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.

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.

One-year follow up on post-placental IUD insertion: A randomized clinical trial.

INTRODUCTION: Our objectives were to compare the 1-year follow-up clinical performance of the TCu380A intrauterine device (TCu380A-IUD) and levonorgestrel (LNG) 52-mg intrauterine system (IUS) inserted at post-placental period. MATERIAL AND METHODS: We conducted an open-label, parallel-group, randomized clinical trial, 1:1 with pregnant women admitted for childbirth independently of the mode of birth. Our primary outcome was expulsion up to 1 year after device placement by type of IUD and mode of delivery. During the follow up (42, 90 and 365 days (±7 days) after device placement), an ultrasound was performed to evaluate the device position. Kaplan-Meier with log-rank test was used to compare the survival curves of the TCu380A IUD and the LNG IUS. Couple-Years of Protection after insertion of both devices was calculated. RESULTS: One hundred and forty women were randomized to the TCu380A IUD (n = 70) or the LNG IUS (n = 70). By the end of the first year after device placement, 38 women experienced device expulsion (27.1%), most of them (33/38; 86.8%) within the first 42 days after delivery. The expulsions were significantly higher among users of TCu380A IUD (39.4%) than among users of the LNG IUS (22.2%; P = .039), and among those with vaginal delivery (43.8%) than among women with cesarean delivery (15%; P = .003). The 1-year cumulative continuation rate was 64.2%, significantly higher for LNG IUS (73.1%) than for TCu380A IUD (54.4%; P = .03), and among women with cesarean delivery (77.6%) than for vaginal delivery (52%; P = .00). The post-placental IUD insertion provided 356.4 Couple-Years of Protection. CONCLUSIONS: Two-thirds of women who accepted a post-placental IUD placement still used the device 1 year after childbirth. However, expulsion was the most prevalent reason for discontinuation, mainly within 42 days after device placement. The expulsion rate was significantly higher among TCu380A IUD users and among women with vaginal delivery.

Postplacental placement of intrauterine devices: A randomized clinical trial.

OBJECTIVE: To compare the expulsion rate of the TCu380A intrauterine device (IUD) or levonorgestrel (LNG) 52 mg intrauterine system (IUS) up to 90 days after postplacental placement (10 min after delivery of the placenta). STUDY DESIGN: Randomized trial (1:1) of women aged 18-43 years and ≥37 weeks pregnant enrolled during early or prodromal labor at the University of Campinas, Brazil. Follow-up was scheduled at 42 and 90 days after device placement. We confirmed the IUD or IUS location using ultrasonography. Multivariate logistic regression was used to assess variables associated with expulsion. RESULTS: We enrolled 140 women, and assigned 70 to the TCu380A IUD and 70 to the IUS groups. By the 90-day follow-up visit, 22/60 women (36.7%) in the TCu380A IUD group had expelled the device, as had 12/60 women in the IUS group (20%). Thirty-three of the 34 expulsions had occurred by the 42-day visit. Multivariate analysis demonstrated that the expulsion odds ratio ([OR]; 95% confidence interval [CI]) was higher after vaginal delivery than after Cesarean delivery (OR 5.60; 95% CI 2.08-15.10; P < 0.00) and higher among women with one (OR 4.38; 95% CI 1.33-14.43; P 0.00) or three or more deliveries (including the present one) (OR 6.08; 95% CI 1.78-20.77; P 0.00) than those with two deliveries. CONCLUSIONS: Postplacental TCu380A IUD placement had a higher expulsion rate than the IUS, and the expulsion rate was higher among women who had a vaginal delivery than those who had a Cesarean delivery. Most of the expulsions occurred within 42 days. IMPLICATIONS: Policy makers should increase the availability of both the TCu380A and the LNG intrauterine devices for the immediate postpartum period, even though the expulsion rate is higher than that after interval placement.

