IUD (Nova-T) insertion following induced abortion

In a prospective study, 86 women who had an IUD (Nova-T) inserted immediately after induced abortion were compared to 95 abortion patients who started another contraception (control I). Additionally, the rate of complications following IUD insertion in a Family Planning Clinic (control II) were studied in 83 non-pregnant women. The overall infection rate for post-abortion patients was 4.4% (5.8% in the study group, 3.2% in control I). No infections were observed in control group II. Confidence limits (95%) for the three groups were overlapping. Among the women in the study group, bleeding and pain were not more frequent, but if one of these complications occurred, it tended to be more serious and the duration was longer. The number of days before resumption of work after abortion was 3-4 days in both abortion groups. After three months, the continuation rate was 83% (71 of 86) in the study group, 76% (72 of 95) in control I and 93% (77 of 83) in control II. Sixty-nine of the 181 women admitted for legal abortion had been admitted for the same reason previously. In this study, the recurrence rate after 12 months was 0% in the study group and 4.2% (4 of 95) in control group I. The insertion of an IUD at the time of abortion seems to be an effective and acceptable solution to the problem of recurrent abortion.     

IUD (TCu380A) insertion following induced first trimester abortion

In this study, 110 women (study group) who received an IUD (TCu380A) immediately after induced legal first trimester abortion were compared with 90 women (group 1) who started another type of contraception following legal abortion. Additionally, 100 women (group 2) who had an interval IUD insertion, were compared with both.In the study group, 3 (2.7%) patients were found to have an infection which did not fulfill the diagnostic criteria described by WHO and were treated easily by relevant antibiotics. One of 90 patients (1.1%) in group 1 developed acute PID after induced abortion within 7 days. None of group 2 patients had either a suspicion of pelvic infection or infection within the follow-up period (3 months). Among the women in the study group, bleeding and pain were not found to be more frequent, intense or of longer duration when compared with the other groups. Spontaneous expulsion of an IUD occurred in 2 patients (1.8%) of the study group and in 1 patient (1%) of group 2. At the end of the follow-up period, the continuation rates of the study group, group 1 and group 2 were 96.3%, 86.6%, 99%, respectively.

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Resumen En este estudio, 110 mujeres (grupo de estudio) a las que se había colocado un DIU (TCu 380A) inmediatamente después de un aborto inducido legal realizado en el primer trimestre fueron comparadas con 90 mujeres (grupo 1) que adoptaron otro tipo de método anticonceptivo después de un aborto legal. Asimismo, 100 mujeres (grupo 2) a las que se había colocado un DIU después de un intervalo fueron comparadas con los dos grupos.En el grupo de estudio 3, se descubrió que el 2.7% de las pacientes tenía una infección que no satisfacía los criterios de diagnóstico descritos por la OMS y estas pacientes fueron tratadas fácilmente con los antibióticos correspondientes. Una de las 90 pacientes (1.1%) del grupo 1 contrajo enfermedad pélvica inflamatoria aguda después del aborto inducido dentro de los 7 días posteriores al mismo. Ninguna de las pacientes del grupo 2 registró signos de infección pélvica o de infección durante el período de seguimiento (3 meses). Entre las mujeres del grupo de estudio, el sangrado y el dolor no fueron más frecuentes, intensos o de duración más prolongada que en los otros grupos. Se observó expulsión espontánea de un DIU en 2 pacientes (1.8%) del grupo de estudio y en 1 paciente (1%) del grupo 2. Al concluir el período de seguimiento, las tasas de continuación del grupo de estudio, el grupo 1 y el grupo 2 fueron 96.3%, 86.6% y 99%, respectivamente.

