (75.4 ± 4.2) was lower than that of both the levonorgestrel 52-mg (88.6 ± 3.1) and 19.5-mg IUDs (86.8 ± 3.3), and bleeding/pain and expulsion were the main reasons for removal of the TCu380A IUD. The duration of menstruation was longer among the TCu380A IUD users (6.0 ± 2.0 days) than those using the levonorgestrel 52 mg (2.5 ± 3.9) and 19.5 mg (3.2 ± 3.2) devices, P < .001. Amenorrhea was reported by 49.5% and 37.8% users of the levonorgestrel 52-mg and 19.5-mg devices, respectively, P < .001. Dysmenorrhea was reported in 68.5% of all participants at the baseline; this was 67.9% of the TCu380A group and 33.3% and 36.0% of the levonorgestrel 52-mg and 19.5-mg IUD groups, respectively, P < .001. Satisfaction ranged from 80.7% in the TCu380A group to 97.8% in the levonorgestrel 52-mg group (P = .03). CONCLUSION: The 3 IUDs are suitable for adolescents, with high contraceptive efficacies and rates of continuation within 1 year of use and high degrees of satisfaction. Users of the hormonal IUDs reported lower expulsion rates, more favorable menstrual patterns, and less dysmenorrhea compared with the TCu380A IUD.

Outcomes of Intrauterine Device Insertion by Certified Midwives and Obstetric Nurse Practitioners.

OBJECTIVES: to evaluate the outcomes of Interval Copper Intrauterine Device (IUD) insertion performed by certified midwives and obstetric nurse practitioners at a Peri-Hospital Birth Center. METHODS: a cross-sectional study was conducted involving 75 women who underwent IUD insertion between January 2018 and February 2020. Data collection was carried out using medical records and telephone interviews. RESULTS: no instances of uterine perforation were observed. Expulsion rates of the devices were 1.3% within 30 to 45 days of use and 5.3% within the first year of use. The follow-up removal rate was 4.0%. The average pain score reported was 4.2 (SD = 3.3). Among those who continued using the device, 93.1% expressed satisfaction. CONCLUSIONS: the findings demonstrate that IUD insertion by certified midwives and obstetric nurse practitioners is a safe procedure, yielding outcomes comparable to those reported in the existing literature.

Expulsion and continuation rates of the 52 mg levonorgestrel intrauterine system in adolescents and adult women.

OBJECTIVE: To compare the continuation rates, expulsion, and other reasons for discontinuation of the hormonal intrauterine device with 52 mg of levonorgestrel (52 mg LNG-IUD) in adolescents and adult women. METHODS: We conducted a retrospective cohort study that included 393 women in whom we placed a 52 mg LNG-IUD and followed up to 5 years. We created two retrospective cohorts, one with 131 adolescents (aged between 12 and 19 years) and the other with 262 women aged ≥20 years. Each adolescent was paired with two adult women who had the same parity and who had a 52 mg LNG-IUD inserted on the same day. We used the Mann-Whitney test to compare numerical variables in both groups, the Kaplan-Meier method, and the log-rank test to compare the continuation, expulsion and other reasons for IUD discontinuation of the two groups. RESULTS: Age of the adolescents and adult women were mean ± SD 18.1 (±1.1) and 31 (±6.8) years, respectively (p = 0.015). Continuation rates by the fifth year of use were 55.6/100 women-years (W-Y) and 70.3/100 W-Y among adolescents and adult women (p = 0.106); and expulsion rates were 8.4/100 and 6.0/100 W-Y, respectively (p = 0.463). Adolescents had a lower continuation rate during 3 to 5 years of follow-up (p = 0.011) and a high rate of removals due to bleeding/pain (18.5 ± 5.7/100 W-Y vs 6.4/100 ± 2.1 W-Y, p = 0.039). CONCLUSION: Adolescents who used the 52 mg LNG-IUD showed a lower continuation rate 3-5 years after device placement than adult women. The expulsion rates were similar in both groups.