Experiencia en la colocación del DIUPP / Experience in the placement of the Diupp

Family planning is a key intervention to decrease the mortality rates and maternal morbidity, and neonatal mortality rates of children by mean of the preventiion of unwanted pregnancies, the same as pregnancies that happen very clsely to another previous one with little space between them. Several studies performed in different parts of the world have demonstrated adverse results related specially with the spaciament of the pregnancies. The risks are particularly higher with women wich get pregnant les after than a previous deliver, spontaneous abortion or induced abortion. The instrauterine device (ID) is a family planning higly efficacious with a prolongued action and reversible, that offers security to most postpartum women, including those who are still nursing. The primary aim of the present report was to determine the frequency in the placement of the DIUPP in our Obstetrical Department between 01/06/2017 and 30/06/2018, and in a second instance, to describe the method for placement of the DIUPP, to determine the curve of learning, to measure the rate of expulsion of the device, and to evaluate the conformity of the users of the method. Unplanned pregnancies have strongly increased, and for that circumstance, we believe that with new strategies, such as it is with the post-event anticonception, we can improve the reproducive health (AU)

Follow-up visits to check strings after intrauterine contraceptive placement cannot predict or prevent future expulsion.

OBJECTIVES: In some settings women are advised to return to the clinic after intrauterine contraceptive (IUC) placement, for a follow-up visit to check the strings and identify any expulsions. Our objective was to evaluate whether the number of follow-up visits to check the strings at the external cervical os after IUC placement predicts or prevents future expulsions. METHODS: This was a retrospective study conducted at the University of Campinas Medical School, Brazil. We reviewed the medical records of all women who used an IUC between January 1980 and December 2017, to identify women who had experienced IUC expulsion (N = 1974). We excluded women whose IUC was expelled more than once (n = 331) or after 10 years of use (n = 31). We fitted a generalised linear model of the time between IUC placement and expulsion, adjusting for several variables at expulsion. Significance was established at p < .05. RESULTS: Most expulsions (843/1612; 52.3%) occurred within the first 6 months after IUC placement and 691/1612 (42.9%) were within the first three months after placement. The adjusted model showed that the number of visits, the woman's age, and complaints of pain and bleeding during use were not significantly associated with and had no influence on expulsion. CONCLUSIONS: Our results indicate that after IUC insertion more than one follow-up visit within the first four to six months after placement is not necessary, as additional visits to check for IUC strings do not appear to reduce or predict future expulsion.

Comparison of two cohorts of women who expulsed either a copper-intrauterine device or a levonorgestrel-releasing intrauterine system.

AIM: To assess if there is a difference in the characteristics of the women who expelled a copper-intrauterine device (TCu-IUD) or the levonorgestrel-releasing intrauterine system (LNG-IUS) and the frequency of expulsions over different periods of observation. METHODS: We retrospectively analyzed 19 697 medical charts of women consulting between January 1980 and December 2013 who requested a TCu-IUD or a LNG-IUS. RESULTS: The medical records of 17 644 Cu-IUD and 2053 LNG-IUS users returning to the clinic for a follow-up visit after insertion of an IUC were reviewed. Of these, 1532 Cu-IUD and 254 LNG-IUS parous users were found to have expelled the IUC for a first time. The mean age at insertion (± standard deviation) was 26.3 ± 6.6 years (range 16-49) for Cu-IUD users and 31.7 ± 7.6 years (range 18-48) for LNG-IUS users (P < 0.001). A total of 263 (13.4%) and 12 (4.3%) of the Cu-IUD and the LNG-IUS users were ≤19 years old, and 49.1% and 54.1% of the expulsions among the Cu-IUD and LNG-IUS users, respectively, were reported in the first six months after placement. A regression model showed that the variables significantly associated with an expulsion of either a Cu-IUD or LNG-IUS were age < 25 years, less than two deliveries and using a Cu-IUD. CONCLUSION: Our findings showed that the characteristics associated with IUC expulsion were age under 25 years, having had less than two deliveries and being users of Cu-IUD.

[Posplacenta intrauterine device. Guide wires not visible]. / Dispositivo intrauterino posplacenta. Hilos guía no visibles.