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Resumé Lors d'une étude, 110 femmes (population de l'étude) à qui on avait posé un DIU (TCu 380A) immédiatement après un avortement légal provoqué au cours du premier trimestre ont été comparées à un groupe de 90 femmes (Groupe 1) qui avaient adopté une autre forme de contraception après un avortement légal. De plus, à ces deux groupes, on a comparé 100 femmes (Groupe 2) qui portaient un DIU après un intervalle.Dans la population de l'étude, chez 3 patientes (2,7%) on a constaté une infection qui ne correspondait pas aux critères de diagnostic définis par l'OMS; elles ont été facilement traitées par des antibiotiques appropriés. Une des 90 patientes (soit 1,1%) du Groupe 1 a développé une inflammation pelvienne aigüe dans les 7 jours qui ont suivi l'avortement provoqué. Aucune femme du Groupe 2 n'a présenté ni un soupçon d'inflammation pelvienne ni une infection durant la période de suivi (3 mois). On a constaté, chez la population de l'étude, une plus grande fréquence, une plus grande intensité et une plus longue durée des pertes sanguines et des douleurs, comparativement aux autres groupes. L'expulsion spontanée du DIU s'est produite chez 2 patientes (1,8%) de la population de l'étude et chez 1 du Groupe 2 (1%). Au terme de la période de suivi, les taux de poursuite dans la population de l'étude et chez les Groupes 1 et 2 étaient respectivement de 96,3%, 86,6% et 99%.

     

IUD insertion immediately after incomplete abortion

All women who were admitted to the Felix Bulnes Hospital, Santiaog, Chile, for incomplete abortion between July 1968 and June 1969 were given instruction in family planning and contraceptive services. A total of 584 women chose to have an IUD insertion. Although all the women thought they had received an IUD, 1 group had a Lippes loop D inserted immediately after curettage and the other group had no insertion. The attending doctor had no prior knowledge as to which women were to receive the device nor did the doctor at the follow-up know until after the physical exam had taken place. 30 days after discharge from the hospital, the women returned from check-up and follow-up. At this time the women who had not received an IUD were given an insertion. Differences between the group with insertion and the one without were significant only for the interval between curettage and first menses and for the quantity of flow in relation to previous menstruation. The difference between the 2 groups for duration of menstrual flow was of borderline significance at the .05 significance level. It is concluded from the study that in the absence of psychologi cal bias of the patient to the IUD insertion, and possibly bias in its use by the doctor, there are no serious complications in the first month following immediate postabortal IUD insertion even where the abortion was a septic incomplete one.     

Comparison of intramenstrual IUD insertion with insertion following menstrual regulation

To evaluate the use-effectiveness and safety of IUD insertion immediately after menstrual regulation (MR) for delayed menses, a Lippes Loop D (LLD) intrauterine device was inserted in each of 100 consecutive clients at the University College Hospital, Ibadan, immediately after menstrual regulation. Pertinent event rates after 12 months of use were compared with those of 100 consecutive women who had the LLD inserted during menstruation. The cumulative net expulsion rate after 12 months of use was 8% for the study group and 4% for the controls. The overall rate of removals was 15% for the study group and 16% for the control group. None of the observed differences was statistically significant. The continuation rates at 12 months were comparable for both groups (78% and 80%, respectively). There were no accidental pregnancies during the study period. The authors suggest that IUD insertion immediately after menstrual regulation is as effective and safe as intramenstrual insertion, provided prophylactic antibiotics are given.

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Resumen Para evaluar el uso, efectividad e inocuidad del DIU insertado inmediatamente después de la regulación menstrual (RM) por atraso en menstruar, se insertó un dispositivo intrauterino, el Asa de Lippes (LLD) en cada una de 100 clientas consecutivas del University College Hospital en Ibadan, inmediatamente después de la regulación de la menstruación. Luego de 12 meses de uso, las tasas de eventos pertinentes fueron comparadas con aquellas de 100 mujeres consecutivas a las que les fuera insertado el LLD durante la menstruación. La tasa acumulativa neta de expulsión después de 12 meses de uso fué de 8% para el grupo estudiado y de 4% para el grupo control. La tasa general de remociones fué de 15% para el grupo estudiado y de 16% para el grupo contro. Ninguna delas diferencias observadas fué estadísticamente significativa. La tasa de continuidad a 12 meses fué comparable en ambos grupos (78% y 80% respectivamente). No hubo embarazos accidentales durante el período del estudio. Los autores sugieren que la inserción de los DIU inmediatamente después de la regulación menstrual es tan efectiva e inocua como la inserción intramenstrual siempre que se administren antibióticos profilácticamente.