Adolescents who used the 52 mg LNG-IUD showed expulsion rates similar than adult women. Despite the good continuation rate, adolescents had a lower continuation rate within 3­5 years of follow-up and high rate of removals due to bleeding/pain than adult users.

Women's perspectives on impact on the post menopause of use of the 52 mg levonorgestrel intrauterine device during the menopausal transition.

OBJECTIVES: To assess perimenopausal users of 52 mg levonorgestrel intrauterine devices (LNG-IUD) regarding the IUD impact after menopause. MATERIAL AND METHODS: a cross-sectional study with users aged 40 and 49 years old, without cognitive impairment that answered a questionnaire regarding worries and benefits after the menopause due to LNG-IUD use. RESULTS: Almost half of 221 users (52.9%) have concerns that LNG-IUD use could influence aspects after menopause, 111 (50.3%) that the post-menopause symptoms get worse and 92 (41.6%) that interfere with recognition of menopausal symptoms. CONCLUSION: Half of perimenopausal LNG-IUD users expressed concerns about how device use could affect post-menopause symptoms.

The 52 mg hormonal-IUD who were at menopausal transition reported worries that the use of the IUD can affect menopausal symptoms. It is important that health professionals can routinely guide these women.

Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates.

OBJECTIVE: To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. MATERIALS AND METHODS: In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. RESULTS: There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. CONCLUSION: Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

OBJETIVO: Avaliar as taxas de expulsão e continuação do dispositivo intrauterino (DIU) de cobre inserido no pós-parto imediato em um hospital universitário brasileiro. MATERIAIS E MéTODOS: Neste estudo de corte transversal, foram incluídas parturientes submetidas à inserção de DIU de cobre no pós-parto imediato entre março de 2018 e dezembro de 2019. Foram coletados dados clínicos e da ultrassonografia (US) transvaginal realizada após seis semanas. As taxas de expulsão e de continuação foram avaliadas após seis meses por meio de dados do prontuário ou por contato telefônico. O resultado principal foi a proporção de DIUs expelidos em seis meses. Para análise estatística, utilizaram-se o teste t de Student, a distribuição de Poisson, e o teste do Qui quadrado. RESULTADOS: Houve 3,728 nascimentos no período, e foram inseridos 352 DIUs, em uma taxa de 9,4%. Com 6 semanas, o DIU estava bem posicionado em 65,1% dos casos, em 10,8%, houve expulsão parcial, e, em 8,5%, fora totalmente expelido. Aos 6 meses de pós-parto, foram obtidas informações de 234 mulheres, 74,4% das quais usavam DIU, com uma taxa de expulsão geral de 25,6%. A taxa de expulsão foi maior após o parto vaginal do que após cesariana (68,4% versus 31,6%, respectivamente; p = 0,031). Não houve diferenças quanto à idade, paridade, idade gestacional, índice de massa corpórea final, e peso do recém-nascido. CONCLUSãO: Apesar da baixa taxa de inserção e alta taxa de expulsão, a taxa de continuação em longo prazo da contracepção intrauterina com DIU de cobre foi elevada, o que indica que se trata de intervenção útil para prevenir gestações indesejadas em curto intervalo de tempo.

Assessment of pain and ease of intrauterine device placement according to type of device, parity, and mode of delivery.

