Índice de satisfação do uso do DIU de cobre colocado no pós-parto imediato em pacientes do HSPM / Satisfaction index for the use of copper IUDs placed postpartum immediate response in HSPM patients

O objetivo do presente trabalho foi avaliar a taxa de satisfação do uso do DIU de cobre colocado no pós-parto imediato em puérperas no Hospital do Servidor Público Municipal na cidade de São Paulo. Foram selecionadas 103 pacientes que fizeram a inserção do DIU no pós-parto imediato nos anos de 2019 a 2021, independentemente do tipo de parto realizado ou paridade. Posteriormente, foram avaliados fatores como: grau de satisfação com o método inserido, controle de posicionamento adequado, aconselhamento sobre o método, razões e vantagens de sua utilização, eventos adversos obtidos, continuação do método e comportamento sexual. A avaliação de tais fatores foi feita por meio de um questionário com perguntas objetivas e subjetivas. De um total de 103 pacientes selecionadas no estudo, foi obtido contato com 44 mulheres. Destas, 28% classificaram o grau de satisfação com o DIU de cobre como muito satisfeita, 44,2% como satisfeita, 14% como um pouco satisfeita e 14% como não satisfeita. 88,4% indicariam o método para outras mulheres e não se arrependem de terem colocado. Quanto ao posicionamento do dispositivo, 38% não realizaram o acompanhamento e, das mulheres que acompanharam, 38% mantêm o DIU bem-posicionado e 24% mal posicionado. Em relação ao aconselhamento prévio, 66% das pacientes foram aconselhadas sobre o DIU no próprio momento do parto e 93,2% dessas afirmam terem tido todas suas dúvidas sanadas, inclusive relacionadas as IST. No momento da colocação, 56,8% já conheciam o método, seus riscos e benefícios. Quanto a permanência do método, 19 pacientes não persistiram com o método devido a fatores relacionados a aumento/alteração do fluxo menstrual (6 mulheres), expulsão espontânea do DIU (6 mulheres) ou mau posicionamento (7 mulheres). De modo geral, a grande maioria das pacientes entrevistadas permanecem com o método escolhido, possuem altas taxas de satisfação (72,2%), indicariam o uso para outras mulheres e não se arrependem da escolha do método. O pré-parto foi o momento em que a maioria foi aconselhada sobre o DIU pós-parto, mostrando que o assunto ainda é pouco abordado durante o pré-natal. O acompanhamento precoce deve ser encorajado para detectar expulsões e enfrentar possíveis problemas como mau posicionamento. Assim, o uso DIU de cobre no pós-parto imediato mostrou que houve satisfação por parte da paciente principalmente pela sua conveniência, pela contracepção no pós-parto e pelo tempo de uso. Palavras-chave: Contracepção. DIU. Período Pós-parto. Dispositivos Intrauterinos.

Preliminary study of the contraceptive effect of a self-assembling intrauterine device (iUPODs) in mares maintained in a paddock with a fertile stallion.

There is an urgent need for practical methods of population control (i.e., contraception and/or sterilization) for free-roaming (i.e., "wild" or "feral") horses and burros on Western Public Lands in the United States. The objective of this study was to evaluate the contraceptive efficacy of a novel self-assembling three-part polymer-coated magnetic intrauterine device termed as an intrauterine POD (self-assembling; iUPOD) when there are natural breeding conditions when iUPOD use was managed by veterinary professionals with no prior experience with the device. Six mares were administered an iUPOD and were then housed continuously with a fertile stallion for 91 days. The intrauterine POD retention and contraceptive efficacy were 100%. Two mares had prolonged corpus luteum function (for 37 and 91 days) immediately after iUPOD placement. For the estrous cycles of the other mares, the duration of diestrus was 7.8 ± 2.7 days (mean ± S.D.). Four of the mares (67%) became pregnant when in a paddock with the same stallion the year after iUPOD removal. These results are encouraging for use of the iUPOD as a practical and reversible method of fertility control in free-roaming horses and burros.

Use of Immediate Postpartum Long-Acting Reversible Contraception Before and After a State Policy Mandated Inpatient Access.