BACKGROUND: Little information exists about the follow- up of the strings of intrauterine device (IUD) applied posplacenta. When the strings are of 10 cm in length are within the uterine cavity should be visible after postpartum involution. OBJECTIVE: To know the incidence of visible strings of intrauterine device (IUD) after posplacental insertion and to establish guidelines of follow-up when strings are not seen. METHODS: A prospective cohort study of 530 women with posplacental insertion of T Cu 380-A IUD with strings 10 cm long. Follow-up was at 6 weeks, 3, 6, 9 and 12 months after IUD insertion, at each visit women were questioned about IUD expulsion or removal and the cervix was inspected to visualize the strings of IUD. We analyzed the cumulative incidence of visible strings and procedures that were performed to locate the IUD when strings were not seen. RESULTS: At one year of follow-up the IUD was in situ in 398 women (75.1%), there were 44 expulsions (8.3%), 24 removals (4.5%) and 64 lost to follow up (12.1%). In women with IUDs in situ the strings were seen in 90.2% (n = 359) and were not seen in 9.8% (n = 39). In 65 women uterine cavity was probed identifying the IUD in situ in 64 cases, we performed 33 pelvic ultrasounds with IUDs in situ in 31 cases and in 2 cases with IUD in the cervical canal.. CONCLUSIONS: Strings of IUD after postplacental insertion was seen in most women at one year of follow up. When we are reasonably sure the woman is not pregnant, interventions for the location of the IUD should be avoided. A pelvic ultrasound should be the initial procedure and usually sufficient to locate IUDs whose strings are not visible.

Management of missing strings in users of intrauterine contraceptives.

BACKGROUND: A common question among health care professionals is how to manage nonvisible strings in users of intrauterine contraceptives (IUCs) at repeat follow-up visits. This study assessed the position of the IUCs in women who consulted repeatedly with nonvisible IUC strings. STUDY DESIGN: The medical records of the clinic were reviewed to identify new acceptors and switchers who had an IUC inserted between 1990 and 2009. All women were identified whose IUC string could not be visualized at the external os of the cervix by the health care professional at any given follow-up visit, even after attempting a standard maneuver of sweeping the strings from the cervical canal using a cervical brush or trying to visualize the strings in the cervical canal using colposcopy. Data were also retrieved on the use of ultrasonography and/or pelvic X-ray to assess IUC position, as well as data from any subsequent visits at which the IUC strings were nonvisible. RESULTS: The medical charts of 14,935 patients using an IUC were reviewed, and 750 women (5.0%) presenting for the first time with missing IUC strings at any follow-up visit were identified. Ultrasound scans showed the IUC to be in situ in 735 cases (98.0%), while 9 women (1.2%) had expelled the device and, in 5 cases (0.7%), the device was found in the pelvis following uterine perforation. IUC strings were missing on a second occasion in 297 cases. The device was found to be in situ in 295 cases (99.3%) and had been expelled in 2 (0.7%). At subsequent consultations, (between 1 and 18 years after the first consultation), strings were missing in 113, 55, 19 and 5 cases. In 111 (98.2%), 54 (98.2%), 18 (94.7%) and 5 (100%) of these cases, respectively, the IUC was found to be in situ, while in the remaining cases, the device had been expelled. CONCLUSIONS: Missing IUC strings are an uncommon finding, and ultrasonography confirmed that the device was in situ in the majority of these cases. For women with persistent missing IUC strings after one ultrasound scan that has verified appropriate intrauterine position, given the 2.4% likelihood that expulsion may have occurred at the time of subsequent visits, repeating the ultrasound (if available) should be considered for at least one (and possibly two) additional women's visit.

Resources and procedures in the treatment of heavy menstrual bleeding with the levonorgestrel-releasing intrauterine system (LNG-IUS) or hysterectomy in Brazil.