OBJECTIVE: We compared pain and the ease of insertion of two different types of intrauterine devices (IUDs; the levonorgestrel intrauterine systems 52 mg (LNG-IUS 52 mg) and the copper-bearing IUD [TCu380A]) among nulligravidas and parous women with and without caesarean delivery. METHODS: A cross-sectional study assessed pain referred by women and ease of insertion of the two IUDs models. We applied a visual analogue scale (VAS) to assess pain, while the ease of insertion was defined by healthcare professionals. RESULTS: We assessed 1076 women, including 334 nulligravidas and 566 parous women who had had at least one caesarean delivery and 176 women with history of only vaginal delivery. Regarding pain at IUD placement, 26 (2.5%) women reported no pain, 167 (16.4%) light pain, 319 (31.3%) moderate and 506 (49.7%) intense pain. The highest scores for pain were reported by nulligravidas (67.2%, p = 0.001), while the mean pain score was higher in the LNG-IUS 52 mg group. Difficulties reported by healthcare providers were more frequent in the nulligravidas (21.2%) and women with previous caesarean delivery (16.9%). CONCLUSIONS: Our findings suggested differences between the two IUDs tested, with higher pain associated with the LNG-IUS 52 mg, and highlights the need for pain management, mainly among nulligravida and women with history of caesarean delivery.SHORT CONDENSATIONIntense pain at insertion was more related to nulligravida than parous women and more pain with placement of LNG-IUS 52 mg IUDs than TCu380A IUDs. Nevertheless, our results confirmed that ease of IUD placement was between 80% to 90% of all insertions, being more common in parous women without previous caesarean delivery.

Pain and ease of insertion of three different intrauterine devices in Brazilian adolescents: A participant-blinded randomized trial.

OBJECTIVES: To compare pain and ease of insertion of the copper 380 mm2, levonorgestrel 52 mg, and levonorgestrel 19.5-mg intrauterine devices (IUDs) in Brazilian adolescents. STUDY DESIGN: We conducted a participant-blinded randomized trial at two clinics in Brazil. We enrolled 318 adolescents<19 years old in a 1:1:1 ratio from November 2021 to February 2022. We informed the adolescents about the IUD type inserted after they evaluated the pain associated with the IUD insertion using a Visual Analogue Scale and immediately after that the healthcare provider who placed the IUD evaluated the ease of the procedure. RESULTS: The VAS pain level was significantly higher after the levonorgestrel 52-mg IUD placement, median and [interquartile range, IQ] 8.0 [4.0] than the copper 380-mm2 IUD 7.0 [4.0], and the levonorgestrel 19.5-mg IUD 7.0 [6.0] (p = 0.001). The placement was easier after the copper 380-mm2 IUD (87/106, 82.1%) and the levonorgestrel 19.5-mg IUD (91/106, 85.8%) when compared with the levonorgestrel 52-mg IUD (75/105, 70.7%). After multiple logistic regression analyses, the higher VAS pain scores were associated with the levonorgestrel 52-mg IUD (OR = 2.90), low number of pregnancies (OR -0.48), and with a history of dysmenorrhea (OR = 2.67). CONCLUSIONS: The placement of the copper 380-mm2 IUD and the levonorgestrel 19.5-mg IUD was associated with lower pain according to the adolescent and was easier according to the provider when compared with the levonorgestrel 52-mg IUD. However, the small observed differences may not be clinically relevant. IMPLICATIONS: We found that the three types of IUDs were generally easy to place; however, mean pain scores were high during insertions. Our findings of high pain scores reinforce the need for interventions to reduce pain for adolescent IUD insertion.

Single-visit long-acting reversible contraception provision and pregnancy rates within 3 months.

OBJECTIVES: To assess the occurrence of pregnancy in a cohort of women who received a copper intrauterine device (IUD), hormonal IUDs or an etonogestrel (ENG) contraceptive implant at a single-visit practice. METHODS: Prospective study conducted at the University of Campinas, Campinas, São Paulo, Brazil. We obtained data from four ongoing studies including both the date of the device placement, the first day of the last menstrual period, and the occurrence of pregnancy up to 3 months after device placement. RESULTS: We included 2479 device placements (413 TCu380A IUDs, 1476 hormonal IUD and 590 ENG implants). Almost half of the device placements (1113/2479; 44.9%) were performed within the first 5 days of the menstrual cycle. We observed three pregnancies: one in an ENG implant user who received the implant within days 1-5 of the menstrual cycle; one in a woman who received a hormonal IUD during days 6-10 of the menstrual cycle; and one in a copper IUD user with placement during days 21-25 of menstrual cycle. CONCLUSIONS: Single-visit long-acting reversible contraception placements are a good strategy with overall very low pregnancy rates. This strategy has a potential to reduce unintended pregnancies and to reduce costs and barriers to both women and the healthcare system.

Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion / Conhecimento, atitude e prática de médicos brasileiros sobre inserção de dispositivo intrauterino no pós-parto e pós-aborto imediatos

Abstract Objective To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. Methods Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. Results One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. Conclusion Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.

Resumo Objetivo Avaliar o conhecimento, atitude e prática de médicos brasileiros sobre a inserção de dispositivos intrauterinos no pós-parto e pós-aborto imediatos. Métodos Estudo transversal com inquérito online envolvendo médicos plantonistas de hospitais públicos brasileiros. Os participantes responderam a um questionário anônimo com perguntas fechadas para avaliar seu conhecimento, atitude e experiência sobre a inserção de dispositivos intrauterinos de cobre no pós-parto e pós-aborto imediatos. Resultados Cento e vinte sete médicos de 23 hospitais localizados nas 5 regiões do Brasil preencheram o questionário. A maioria era do sexo feminino (68,5%) e trabalhava em hospitais de ensino (95,3%). O escore médio (desvio padrão) de conhecimento (escala 0-10) foi 5,3 (1,3); apenas 27,6% tiveram escore ≥7,0. A maioria (73,2%) faria inserção de dispositivo intrauterino no pós-parto imediato em si mesma/familiares. Cerca de 42% dos participantes declararam não ter recebido nenhum treinamento sobre inserção de dispositivos intrauterinos no pós-parto ou pós-aborto imediatos. Nos últimos 12 meses, 19,7%, 22,8% e 53,5% declararam não ter inserido nenhum dispositivo intrauterino durante uma cesárea, após um parto vaginal ou um aborto, respectivamente. Conclusão A maioria dos participantes tem uma atitude positiva em relação à inserção de dispositivos intrauterinos no pós-parto imediato, porém tem um conhecimento limitado sobre esse método. Uma grande porcentagem dos respondentes não teve treinamento sobre inserção de dispositivos intrauterinos no pós-parto ou pós-aborto imediatos e não fez nenhuma inserção desse tipo nos últimos 12 meses. São necessárias estratégias para melhorar o conhecimento, o treinamento e a experiência dos médicos brasileiros sobre a inserção de dispositivos intrauterinos no pós-parto e pós-aborto imediatos.

Consulta de seguimento após inserção de dispositivo intrauterino de cobre (tcu 380a) pós-placentário / Consulta de seguimiento tras inserción de dispositivo intrauterino de cobre (tcu 380a) post placentario / Follow-up visit after post-placental copper intrauterine device insertion (tcu 380a)

RESUMO Objetivo: analisar a ocorrência de consultas de seguimento das mulheres usuárias de DIU de cobre (TCu 380A), inserido durante período pós-placentário (pós-parto e trans-cesárea), em um hospital público, da região Sul do Brasil. Método: coorte prospectiva com mulheres que inseriram o DIU no período pós-placentário e que responderam ao questionário referente à consulta de seguimento. A coleta ocorreu entre setembro/2020 e fevereiro/2021. Utilizou-se teste Qui-quadrado para análise, considerando-se valor de significância de 5% (p<0,05). Resultados: foram entrevistadas 285 mulheres, com média de idade de 28,5 anos e 10 de anos de estudo. Na amostra, 60,7% realizaram a consulta de seguimento com 29,8% no período adequado, 61,3% tiveram o exame ginecológico realizado e 78,1 % foram atendidas por médicos. As principais razões relatadas para a não ocorrência da consulta de seguimento foram indisponibilidade de consulta no período recomendado (38,2%) e orientação profissional para realização da consulta após ultrassonografia (26,3%). Conclusão: observou-se dificuldades na realização adequada da consulta de seguimento para grande parte da amostra. Os achados deste estudo sugerem a necessidade de ampliação do acesso aos serviços de saúde e capacitação das equipes de saúde para atendimento da consulta de seguimento após a inserção do DIU pós-placentário, baseada em protocolos definidos.