OBJECTIVE: To assess the rate of immediate postpartum long-acting reversible contraceptive (LARC) use in a multihospital health care system 2 years before and after the policy was implemented, and to assess factors associated with LARC use and repeat pregnancy rates within 12 months after delivery. METHODS: We conducted a retrospective chart review of all patients giving birth at three Cleveland Clinic Ohio hospitals from July 1, 2015, to June 30, 2019. We reviewed the inpatient medication reconciliation to identify the LARC initiation rate. We compared all patients who received inpatient postpartum LARC to a 1:3 matched sample of patients who did not receive LARC, matched by delivery date and location, to identify patient characteristics associated with LARC use. The electronic medical record (Epic) was reviewed to identify new pregnancies occurring within 12 months postdelivery. RESULTS: We identified 17,848 deliveries prepolicy and 18,555 deliveries postpolicy. Immediate postpartum LARC was used by 0.5% (monthly range 0-2.1%) of patients prepolicy and 11.6% (monthly range 8.3-15.4%) of patients postpolicy. Levonorgestrel intrauterine devices (IUDs) were used by 56.5%, implants by 29.1%, and copper IUDs by 14.5% of LARC users. Characteristics associated with LARC use included younger age, public insurance, non-White race, Hispanic or Latina ethnicity, higher body mass index, sexually transmitted infection in pregnancy, and tobacco use. Long-acting reversible contraceptive users had a lower rate of repeat pregnancy at 12 months postpartum compared with the non-LARC group (1.9% vs 3.6%, P<.001). CONCLUSION: Immediate postpartum LARC use increased after a state policy change mandated universal access and was associated with decreased pregnancy rates in the first year postdelivery.

Uterine adhesion: Is luteal phase prior to follicular phase in uterine adhesiolysis?

ABSTRACT: To compare the patients' outcomes of Asherman syndrome who underwent uterine adhesiolysis in luteal phase or follicular phase.A retrospective cohort study.A tertiary hospital in China.Four hundred sixty-four women suffered intrauterine adhesion who underwent monopolar adhesiolysis from March 2014 to March 2017 were analyzed. One hundred seventy-eight patients underwent operations in follicular phase (OFP) and 286 underwent operations in luteal phase (OLP).Hormone therapy was accompanied with an intrauterine device and a second-look hysteroscopy was performed postoperatively.Endometrial thickness in women was analyzed by a transvaginal 3-dimensional ultrasound examination. Re-adhesion was confirmed by a second-look hysteroscopy 3 months after hysteroscopic adhesiolysis. Pregnancy rate was acquired by questionnaires 3 months after a second-look hysteroscopy.OLP has advantages with thicker luteal endometrium (P = .001), higher pregnancy rates (P < .001), and lower re-adhesion rates (P = 0015) compared to these values of OFP.For Asherman syndrome, our study showed that OLP is more feasible than OFP in intrauterine adhesiolysis.

Long-acting reversible contraceptive use, active component service women, U.S. Armed Forces, 2016-2020.

Long-acting reversible contraceptives (LARCs) are highly effective means of birth control that can improve service women's overall health and readiness. This report expands upon prior data and summarizes the annual prevalence (overall and by demographics) of LARC use from 2016 through 2020 among active component U.S. service women, compares LARC prevalence to the prevalence of short-acting reversible contraceptives (SARCs), and evaluates the probability of continued use of LARCs by type. LARC use increased from 21.9% to 23.9% from 2016 through 2019 while SARC use decreased from 28.3% to 24.9%. Both SARC and LARC use decreased in 2020 which may have been related to the coronavirus disease 2019 (COVID-19) pandemic. The prevalence of intrauterine devices (IUDs) was greater than implants, and IUDs also had a higher probability of continuation than implants. At 12 months, the continuation for IUDs was 81% compared to 73% for implants. At 24 months, the probabilities of continuation were 70% for IUDs and 54% for implants. Probabilities of continuation were similar across outsourced care and direct care settings. The increased use of LARCs along with their high frequency of continuation in U.S. service women may have a positive impact on overall health and readiness.

Comparison of Levonorgestrel-releasing Intrauterine System (LNG-IUS) against Laparoscopic Assisted Supracervical Hysterectomy (LASH) for menorrhagia treatment: An economic evaluation.