BACKGROUND: Heavy menstrual bleeding (HMB) is the most common complaint of women seeking gynecological care. Treatments included surgical or medical options including hysterectomy and the levonorgestrel-releasing intrauterine system (LNG-IUS) due to the profound suppression of endometrial growth that intrauterine LNG exerts which results in amenorrhea or in a reduction of blood loss. OBJECTIVE: The study was conducted to evaluate the resources and procedures involved in inserting an LNG-IUS compared to performing hysterectomy in women with HMB in a public sector hospital in Brazil. STUDY DESIGN: Two cohorts of women were studied: women who accepted an LNG-IUS (n=124) and matched women who underwent hysterectomy on the same day (n=122). We evaluate the number of procedures carried out in each group of women, including those performed before the decision was made to insert an LNG-IUS or to perform hysterectomy, the insertion of the device itself and the surgical procedure, in addition to the procedures and complications registered up to 1 year after LNG-IUS insertion or hysterectomy. RESULTS: Age and the duration of HMB were significantly lower in the LNG-IUS acceptors than women at the hysterectomy group. The numbers of gynecological consultations and Pap smears were similar in both groups; however, women in the hysterectomy group also underwent laboratory tests, ultrasonography, chest X-ray and electrocardiogram. In the hysterectomy group, the main complications were hemorrhage (six), bladder/bowel perforation (four), complications with anesthesia (one), ureteral reimplantation required (one) and abdominal pain (two). At 1 year, HMB was controlled in 83.1% of women in the LNG-IUS group, and 106 women continued with the device. CONCLUSIONS: Both treatments were effective in HMB control. Fewer resources and complications were observed in LNG-IUS acceptors when compared to hysterectomy. The LNG-IUS represents a good strategy for reducing the number of hysterectomies and the resources required for women with HMB.

Length of the endometrial cavity and intrauterine contraceptive device expulsion.

OBJECTIVE: To evaluate the correlation between endometrial cavity length and expulsion rate in acceptors of the TCu380A intrauterine device (IUD) or the levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: The study included 235 nulligravida and parous women who received a TCu380A IUD or LNG-IUS and who were observed for up to 1 year. The length of the uterine cavity was measured by uterine sounding and ultrasonography. RESULTS: The endometrial cavity was shorter than 3.2 cm in 2 LNG-IUS users and at least 3.2 cm long in 87 LNG-IUS users, with expulsions occurring in 0 (0.0%) and 2 (2.3%) of these women, respectively (P>0.999). Among the TCu380A IUD users, the endometrial cavity was shorter than 3.6 cm in 63 women and at least 3.6 cm long in 83 women, with expulsions occurring in 3 (4.8%) and 5 (6.0%) of these women, respectively (P>0.999). The mean length of the endometrial cavity-evaluated via ultrasonography-among the 10 women whose devices were expelled was 3.9 ± 0.3 cm, compared with 3.9 ± 0.0 cm in those who retained their devices (P=0.799). CONCLUSION: The present results do not support the hypothesis of an association between uterine length and risk of intrauterine contraceptive expulsion.

Dispositivo intrauterino intravesical en expulsión en embarazo de tercer trimestre: reporte de un caso / Intravesical migration of intrauterine device in a pregnant woman

Se estima que en el mundo cerca de 160 millones de mujeres son usuarias de dispositivos intrauterinos (DIU), siendo Chile uno de los países con más alta tasa, con cerca del 70 por ciento de las usuarias en el sistema público. Sin embargo, su uso no está exento de complicaciones. Presentamos un caso infrecuente de DIU intravesical en expulsión en gestante de 28 semanas.

In the world, about 160 million women are users of intrauterine devices (IUD); Chile is one of the countries with the highest rate, with about 70 percent of users in public system. However, its use may be complications. We present an unusual case of intravesical IUD expulsion in 28 weeks pregnant.

Length of the endometrial cavity as measured by uterine sounding and ultrasonography in women of different parities.