RESUMEN Objetivo: analizar la ocurrencia de consultas de seguimiento de las mujeres usuarias de DIU de cobre (TCu 380A), insertado durante período post placentario (postparto y transcesárea), en un hospital público, de la región Sur de Brasil. Método: cohorte prospectivo con mujeres que colocaron el DIU en el período post placentario y que respondieron al cuestionario referente a la consulta de seguimiento. La recolección tuvo lugar entre septiembre/2020 y febrero/2021. Se utilizó la prueba de chi-cuadrado para análisis, considerándose valor de significancia del 5% (p<0,05). Resultados: fueron entrevistadas 285 mujeres, con edad media de 28,5 años y 10 de años de estudio. En la muestra, 60,7% realizaron la consulta de seguimiento con 29,8% en el período adecuado, 61,3% tuvieron el examen ginecológico realizado y 78,1 % fueron atendidas por médicos. Las principales razones relatadas para la no ocurrencia de la consulta de seguimiento fueron indisponibilidad de consulta en el período recomendado (38,2%) y orientación profesional para realización de la consulta tras ultrasonografía (26,3%). Conclusión: se observaron dificultades en la realización adecuada de la consulta de seguimiento para gran parte de la muestra. Los hallazgos de este estudio sugieren la necesidad de ampliar el acceso a los servicios de salud y capacitación de los equipos de salud para atender la consulta de seguimiento después de la inserción del DIU post placentario, basada en protocolos definidos.

ABSTRACT Objective: to analyze the occurrence of follow-up visits of women using copper IUDs (TCu 380A) inserted during the post-placental period (postpartum and trans-cesarean), in a public hospital in Southern Brazil. Method: prospective cohort with women who had an IUD inserted in the post-placental period and who answered a survey regarding the follow-up visit. Collection took place between September 2020 and February 2021. The chi-square test was used for analysis, considering a significance value of 5% (p<0.05). Results: 285 women were interviewed, with an average age of 28.5 years and 10 years of study. In the sample, 60.7% had a follow-up visit, with 29.8% in the recommended period, 61.3% underwent a gynecological examination, and 78.1% were seen by physicians. The main reasons reported for non-occurrence of follow-up visit were unavailability to schedule an appointment in the recommended period (38.2%) and professionals advising to schedule the appointment after an ultrasonography (26.3%). Conclusion: difficulties in appropriately performing the follow-up visit were observed for a large part of the sample. The findings of this study suggest the need to expand access to health services and train health teams to provide follow-up visits after post-placental IUD insertion, based on defined protocols.

Comparison between two methods of the immediate post-placental insertion of copper intrauterine device in vaginal birth-a protocol for a randomized clinical trial.

BACKGROUND: Ensuring effective and long-term contraception in the immediate postpartum period is an effective strategy for reducing unplanned pregnancies. In the meantime, the intrauterine device (IUD) is an excellent option. The aim of our study was to evaluate the best way to insert post-placental IUDs in the immediate postpartum period. Discomfort during insertion, expulsion rate, uterine perforation rate, and proper positioning 40-60 days postpartum will be analyzed. METHODS: Randomized, controlled, open clinical trial. The study group will be composed of women between 18 and 43 years old who are admitted for vaginal birth at the Women's Hospital of the State University of Campinas and who wish to use the IUD as a contraceptive method. The sample will be randomized into two insertion groups: manual and forceps. To calculate the sample size, the method of comparing the proportion between 2 groups was used, setting the level of significance alpha at 5% (alpha=0.05) and the power of the sample at 80% (beta=0.20). Based on the results, it was estimated that a sample of n=186 women (n=93 with manual insertion and n=93 with forceps) would be representative for comparison of expulsion between the 2 groups. All participants will undergo a postpartum consultation 40-60 days after birth with transvaginal ultrasound to assess the proper placement of the IUD. DISCUSSION: Insertion of an IUD in the immediate postpartum period has been considered a good option to increase coverage and access to contraception, and its benefit outweighs the inconvenience of a higher expulsion rate. TRIAL REGISTRATION: This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 50497321.4.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC) (number RBR-4j62jv6). This is the first version of the study protocol approved on 11/12/2021 prior to the start of participant recruitment.