BACKGROUND: This economic evaluation and literature review was conducted with the primary aim to compare the cost-effectiveness of laparoscopic assisted supracervical hysterectomy (LASH) with NICE's gold-standard treatment of Levonorgestrel-releasing intrauterine system (LNG-IUS) for menorrhagia. MATERIALS AND METHODS: A cost-utility analysis was conducted from an NHS perspective, using data from two European studies to compare the treatments. Individual costs and benefits were assessed within one year of having the intervention. An Incremental Cost-Effectiveness Ratio (ICER) was calculated, followed by sensitivity analysis. Expected Quality Adjusted Life Years (QALYS) and costs to the NHS were calculated alongside health net benefits (HNB) and monetary net benefits (MNB). RESULTS: A QALY gain of 0.069 was seen in use of LNG-IUS compared to LASH. This yielded a MNB between -£44.99 and -£734.99, alongside a HNB between -0.0705 QALYs and -0.106 QALYS. Using a £20,000-£30,000/QALY limit outlined by NICE,this showed the LNG-IUS to be more cost-effective than LASH, with LASH exceeding the upper bound of the £30,000/QALY limit. Sensitivity analysis lowered the ICER below the given threshold. CONCLUSIONS: The ICER demonstrates it would not be cost-effective to replace the current gold-standard LNG-IUS with LASH, when treating menorrhagia in the UK. The ICER's proximity to the threshold and its high sensitivity alludes to the necessity for further research to generate a more reliable cost-effectiveness estimate. However, LASH could be considered as a first line treatment option in women with no desire to have children.

Intention of pregnant women for the postpartum use of intrauterine devices in Upper Egypt's rural communities.

OBJECTIVES: This study aims to assess pregnant women's intention in rural Upper Egypt to use the copper-bearing intrauterine device (IUD) and to identify the factors influencing their intention to use the method. METHODS: The study was a household survey of 400 pregnant women in 16 villages in Assiut and Sohag Governorates in Upper Egypt. RESULTS: Only one third of the study participants (30.8%) had the intention to use IUD. Reasons of not intending to use IUD were; perceived pain during IUD insertion or removal (37.5%), perceived side effects (21.3%) and misconceptions (15.2%), husbands' disapproval for using the method (15.8%) and the desire for future fertility (12.3%). Having a secondary or a higher level of education (OR (95% CI) = 1.726 (1.085-2.746), p = 0.01) and previous use of IUD (OR (95% CI) = 2.277 (1.108-4.678), p = 0.02) were the positive predictors of the intention to use IUD, while perception of husband opposition to IUD use (OR (95% CI) = 0.604 (0.379-0.964), p = 0.03) and perception of IUD related myths (OR (95% CI) = 0.893 (0.836-0.955), p = 0.004) were the negative predictors of the intention to use IUD. CONCLUSION: The intention to use IUD is relatively low among pregnant women in rural Upper Egypt. Targeting pregnant women and their husbands with proper counselling regarding IUD use during antenatal care visits would greatly impact increasing their use of the method.

Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study.

BACKGROUND: In the 1970s, numerous medical reports, media coverage, and litigation around the Dalkon Shield intrauterine device led to a perception that all intrauterine devices cause upper genital tract infection and infertility. OBJECTIVE: This study aimed to assess the association between intrauterine device use and time to conception. STUDY DESIGN: The Fertility After Contraceptive Termination Study is a multicenter, prospective cohort study of women stopping their contraceptive method to attempt conception. We recruited participants between 2011 and 2017. Participants were a convenience sample of women recruited from academic centers in Philadelphia, PA; Los Angeles, CA; St. Louis, MO; Indianapolis, IN; Aurora, CO; and Salt Lake City, UT. Women were eligible if they stopped their contraceptive method within the past 120 days before enrollment, were between 18 and 35 years of age, had no history of infertility or sterilization, and had at least 6 months of follow-up. Baseline data included demographic and reproductive characteristics, past contraceptive use, nucleic acid amplification testing for sexually transmitted infections, and serology for past infection with Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. The primary exposure was intrauterine device use (ever); the primary outcome was time to conception. All participants were observed longitudinally for up to 24 months. We used piecewise exponential proportional hazards models with multiple imputation to provide hazard ratios and their respective 95% confidence intervals. RESULTS: Of the 461 participants, mean age was 28.2 years, 178 (38.7%) were Black, 157 (34.1%) were considered as low socioeconomic status, and 275 (59.7%) had a history of intrauterine device use. Without adjusting for any covariates, the median time to conception was shorter for participants who had a history of intrauterine device use (5.1 months) than participants who never used an intrauterine device (7.5 months). After controlling for potential confounders, the association of past intrauterine device use with time to conception was not statistically significant (adjusted hazard ratio, 1.25; 95% confidence interval, 0.99-1.58). In our multivariable model, age, nulligravidity, Black race, low socioeconomic status, and past Mycoplasma genitalium infection were associated with longer times to conception (hazard ratio, 0.76; 95% confidence interval, 0.58-0.99). Conception by 12 months was lower in participants with past Mycoplasma genitalium infection (68% vs 80% without past infection; P=.019). CONCLUSION: We found no impairment of fertility with ever use of an intrauterine device. Serologic evidence of past Mycoplasma genitalium infection was associated with longer times to conception and higher rates of infertility. Mycoplasma genitalium infection is a potential modifiable cause of infertility.

Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.

STUDY OBJECTIVE: Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana. DESIGN: Cross-sectional mixed methods. SETTING: Gaborone, Botswana. PARTICIPANTS: Twenty sexually active AGYW ages 18-24 years; 20 health system stakeholders. INTERVENTIONS: Surveys and semistructured interviews grounded in the Consolidated Framework for Implementation Research. MAIN OUTCOME MEASURES: Themes reflecting barriers and facilitators of LARC implementation. RESULTS: The median age for AGYW was 22 (interquartile range, 21-23) years. Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators of LARC implementation spanned factors at each Consolidated Framework for Implementation Research domain: (1) LARC characteristics like side effects; (2) the clinics' inner settings, including availability of youth-friendly services; (3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes, and beliefs about LARCs; (4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and (5) the implementation process level such as the availability of free or low-cost LARCs. CONCLUSION: We identified multilevel, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.

Marginal cord insertion among singleton births at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: Umbilical cord may insert abnormally i.e. marginal insertion to a placenta which can cause different birth and perinatal complications. Despite the increased effort taken by different responsible bodies, the prevalence of birth and perinatal complications are still high, possibly due to anomalous cord insertion. So far, anomalous cord insertion lacks proper attention in different medical settings. Hence, the present study aims to assess the magnitude, risk factors, and adverse birth outcomes of marginal cord insertion among singleton births. METHODS: An institution-based cross-sectional study design was conducted. A systematic random sampling technique was used to select study participants. Data were collected by using a structured questionnaire and it was entered into epi-data version 3.1 then exported to SPSS version 20 for data cleansing and analysis. Bi-variable and multivariable logistic regressions were employed to identify risk factors and adverse outcomes associated with marginal cord insertions. Crude and adjusted odds ratio (P-value < 0.05) with a 95% confidence interval were calculated. RESULT: The magnitude of marginal cord insertion was 6.4% (95% CI = 4.4-8.8%) in singleton pregnancies. Independent risk factors for marginal cord insertion were advanced maternal age (AOR = 2.24, 95% CI: 1.35-11.08), primiparity (AOR = 1.98, 95% CI: 1.37-8.69), maternal chronic hypertension (AOR = 3.07, 95% CI: 1.66-9.76), previous cesarean delivery (AOR = 2.51, 95% CI: 1.43-10.21), and use of intrauterine contraceptive device before pregnancy (AOR = 2.22, 95% CI: 1.36-12.30). Pregnancies complicated by marginal cord insertion are at higher risk to develop low birth weight (AOR = 2.89, 95% CI: 1.23-6.80), preterm birth (AOR = 4.00, 95% CI: 1.44-11.14), and emergency cesarean delivery (AOR = 3.68, 95% CI: 1.03-13.81). CONCLUSION AND RECOMMENDATION: Marginal cord insertion is a mistreated potential risk for low birth weight, preterm birth, and emergency cesarean delivery. Routine screening of marginal cord insertion should be considered in pregnancies with advanced age, nulliparity, hypertensive disorder, history of cesarean section, and intrauterine contraceptive device usage before pregnancy.

Assessing knowledge, attitudes, and practice of health providers towards the provision of postpartum intrauterine devices in Nepal: a two-year follow-up.