BACKGROUND: In view of current controversies regarding the need for new, shorter intrauterine devices (IUDs) that would reduce expulsion rates in nulligravida, endometrial cavity length was measured in women of different parities using uterine sounding and ultrasonography. STUDY DESIGN: A cross-sectional descriptive study was performed including 570 women of 17-52 years of age, 260 of whom were nulligravida and 310 parous. RESULTS: The difference in mean length between measurements taken by uterine sounding and ultrasonography was 0.28 cm. Mean endometrial cavity length was 3.84+/-0.03 cm (mean+/-S.E.M.) in nulligravida and 4.25+/-0.03 cm in parous women according to uterine sounding (p<.001) and 3.70+/-0.03 cm and 3.84+/-0.03 cm, respectively, according to ultrasonography (p=.006). CONCLUSIONS: By either technique, mean length of the endometrial cavity was >3.6 cm, the length of the most common IUDs, the TCu380A and the levonorgestrel-releasing intrauterine system. Therefore, the issue appears controversial for developing new, shorter IUDs, since current models fit most women, including nulligravida, albeit one third of the women of our sample showed endometrial length shorter than 3.2 cm.

Rompimento intra-uterino do DIU T- Cu 380 A: relato de caso / Intra-uterine rupture of IUD T Cu 380-A: case report

Relato de caso de uma paciente jovem que compareceu ao Serviço de Ginecologia da Faculdade de Medicina de Barbacena após a expulsão de um fragmento plástico, compatível com parte de um DIU T Cu 380 A. A expulsão foi espontânea, não associada à dor ou sangramento vaginal. Desta forma, reafirma-se a importância do controle de pacientes que fazem uso do referido dispositivo.

The authors report a case of a young patient who attended the Department of Gynecology, Faculty of Medicine of Barbacena after the expulsion of a plastic fragment, compatible with part of an IUD (intrauterinedispositive). The expulsion was spontaneous, not associated with pain or vaginal bleeding. The authors reaffirm the importance of control of these patients.

[Random comparative study between intrauterine device Multiload Cu375 and TCu 380a inserted in the postpartum period]. / Estudio comparativo al azar entre los dispositivos intrauterinos Multiload Cu375 y TCu 380A, colocados durante el posparto.

OBJECTIVE: To evaluate safety and effectiveness of the intrauterine device Multiload Cu375 compared with the TCu 380A inserted in the postpartum period. PATIENTS AND METHODS: In a randomized comparative study carried out in the National Perinatology Institute, intrauterine devices MLCu 375 and Tcu 380A were inserted to 157 patients who voluntary accepted, and previously signed informed consent. There were four instances for the intrauterine devices insertion: within 10 minutes after vaginal delivery, during cesarean section (immediate postplacental insertion) and postpartum-postcesarean insertion (in the time range of 10 min to 48 h). All insertions were made with ring forceps. From 1 h to 24 h later, abdominal ultrasound examinations were performed to assess the distances between the upper part of the device to the fundus of uterine cavity. Follow up visits were scheduled at 3, 6, 9 and 12 months. Net cumulative life table event rates of discontinuations were estimated at one year. RESULTS: The expulsion rates were 10.4 for the MLCu 375 and 7.7 for the TCu 380A and they were not influenced by the moment of the intrauterine device insertion, not by the cervical dilatation, neither by the distance of the intrauterine device to the fundus of uterine cavity. The removal rates for bleeding and pain were 4.9 and 4.8, the removal rates for non medical reasons were 3.7 and 4.9 respectively. There was one case of genital infection in the MLCu 375 group. There were no pregnancies, nor uterine perforation. The one year continuation rates were 77.1 and 82.6 respectively. There were no statistical significant differences in the comparative rates. CONCLUSIONS: The intrauterine device MLCu 375 is as safe and effective as the TCu380A when they are inserted in the postpartum period.

TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age.