Long-acting reversible contraceptives effects in abnormal uterine bleeding, a review of the physiology and management.

Around two-thirds of women who are of reproductive age use some type of contraception. Two of the most effective long-acting reversible contraceptives (LARC) are the intrauterine device (IUD) and the subdermal contraceptive implant (SCI). Despite their effectiveness, women often report abnormal uterine bleeding as the reason for discontinuation. In this review, we analyze key aspects regarding the mechanisms of action of IUDs (both copper-containing and levonorgestrel-releasing) and SCIs, as well as how they change the intrauterine environment in order to provide effective contraception at a physiological level. Additionally, we introduce the pathophysiology of different types of abnormal intrauterine bleeding provoked by the mentioned LARCs. These three contraceptive methods work in diverse ways, thus, the etiology of abnormal uterine bleeding is different and multifactorial according to each LARC. This review intends to provide information in order to better our understanding of bleeding induced by these contraceptive methods, as well as introduce current and potential new therapies. Furthermore, this review intends to provide updated and concise information that could be available firsthand not only to health care providers but scientists who are innovating and revolutionizing this field. In 2013, the American College of Obstetricians and Gynecologists published a management of abnormal uterine bleeding, however, there is limited updated data regarding the physiology and pathophysiology of abnormal uterine bleeding and its treatment based on different LARCs (hormonal and non-hormonal).

Immediate Postpartum Copper IUD: A Comparative Analysis between Profiles of Women who Accept and who Refuse it.

OBJECTIVE: To analyze the profiles of women who accepted and who refused the insertion of the copper intrauterine device (IUD) postpartum and to learn the motivations related to the refusal of the method. METHODS: Cross-sectional study with 299 pregnant women. The women were informed about the possibility of inserting a copper IUD postpartum and were questioned about their interest in adopting or not this contraceptive. All participants answered a questionnaire with information relevant to the proposals of the present study. The sample size was limited to the number of devices available for the present study. RESULTS: A total of 560 women were invited to join the present study and 299 accepted. Out of the 299 women included in the present study, 175 accepted the copper IUD and 124 refused. As the number of pregnancies increased, the IUD acceptance rate raised (p = 0.002), especially between the groups with 1 and with ≥ 4 pregnancies (p = 0.013). Regarding the desire to have more children, the women who planned to have more children were more likely to refuse the method than the ones who did not (p < 0,001). CONCLUSION: Women with multiple pregnancies and desire to not have more children were more likely to accept the copper IUD. The profile of those who refused was first pregnancy and desire to have more children. Among the three most frequent reasons reported for copper IUD rejection, two responses stood out: no specific justification and desire to have more children.

OBJETIVO: Analisar o perfil das mulheres que aceitaram e recusaram a inserção do dispositivo intrauterino (DIU) de cobre no pós-parto imediato e conhecer as motivações relacionadas à recusa ao método. MéTODOS: Estudo transversal com 299 gestantes, as quais foram informadas sobre a possibilidade de inserir o DIU de cobre imediatamente após o parto e questionadas sobre o interesse em adotar ou não este contraceptivo. Todas as participantes responderam a um questionário com informações pertinentes às propostas do presente estudo. O tamanho da amostra foi limitado ao número de dispositivos disponíveis para o presente estudo. RESULTADOS: Um total de 560 mulheres foram convidadas a participar do estudo, dentre as quais 299 aceitaram. Das 299 participantes, 175 aceitaram o DIU e 124 recusaram. Conforme aumentou o número de gestações, maior foi a taxa de aceitação do DIU (p = 0,002), principalmente quando comparados os grupos de mulheres com 1 e ≥ 4 gestações (p = 0,013). Quanto ao desejo de ter mais filhos, as mulheres que planejavam ter mais filhos tiveram maior chance de recusar o dispositivo do que as que não planejavam (p < 0,001). CONCLUSãO: Mulheres com múltiplas gestações e sem desejo de ter mais filhos apresentaram maior probabilidade de aceitar o DIU. O perfil das que recusaram foi primeira gravidez e desejo de ter mais filhos. Dentre os três motivos mais frequentes de rejeição do DIU relatados, duas respostas se destacaram: a falta de justificativa específica e o desejo de ter mais filhos.