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Resumé Pour évaluer l'efficacité et l'innocuité de la mise en place d'un DIU immédiatement après les règles, on a mis en place un DIU Lippes Loop D (LLD) chez 100 patientes consécutives, immédiatement après les règles, à l'University College Hospital d'Ibadan. On a comparé le taux d'événements pertinents au bout de 12 mois d'utilisation au taux enregistré chez 100 femmes consécutives, chez lesquelles le DIU avait été mis en place pendant les règles. Le taux cumulé net d'explusion après un an d'utilisation a été de 8% dans le groupe étudié contre 4% dans le groupe témoin. Le taux global de retrait a été de 15% dans le groupe étudié contre 16% dans le groupe témoin. Aucune des différences observées n'était statistiquement significative. Le taux de poursuite au bout de 12 mois était comparable dans les 2 groupes (78% et 80%, respectivement). Il n'y a eu aucune grossesse non désirée pendant la période d'étude. Les auteurs estiment que l'insertion d'un DIU immédiatement après les règles est aussi efficace et sûre que l'insertion pendant les règles, à condition de prescrire une antibiothérapie préventive.

     

剖宫产术后1年内行人工流产妇女术后放置IUD的避孕效果观察

目的 探讨剖宫产术后1年内行人工流产患者术后立即放置宫内节育器(IUD)的避孕效果.方法 选取2015年8月至2016年7月于安徽省马鞍市妇幼保健院就诊的人工流产术后立即放置IUD妇女480例,根据患者有无剖宫产史及剖宫产术后时间将所有患者分为A、B、C三组,剖宫产术后12个月内为A组,剖宫产术后12个月以上为B组,无剖宫产史的患者为C组.对比分析所有人工流产患者术后立即放置IUD的避孕效果和副作用.结果 置入IUD后1个月中,A组患者经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率高于其他两组,但差异无统计学意义(χ2值分别为0.28、0.01、0.14、0.01、0.07,均P>0.05).三组患者在3个月及以后时间点发生经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率比较,差异无统计学意义(χ2值分别为0.16、0.05、0.07、0.01、0.23,均P>0.05).所有患者在随访期间无出现闭经(宫腔粘连)的情况.三组患者置入IUD后,术后6个月时因疼痛或因出血取出率最高,三组之间比较差异无统计学意义(χ2=0.02,P>0.05).在随访期间,所有患者均未出现带器妊娠0.置入IUD后,B组在术后3个月内完全脱落2例,其余患者未发生完全脱落及部分脱落情况.至术后12个月时,三组患者累计续用率比较差异无统计学意义(χ2=0.92,P>0.05).结论 剖宫产术后1年内行人工流产的患者术后立即放置IUD是安全、可行的.     

Perforation of the uterus following IUD insertion in the puerperium

Perforation of the uterus by an IUD is very rare. However, during the puerperium when the uterus is small and the uterine wall is thin the risk of perforation increases. We present three patients treated within a rather short period of time at our institution for perforation of the uterus caused by IUD insertion 3–4 months after delivery. Although perforation is by no means always associated with pain, our patients did present with abdominal pain caused by this rare IUD-associated complication. One patient underwent laparotomy, and in two, laparoscopy sufficed to treat this complication.

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Resumen La perforación del útero por un DIU ocurre muy rara vez. Sin embargo, el riesgo de perforación aumenta durante el puerperio, cuando el útero es pequeño y la pared uterina delgada. El artículo presenta tres casos de pacientes tratadas en nuestro establecimiento por una perforación de útero tras la inserción de un DIU 3 ó 4 meses después del parto y que se produjeron con poco intervalo. Si bien una perforación no va siempre acompañada de dolores, nuestras pacientes experimentaban dolores abdominales causados por esta rara complicación asociada con los dispositivos intrauterinos. Una paciente debió ser sometida a una laparotomía y, en el caso de las otras dos, fue suficiente una laparoscopia para tratar esta complicación.

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Resumé La perforation de l'utérus par un DIU se produit très rarement. Toutefois, le risque de perforation augmente pendant la période de puerpéralité, lorsque l'utérus est petit et que sa paroi est mince. L'article présente trois cas de patientes traitées dans notre établissement pour une perforation de l'utérus après insertion d'un DIU 3 à 4 mois après l'accouchement et qui se sont produits à peu de temps d'intervalle. Bien qu'une perforation ne soit pas forcément toujours accompagnée de douleurs, nos patientes étaient affligées de douleurs abdominales dues à cette rare complication liée aux dispositifs intra-utérins. L'une d'elles a dû être laparotomisée et pour les deux autres, la laparoscopie a suffi pour traiter cette complication.