BACKGROUND: Health service providers play a key role in addressing women's need for postpartum pregnancy prevention. Yet, in Nepal, little is known about providers' knowledge, attitudes, and practice (KAP) on providing postpartum family planning (PPFP), particularly the immediate postpartum intrauterine device (PPIUD). This paper assesses providers KAP towards the provision of PPIUDs in Nepal prior to a PPIUD intervention to gain a baseline insight and analyzes whether their KAP changes both 6 and 24 months after the start of the intervention. METHODS: Data come from a randomized trial assessing the impact of a PPIUD intervention in Nepal between 2015 and 2017. We interviewed 96 providers working in six study hospitals who completed a baseline interview and follow-up interviews at 6 and 24 months. We used descriptive analysis, McNemar's test and the Wilcoxon signed-rank test to assess KAP of providers over 2 years. RESULTS: The PPIUD KAP scores improved significantly between the baseline and 6-month follow-up. Knowledge scores increased from 2.9 out of 4 to 3.5, attitude scores increased from 4 out of 7 to 5.3, and practice scores increased from 0.9 out of 3 to 2.8. There was a significant increase in positive attitude and practice between 6 and 24 months. Knowledge on a women's chance of getting pregnant while using an IUD was poor. Attitudes on recommending a PPIUD to different women significantly improved, however, attitudes towards recommending a PPIUD to unmarried women and women who have had an ectopic pregnancy improved the least. Practice of PPIUD counseling and insertion improved significantly from baseline to 24 months, from 10.4 and 9.4% to 99% respectively. CONCLUSIONS: Although KAP improved significantly among providers during the PPIUD intervention, providers' knowledge on a women's chance of getting pregnant while using an IUD and attitudes towards recommending a PPIUD to unmarried women and women who have had an ectopic pregnancy improved the least. Provider KAP could be improved further through ongoing and more in-depth training to maintain providers' knowledge, reduce provider bias and misconceptions about PPIUD eligibility, and to ensure providers understand the importance of birth spacing.

Effectiveness of an intrauterine device informative intervention among post-natal women in Western Jamaica.

INTRODUCTION: Intrauterine devices are the most effective long-acting reversible contraceptives, but in many developing countries, such as Jamaica, these devices remain underutilized. METHODS: A cross-sectional informative intervention was conducted among women ≥ 18 years of age attending postnatal clinics in western Jamaica from May to August 2018. Data were collected using an investigator-administered questionnaire/pre-test followed by a 12-slide PowerPoint® presentation and a post-test. RESULTS: Most of the 299 women who participated were 18-29 years of age, with a mean age of 27.1 (SD ± 6.1) years. Most had their first pregnancy between ages 18 and 24 years, with mean age at first pregnancy of 20.2 (SD ± 4.0) years. Only 3.0% of participants reported current use of an intrauterine device; 3.5% reported using an intrauterine device in the past. For nearly every measure of knowledge of intrauterine devices, there was a significant change in the proportion of participants who got the correct answer from the pre-test to the post-test. The mean summed pre-test knowledge score was 9.54 (SD ± 3.46) and the post-test score was 15.23 (SD ± 1.92); the possible total score is 18. The difference between the mean scores (5.69 points) was also significant. CONCLUSION: The intervention resulted in significant change in knowledge of intrauterine devices among the women and cleared up many misconceptions that may have contributed to reluctance of women to use intrauterine devices. Women of reproductive age in Jamaica should be counseled on contraceptive methods including intrauterine devices so that these devices can be considered in their contraceptive choices.

Contraceptive discontinuation and switching in urban Istanbul region in Turkey.

OBJECTIVE: To evaluate rates of contraceptive discontinuation and method switching and examine their determinants in Istanbul, Turkey, because discontinuation of modern contraception leading to unintended pregnancy is a public health concern. METHODS: We conducted a cross-sectional household survey between March and June 2018 among 4224 married women of reproductive age (16-44 years). Information on contraceptive use and discontinuation for the 31 months preceding the survey was recorded in a monthly calendar. Using single and multiple decrement life-table methods, we calculated the overall discontinuation and the cause-specific discontinuation rates. RESULTS: The 12-month overall discontinuation rate was 12.32%. Intrauterine devices had the lowest discontinuation rate (7.12%). The most common reasons for discontinuation were the desire to become pregnant (6.56%) and method failure (2.76%). One in three episodes of discontinuation was not followed by method switching (32.16%). Age, education, and the method type were predictive of contraceptive discontinuation. CONCLUSION: To reduce method failure, women should be provided with information about method effectiveness, correct use of methods, and what to do if they anticipate their method failed (e.g., emergency contraception). Programs should focus on improving knowledge about discontinuation and method failure. Contraceptive counseling should also emphasize timely switching to an effective method after discontinuation.