OBJECTIVE: The objective of the study was to evaluate the performance of the TCu 380A IUD in women who had been using the device for more than 10 years and who were 35 years of age or more on completion of the 10th year of IUD use. METHODS: A total of 228 women who had an IUD inserted between 1987 and 1992 were included in the study. The cutoff date for analysis was January 31, 2004. Clinical performance was evaluated by life-table analysis. The mean age of women at 10 years of use was 38.8+/-0.4 years and mean parity was 2.2+/-0.08 (mean+/-SD). The duration of follow-up beyond 10 years ranged from 1 to 72 months. No pregnancy was observed in 366 woman-years of observation beyond 10 years of use. The main reason for discontinuation was removal of the device because the clients had previously been informed that the IUD was not approved for use beyond 10 years. This reason accounted for a gross cumulative 6 years discontinuation rate of 42.5 per 100 women beyond 10 years. The other main reasons for discontinuation beyond 10 years of use were surgical sterilization, menopause and expulsion with gross cumulative 6-year termination rates of 19.2, 11.0 and 21.2 per 100 women, respectively. The cumulative continuation rate beyond 10 years was 67.0 at the end of the first year of follow-up and 21.2 at the end of the sixth year. CONCLUSION: We found no evidence that the TCu 380A IUD loses its effectiveness after 10 years of use. RESULTS: The concept that women who have insertion of a TCu 380A IUD at the age of 25 years or older could use this IUD as a reversible but permanent method of contraception up to the menopause continues to be supported by the accumulation of evidence, although definitive evidence remains to be obtained.

Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study.

OBJECTIVE: To compare the expulsion rates of intrauterine devices (IUDs) inserted in the immediate postpartum after vaginal birth and cesarean section. METHODS: Nineteen patients who had a vaginal birth and 19 patients who had a cesarean section at Hospital de Clínicas de Porto Alegre, Brazil, were selected for copper T 380A IUD insertion. With the aim of detecting clinically unnoticed dislodged devices, ultrasound examinations were performed at 1 month and between 3 and 12 months after delivery. The IUDs were considered completely expelled when found outside the endometrial cavity (e.g., in the cervical canal) or outside the uterus (in the vagina). RESULTS: Expulsion rates were statistically different between the two groups: after a vaginal birth, 50% (ultrasound only) + 27.8% (clinical examination); and post-cesarean section, 0% (p < .001; OR 5.75, 95% CI 2.36-14.01). CONCLUSION: Considering that the contraceptive efficacy of IUDs is associated with their intrauterine location, the high expulsion rates seen when they are inserted immediately after vaginal delivery contraindicate their use in this setting. The use of IUDs immediately after a cesarean section is still a reasonable alternative because its expulsion rate was zero. Ultrasound assessment of IUD positioning performed better than clinical examination, which failed to detect expulsion after postpartum insertion in 75% of the cases (9 from 12 cases).

[Factors for expulsion of intrauterine device Tcu380A applied immediately postpartum and after a delayed period]. / Factores de expulsión del dispositivo intrauterino TCu380A aplicado en puerperio inmediato y tardío.

OBJECTIVE: To determine the frequency of expulsion of the intrauterine device TCu380A (IUD) inserted either immediately postpartum or after a delayed period. We aimed to identify the factors associated with expulsion. MATERIALS AND METHODS: A longitudinal and comparative study was carried out in three Family Medicine Units of the Instituto Mexicano del Seguro Social (IMSS) of Leon, Guanajuato. One hundred twenty-five women who had a vaginal delivery and who elected to have IUD inserted immediately after delivery participated in the study along with 125 women who elected to have the IUD inserted after a delayed period after delivery. Studied factors were parity, technique, and insertion by the doctors assigned to the service and medical personnel in training (pre or postdegree). A medical review was performed one month and three months after insertion of the IUD. Results were analyzed by chi-square and Student t test. RESULTS: The expulsion rates of IUDs during immediate puerperium and also after a delayed period were 16 and 2.7%, respectively (p<0.0004). There was no statistically significant association between expulsion of the IUD and the following factors that were taken into account: age, primipara, personnel who inserted the device, and the application technique. In immediate puerperium, 25.9% of women who had multiple deliveries expelled the IUD, and in those who delayed IUD insertion, it was 4% (p=0.03). CONCLUSIONS: There is a greater risk of expulsion if the IUD is inserted immediately after delivery and it is associated with multiparity. The percentage of expulsion in immediate puerperium is similar to that reported in the literature.