     

Postabortal insertion of IUD

Advances in Contraception - During 1983, 823 first trimester therapeutic abortions were performed at the University Hospital of Trondheim, Norway. Of these patients, 229 had an IUD inserted at the...     

元宫药铜环、Tcu环、母体乐三种IUD产生副反应的比较

目的:比较新型宫内节育器(IUD)元宫药铜环和传统的节育器 Tcu380IUD 母体系 MLcu IUD 的避孕效果和副反应.方法:1380 例自愿放置 IUD 的育龄妇女为对象.随机分为3组.分别放置元宫药铜 Tcu380IUD MLcu IUD.结果:元宫药铜 IUD、Tcu380IUD 和 MLeuIUD 使用12月带器妊娠率分别为0.48%、3.75%、0.85%.脱落率分别为 0.93%、2.92%、0.85%.因症取出率分别为2.80%、6.25%、3.81%.续用率分别为 95.8%、87.08%、94.49%.结论:元宫药铜环是一种安全可靠对月经影响小的宫内节育器.     

Wider opportunities for IUD insertion

The timing of IUD insertion has important implications for those who insert the devices as well as the users. In 1978 the US Food and Drug Administration recommended insertion during menstruation but acknowledged that it is also "necessary and proper" to insert IUDs at other times in the cycle. A 1977 study found that 30% of European and North American obstetricians limited insertion to the time of menstruation. Nearly half those in Africa and the Middle East and 13% of those in Asia followed this practice. Consequently, many women are required to make more than 1 visit to a clinic, meaning inconvenience for both the user and provider and some unintended pregnancies. In developing countries women may depend on mobile clinics or infrequent visits by trained personnel and many seek help without an appointment. 1 reason for insertion at or just after menstruation is to ensure that the woman is not pregnant when the IUD is inserted. 2 recent articles attempt to assess the best time for IUD insertion with regard to IUD performance. White et al. found that women whose Copper T IUDs were inserted on days 1-5 of the menstrual cycle had a lower continuation rate in the 1st few months than did those whose IUDs were inserted at a later time in the cycle. Edelman et al. found that Copper T and Copper 7 IUDs could be inserted at any time during the menstrual cycle without any increased risk of subsequent pregnancy, removal for medical reasons or expulsion during the 1st 12 months after insertion. Pooled International Fertility Research Program (IFRP) data indicate that there is no consistent pattern with regard to the time in the cycle that the IUD is inserted and its later performance. In no case is there a distinct advantage for the 1st 5 days of the menstrual cycle. It is much simpler to offer a woman an IUD when she is first seen, provided she is reasonably sure she is not pregnant. New practices are evolving in relation to recently pregnant women. The postabortal use of IUDs has been extensively researched and is a useful option, using a variety of currently available devices. In regard to the postpartum use of IUDs, some programs have reported a high expulsion rate. Provided proper insertion technique is used, IUDs can be inserted immediately postpartum with a high degree of retention. Another use for copper containing IUDs is insertion within 5 days of unprotected sexual intercourse. In sum, women can be provided with IUDs upon request at any time during the menstrual cycle.     

IUD insertion during cesarean section

An IUD (TCu220C) was inserted in 82 women during low-transverse cesarean section. No untoward effect on puerperal morbidity or lactation was observed and no serious complications occurred in this series. At 12 months the rates were zero for pregnancy and 7.7 for expulsion; the latter figure is comparable to that reported after immediate postplacental insertion of the same IUD model. Intracesarean IUD insertion is a procedure that deserves further promotion.

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Resumen A 82 mujeres se les insertó un DIU (TCu220C) durante una cesárea transversa en el segmento bajo. No se observaron efectos adversos en la morbilidad puerperal y la lactancia y no ocurrieron complicaciones serias en esta serie. A los 12 meses la tasa de embarazos fue de cero y de 7,7 la de expulsiones; esta última cifra es comparable a la registrada después de la inserción postparto inmediato del mismo modelo du DIU. Por lo tanto, la inserción intracesárea de DIU se considera un procedimiento que merece mayor promoción.

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Résumé Un dispositif intra-utérin (TCu220C) a été mis en place chez 82 femmes au cours d'une césarienne transverse basse. On a noté aucune répercussion défavorable sur la morbidité post-puerpérale ni sur l'allaitement et aucune complication sérieuse est apparue dans cette série. Au bout de douze mois, les fréquences étaient de zéro pour les grossesses et de 7,7 pour les expulsions. Les chiffres ultérieurs sont comparables à ce qui a été publié après insertion post-placentaire immédiate du même modèle de DIU. La mise en place d'un DIU au cours de la césarienne est une méthode qui mérite d'être plus largement répandue.