Pelvic inflammatory disease among users and non-users of an intrauterine device.

The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) has been debated. We aimed to evaluate the differences between IUD users and non-users among women hospitalised with a diagnosis of PID. Our hypothesis was that the role of a present IUD among PID patients is minimal, if any. We performed a retrospective cohort study during 2010-2018 in a tertiary university hospital. Overall, 474 hospitalised patients were diagnosed with PID. Of these, 121 patients were IUD users. The patients without an IUD were younger and had lower gravidity and parity. Among the patients without an IUD, higher rates of prior history of PID and fever at presentation were noticed. In 23.9% (29/121) of women, the IUD was inserted less than four weeks prior to the PID diagnosis. The patients with an IUD insertion-associated PID, had lower rates of tubo-ovarian abscess (2 (6.9%) versus 24 (26.0%), OR [95% CI] 0.18 (0.04-0.84), p = .02) at presentation, as well as a shorter length of stay (LOS) (median 4 versus 5 days, p = .05). In a patient in whom the IUD was retained, hospitalisation period was shorter (median LOS 4 days versus 5 days, p = .007). PID inpatients who carry an IUD represent a specific subset of patients with a milder disease.Impact statementWhat is already known on this subject? The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) is debateable.What the results of this study add? PID inpatients who carry an IUD represent a specific subset of patients with milder disease.What the implications are of these findings for clinical practice and/or further research? Our results show that in IUD users with PID, the practice of IUD removal as part of their PID treatment is of little benefit.

Ever-use of the intra-uterine device and the risk of ovarian cancer.

The association between the use of the intra-uterine device (IUD) and the risk of ovarian cancer is not well known. In this study, we sought to determine whether the use of an IUD is associated with a reduction in the risk of ovarian cancer. We searched Medline, EMBASE, Google Scholar, Scopus, ISI Web of Science and Cochrane database search, as well as PubMed (www.pubmed.gov) and RCT registry (www.clinicaltrials.gov) until the end of June 2019 to conduct a systematic review and meta-analysis comparing ever-use vs. never-use of an IUD and the risk of subsequent ovarian cancer. We obtained 431 records, of which 9 met inclusion criteria. A total of five case-control studies and four cohort studies were retrieved to establish the risk of ovarian cancer amongst ever-users of an IUD. Relative to the never-use of the IUD, ever-use conferred a lower risk of ovarian cancer with an estimated OR of 0.67 95% CI [0.60 - 0.74], p < .0001, I2 = 71%. This relationship remained significant when results were restricted to studies evaluating the levonorgestrel intrauterine system (LNG-IUD) alone, with an estimated OR of 0.58 95% CI [0.47 - 0.71], p < .0001, I2 = 0%, as well as when the analysis was stratified by study design, with an OR of 0.64 95% CI [0.56 - 0.74] for case-control studies, and OR of 0.71 95% CI [0.60 - 0.84] for cohort studies (p < .0001). Ever-use of an intrauterine contraceptive device reduces the risk of ovarian cancer by an average of 30%. Whether differences exist for duration of use, use of type-specific device, and specific tumour type needs to be addressed in future studies.Impact statementWhat is already known on this subject? The use of IUDs is very common practice in today's society. Its benefits regarding contraception, the treatment of abnormal uterine bleeding and even the reduction of the rates of endometrial cancer are well established. However, whether IUD's are associated with a reduction in the risk of ovarian cancer is unknown.What do the results of this study add? In this study, we show that the ever-use of the IUD reduces the risk of ovarian cancer by an average of 30%. We provide insight regarding the potential theories that may underlie these findings.What are the implications of these findings for clinical practice and/or further research? future studies will need to determine whether the beneficial effects found are a function of duration of use, of type-specific device, or specific tumour types. In the meantime, these findings may serve clinicians to reassure and counsel patients about the added benefits of intra-uterine devices.

Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives.