Female sexual function in women using LARC methods.

OBJECTIVE: This study aims to assess sexual function (SF) and quality of life (QoL) among women using copper intrauterine devices (Cu-IUD), levonorgestrel-releasing intrauterine system (LNG-IUS) or etonogestrel(ENG)-releasing subdermal implant. METHODS: This is a cross-sectional study involving 213 women who are sexually active, using Cu-IUD, LNG-IUS or ENG implant for at least one year. SF assessment was carried out through the Female Sexual Function Index (FSFI) and QoL was made through The Short Form Health Research. RESULTS: Frequency of sexual dysfunction score in Cu-IUD users was 33.8%; 47.2% in LNG-IUS users and 47.8% in ENG-implant users, without difference between groups. Desire domain had higher score in Cu-IUD users (Cu-IUD:4.20 ± 1.15 × LNG-IUS:3.76 ± 1.17 × ENG-implant:3.63 ± 1.15; p = .009). Between Cu-IUD and LNG-IUS users there was no difference in FSFI score. Total FSFI score was higher in Cu-IUD group when compared only to ENG-implant (Cu-IUD:27.48 ± 6.14 × Implant:25.07 ± 6.89; p = .029). Regarding the QoL score, difference was found only in general health domain (Cu-IUD:65.22 ± 14.91 × LNG-IUS:62.61 ± 19.04 × Implant:58.33 ± 16.46; p = .034), with lower score for implant group. CONCLUSION: There was no difference in the SF total score between the users of Cu-IUD, LNG-IUS and ENG implant. However, the score of the FSFI desire domain and general health status were higher among users of the Cu-IUD.

Post-Placental Intrauterine Device Insertion in Brazilian Adolescents: Clinical Outcomes at 12 Months.

STUDY OBJECTIVE: To assess the acceptability, expulsion and continuation rates, satisfaction, and complications associated with post-placental intrauterine device insertion (PPIUDI) in Brazilian adolescents DESIGN: Prospective cohort SETTING: A single public, tertiary teaching hospital PARTICIPANTS: Adolescents (≤ 19 years) giving birth by vaginal delivery or cesarean section INTERVENTION: PPIUDI MAIN OUTCOME MEASURES: Primary outcomes were PPIUDI acceptability, expulsion, continuation, and user satisfaction. Secondary outcomes were changes in menstrual bleeding and pain, infection, uterine perforation, and repeat pregnancy up to 12 months after PPIUDI. RESULTS: Of 1710 adolescents who delivered during the study period, 294 accepted PPIUDI (acceptability 17.2%). There were no cases of infection or uterine perforation among the 91 adolescents who completed the 12-month follow-up. Overall expulsion rate was 28.6%, and most cases (54%) occurred in the first 6 weeks after insertion. At 12 months, 85.7% of users were satisfied with the method, and continuation rate was 69.2%. At the end of 12 months, there were no repeat pregnancies among the adolescents who remained with the device in place. CONCLUSION: PPIUDI can be an effective and safe method to reduce repeat unplanned pregnancies in adolescents who have just given birth.

Major differences in the characteristics of users of the copper intrauterine device or levonorgestrel intrauterine system at a clinic in Campinas, Brazil.