     

Febrile spontaneous abortion and the IUD

A case-control study was done to determine the risk and pathogenesis of febrile spontaneous abortion for intrauterine device (IUD) wearers compared to non-wearers. Four groups of women coming to a large city hospital between 1970 and 1975 were compared: 1) women presenting with febrile spontaneous abortion, 2) women presenting with afebrile spontaneous abortion, 3) women presenting with afebrile spontaneous abortion which subsequently became febrile, and 4) women delivering a live infant.Pregnant women with an IUD $\text{in situ}$ had a 5-fold higher risk of both febrile and afebrile spontaneous abortion compared to pregnant women without an IUD $\text{in situ}$. Women who had a spontaneous abortion that shifted from afebrile to febrile were somewhat more likely to be IUD wearers than the other 2 spontaneous abortion groups. In our study population, the increased risk of febrile spontaneous abortion for IUD wearers appeared primarily due to the increased risk of the spontaneous abortion event itself, rather than a primary IUD-related infection causing febrile spontaneous abortion.     

Timing of the IUD insertion.

The relationship between the time in the menstrual cycle when a TCu-200 or Cu-7-200 is inserted and subsequent IUD-related events was evaluated. For women who had either TCus or Cu-7s inserted, the pregnancy, expulsion and medical removal rates were similar for insertions performed at any time of the menstrual cycle.     

重复放置宫内节育器并节育器异位4例临床分析

目的 探讨重复放置宫内节育器（ IUD）并IUD异位的原因及处理。方法 回顾分析陕西省妇幼保健院4例重复放置宫内IUD并IUD异位患者的临床资料。结果 3例患者经腹腔镜取出异位的IUD,其中1例患者因IUD与周围组织粘连分离困难而中转开腹,患者均手术过程顺利,无术中及术后并发症。另1例患者因无明显不适而拒绝手术。结论 对于放置IUD患者应定期随访观察IUD位置,可疑IUD异位者应进一步确诊检查,以避免重复放置IUD或IUD异位危害患者健康。     

Immediate postabortal insertion of a levonorgestrel-releasing IUD

Experimental IUDs releasing only 10 μg levonorgestrel per day and established copper-releasing IUDs (Nova-T) were inserted in 60 women in connection with legal first-trimester abortion. Bleeding and spotting and other events were recorded during the first year. Restoration of the menstrual cycle was studied. Blood samples were collected twice a week over a three-month period from five women receiving a levonorgestrel-releasing IUD to determine plasma levels of estradiol, progesterone, levonorgestrel, LH and FSH. FSH showed an increase approximately ten days (range 4–19) after abortion. LH/hCG concentrations reached a plateau approximately 24 days (range 9–42) after abortion. Initially, levonorgestrel concentrations were two-fold compared with concentrations of 90 pg/ml after four weeks. After four weeks the plasma levonorgestrel concentrations were stable. All five women had an ovulatory menstrual cycle. The first periods occurred 35 days after operation in the levonorgestrel-IUD group and 30 days after operation in the Nova-T group. The median duration of bleeding and spotting after the insertion was 12 days (range 3–26) in the Nova-T group and 12.5 days (range 3–93) in the levonorgestrel-IUD group. The difference was not statistically significant. From the second month on, menses-like bleeding was more common in the copper-releasing IUD group than in the levonorgestrel-IUD group. The difference was statistically significant (p < 0.001). After one year 75 percent of the patients continued with their IUDs in both groups. One pregnancy occurred in the experimental levonorgestrel-IUD group. One total expulsion was noticed in both groups, and one partial expulsion in the levonorgestrel-IUD group. Two levonorgestrel-IUDs and four Nova-Ts were removed because of bleeding and/or pain. One infection was noticed in the whole group six days after the operation. In the levonorgestrel-IUD group 74 percent of the women had a regular cycle after one year, while all Nova-T patients had a regular cycle. Twelve percent (7 women) were lost to follow-up at one year. The results of this study suggest that a levonorgestrel-releasing IUD can be inserted after legal first-trimester abortion and the results are comparable with those of previous studies that have been made using copper-releasing IUDs.