BACKGROUND: Reproductive tract infections (RTIs) are a major cause of morbidity and mortality, yet RTI testing remains limited in resource-constrained settings. We assessed performance of an existing RTI risk assessment screening tool among women living with HIV (WLHIV) considering intrauterine contraceptive (IUC) use. METHODS: We conducted a cross-sectional analysis among WLHIV screened for participation in an IUC trial in Cape Town, South Africa (NCT01721798). RTI testing included Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis. Tool scoring was based on five separately scored criteria: (1) age under 25 years, (2) cohabitation with a partner, (3) secondary education, (4) self-reported intermenstrual bleeding and (5) number of current sexual partners and condom use frequency (score 0-5). We assessed tool performance in detecting RTI at 0 vs 1-5, 0-1 vs 2-5 and 0-2 vs 3-5 score thresholds. RESULTS: Of 303 women, 52% (n=157) reported antiretroviral therapy use and median age was 31 years. The prevalence of any RTI was 38% (gonorrhoea=7%, chlamydia=11%, trichomoniasis=12% and bacterial vaginosis=18%) and 8% of women had multiple RTIs. Overall, 4%, 27% and 69% of women had screening tool scores of 0, 1 or 2+, respectively. At a threshold of at least one scored criterion, the tool demonstrated high sensitivities (95%-97%) but low specificities (3%-4%) for detecting any RTI. Increasing the score threshold and/or inclusion of abnormal vaginal discharge marginally improved specificity. CONCLUSION: The prevalence of RTIs observed in this population was high, and the screening tool had no discriminatory power to detect prevalent RTIs.

Barriers to post-placental intrauterine device receipt among expectant minority women.

PURPOSE: We aimed to identify barriers to breastfeeding-compatible post-placental intrauterine devices (IUDs) for expectant predominantly non-Hispanic African-American women. MATERIALS AND METHODS: This cross-sectional survey study, conducted at 3 Cleveland community partner locations, enrolled 119 expectant predominantly unmarried but partnered non-Hispanic African-American women. The survey assessed contraceptive, IUD-specific and breastfeeding attitudes and intentions. Survey responses were described with percentages and frequencies, and compared by feeding intention using 2-sided Chi-Square tests. Factor analysis with Varimax rotation identified 2 potential measures of reluctance to post-placental IUD acceptance. The relationship of factors scores to maternal characteristics was assessed. RESULTS: Feeding intention (breastfeeding versus not) was not related to perceived barriers to post-placental IUD receipt among expectant minority women. A "Personal Risks Reluctance" factor included low risk IUD events (migration and expulsion), misconceptions (delayed fertility return), menstrual changes and partner preference: a higher score was significantly associated with younger age group but no other maternal characteristics. A "Not Me Reasons" factor included provider and insurance barriers, and was not related to any maternal characteristics. CONCLUSIONS: Expectant minority women's perceived barriers to post-placental IUDs are not related to prenatal feeding intentions. We identified two clinically relevant factors that appear to measure barriers to post-placental IUD acceptance.

The effect of intrauterine device presence and other factors in medical treatment success of tuboovarian abscess.

BACKGROUND: To identify the epidemiologic and clinical risk factors associated with failed response to medical treatment in tuboovarian abscess (TOA) patients and whether there is a relationship between the presence of intrauterine device (IUD), duration of use and medical treatment success or not. METHODS: For this study, the medical records of patients diagnosed with TOA and hospitalized in an 8-year period were analyzed retrospectively. The presence of TOA and IUD was confirmed ultrasonographically in all patients. Parenteral antibiotic treatment was initiated as the first step. Patients who did not improve with this medical treatment underwent surgery. Patients who recovered with medical treatment were defined as the successful group, while those who underwent surgery after medical treatment failure were recorded as the failed group. RESULTS: There were 37 patients in successful group and 87 patients in failed group. The mean age, parity, white blood count, TOA size, duration of IUD use, rate of multigravida and multiparity were higher in the failed group. Logistic regression analysis revealed that presence of multiparity, TOA size and the duration of IUD use were significant independent factors in predicting medical treatment success of TOA. The best cut-off value for TOA size was 4.5 cm and for duration of IUD use was 5.5 years in the Receiver Operating Characteristic curve analysis. CONCLUSION: The presence of long-term IUD use, increased TOA size, and multiparity were found to be risk factors related to the failure of medical treatment in TOA cases.