OBJECTIVE: To compare the sociodemographic characteristics of users of the copper intrauterine device (Cu-IUD) and the levonorgestrel intrauterine system (LNG-IUS) at a family planning clinic in Campinas, SP, Brazil. METHODS: A retrospective audit study was conducted to analyze the characteristics of new users of IUDs at the clinic of the Department of Obstetrics and Gynecology, University of Campinas. Data covered insertions performed between 1979 and 2006 when only the Cu-IUD was offered at the clinic, and between 2007 and 2019 when the LNG-IUS was also offered, both free of charge to women. Logistic regression analysis was performed. RESULTS: There were 31 385 insertions. Cu-IUD: n = 17 156 (1979-2006) and n = 2013 (2007-2019); LNG-IUS n = 12 216 (2007-2019). Up to 2006, Cu-IUD users were less likely to be nulligravidas, more likely to be younger than 40 years of age, and with fewer years of schooling. Following introduction of LNG-IUS, the sociodemographic characteristics of users presented major changes over time. Comparing the period 1979-2006 with 2007-2019, new users of the LNG-IUS were more likely to be older than 40 years of age, with fewer years of completed schooling, and to be nulligravidas. CONCLUSION: Major changes in sociodemographic characteristics of users were noted according to preference over time. Introduction of the LNG-IUS presents a major opportunity to increase IUD use.

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

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.

Continuation and satisfaction with intrauterine copper device inserted during caesarean delivery.

PURPOSE: The objective was to assess the continuation and satisfaction of women who had copper IUDs inserted during caesarean delivery, in addition to possible factors associated with device positioning. MATERIALS AND METHODS: A prospective, observational study was carried out involving 158 women who underwent copper IUD insertion during caesarean delivery in Fortaleza, Brazil. The women were followed up 6 weeks and 6 months after insertion of the IUD, at which time they completed a satisfaction questionnaire. We performed speculum and ultrasound examination. RESULTS: IUD continuation rates after 6 weeks and 6 months were 92% and 71.5%, respectively. Approximately 85% and 76% of the women were satisfied with the method after 6 weeks and 6 months, respectively. The rate of poor positioning on ultrasound was 5% and the rate of visible thread after 6 weeks was 29.1%, both without association with age, parity, gestational age or active labour. There were 2 cases of infection (1.3%) and no cases of perforation or pregnancy. CONCLUSIONS: There was a good rate of continuation and satisfaction with the immediate post-caesarean IUD. There was no association between IUD malpositioning and age, parity, gestational age or active labour.

Intrauterine device use is safe among nulligravidas and adolescent girls.

The use of intrauterine devices (IUDs), including the copper-bearing device and the levonorgestrel intrauterine system (LNG-IUS), is safe among nulligravidas and adolescent girls. However, several misconceptions limit their use in clinical practice; health-care providers are hesitant to prescribe IUDs, and several myths associated with their usage in nulligravidas and adolescents exist among both providers and women themselves. The high rates of unplanned pregnancies (which in many settings constitute a public health issue, primarily among adolescent females) can be attributed at least partially to lack of awareness and limited use of highly effective contraceptives such as IUDs. In this review, we discuss the role of non-hormonal and hormonal IUDs as effective contraceptives in nulligravidas and adolescent girls. We present a literature review of data that highlight contraceptive efficacy, side effects (including reasons for discontinuation), and continuation rates with the method. We searched the PubMed/MEDLINE, Cochrane Library, Embase, and Scopus databases for all articles published in English between January 1990 through September 2020. A large body of evidence confirmed the effectiveness of IUD/IUS, independent of age and parity. Studies showed a high expulsion rate among adolescents but not among nulligravidas. Additionally, bleeding patterns among adolescents and nulligravidas were similar to those observed among adults and parous women. The high early removal rates observed in adolescents were attributable to bleeding and/or pain, which indicate that compared with adults, adolescents are less likely to accept IUD-induced side effects. IUD placement is an excellent strategy to avoid the high rates of unplanned pregnancies in adolescents and nulligravidas. IUDs are more effective than short-acting reversible contraceptives with failure rates that are equivalent to those observed with permanent contraception. However, few long-term studies have investigated this category of women to definitively establish the role of IUD/IUS as effective means of contraception.