Advances in Contraception

, Volume 5, Issue 3, pp 127–146 | Cite as

Postpartum IUD contraception — a review of an international experience

  • I-Cheng Chi
  • G. Farr
Review Article

Abstract

Postpartum insertion of intrauterine contraceptive devices (IUDs) performed while women are still in hospital has a number of advantages. Earlier reports, however, generally associated this procedure with high expulsion rates. Recent studies, on the other hand, have shown that if IUDs are inserted immediately (within 10 minutes) after placental delivery, it is safe and effective. In some experienced centers, fairly low expulsion rates are reported. In this paper the experiences with postplacental IUD insertions from international studies are reviewed, the lessons we have learned from these experiences summarized, and future research directions suggested.

Resumé

La mise en place d'un dispositif intra-utérin (DIU) après un accouchement, alors que les femmes se trouvent encore à l'hôpital, présente un certain nombre d'avantages. Toutefois, dans des rapports antérieurs, cette pratique a généralement été associée à des taux de rejet élevés. D'autre part, des études récentes ont montré que si l'insertion du DIU de fait immédiatement après l'expulsion du placenta (dans les 10 minutes qui suivent), cette méthode est sûre et efficace. Certains centres expérimentés ont rapporté des taux de rejet relativement faibles. La présente étude passe en revue les expériences décrites dans des études internationales sur les insertions des DIU après le post-partum, résume les enseignements tirés de ces expériences et suggère des orientations pour les recherches futures.

Resumen

La inserción de un dispositivo intrauterino (DIU) después des parto, mientras las mujeres continúan hospitalizadas, presenta cierto número de ventajas. Sin embargo, en informes anteriores, esta práctica estuvo asociada generalmente con tasas elevadas de rechazo. Por otra parte, estudios recientes señalaron que si la inserción del DIU se realiza immediatamente después de la expulsión de la placenta (dentro de los 10 minutos siguientes), este método es seguro y eficaz. Ciertos centros experimentados señalaron tasas de rechazo relativamente bajas. En este estudio se examinan las experiencias descritas en estudios internacionales sobre las inserciones posparto de DIU, se resumen las lecciones aprendidas de estas experiencias y se sugieren orientaciones para futuras investigaciones.

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References

  1. 1.
    PotterR.G., MasnickG.S. and GendellM. (1973) Postamenorrheic versus postpartum strategy of contraception.Demography,10, 99–112.PubMedGoogle Scholar
  2. 2.
    HefnawiF., DannoilO., BradraouiM.H.H. et al. (1975). Effect of inert IUDs on lactation. In: HefnawiF. and SegalS., eds.,Analysis of Intrauterine Contraception. North Holland Publishing Company, Amsterdam, pp. 431–438Google Scholar
  3. 3.
    HingoriV. and UmaB. (1970) Lactation and lactational amenorrhea with postpartum IUCD insertion.Reprod. Fertil.,23, 513–515.Google Scholar
  4. 4.
    PremaK. (1982). Duration of lactation and return of menstruation in lactating women using hormonal contraception and IUDs.Contracept. Deliv. Syst.,3, 39–46PubMedGoogle Scholar
  5. 5.
    ZatuchniG.I. (1970). Postpartum Family Planning. A report on the International Program. McGraw-Hill, New York.Google Scholar
  6. 6.
    RatnamS.S. and TowS.H. (1970). Translocation of the loop. In: ZatuchniG.I., ed.,Postpartum Family Planning: A report on the international program. McGraw-Hill, New York, P. 371Google Scholar
  7. 7.
    World Health Organization. (1980). Comparative multicentre trial of three IUDs inserted immediately following delivery of the placenta.Contraception,22, 9–18Google Scholar
  8. 8.
    EcheverryG. (1973) Family planning in the immediate postpartum period.Stud. Fam. Plann.,4, 33–35PubMedGoogle Scholar
  9. 9.
    AznarR., ReynosoL., MontemayorG. and GinerJ. (1980) Postplacental insertion of IUDs.Contracept. Deliv. Syst.,1, 143–148.PubMedGoogle Scholar
  10. 10.
    Family Health International. (1985). Postpartum IUDs: a boon to family planning.Network,1 (4), 1–2Google Scholar
  11. 11.
    NewtonJ., HarperM. and ChanK.K. (1977). Immediate post-placental insertion of intrauterine contraceptive devices.Lancet,1, 272–274Google Scholar
  12. 12.
    EmensJ.M. and ShahS.R. (1982). Early postpartum insertion of the Multiload Cu250 intrauterine device.Br. j. Obstet. Gynaecol.,89, (Suppl 4), 43–45.PubMedGoogle Scholar
  13. 13.
    AnanthasubramaniamL., PremlathaJ. and AyyarS. (1988). Post placental insertion of copper IUD.J. Obstet. Gynaecol. India,18, 683–686Google Scholar
  14. 14.
    ThieryM., Van DerPasH., DelbekeL. and VanKetsH. (1980). Comparative performance of two copper-wired IUDs (MLCu250 and TCu200) immediate postpartum and interval insertion.Contracept. Deliv. Syst.,1, 27–35PubMedGoogle Scholar
  15. 15.
    ThieryM., VanKetsH. and Van DerPasH. (1985). Immediate postplacental IUD insertion: The expulsion problem.Contraception,31, 331–349PubMedGoogle Scholar
  16. 16.
    ThieryM. (1980). Immediate postpartum insertion of IUDs.Contracept. Deliv. Syst.,1, 228–229Google Scholar
  17. 17.
    LaufeL.E., WheelerR.G. and FrielP.G. (1979) Modification of intrauterine devices for postpartum insertion.Lancet,1, 853–854PubMedGoogle Scholar
  18. 18.
    KamalI., EzzatR., ZakiS. et al. (1980). Immediate postpartum insertion of sutured Lippes Loop.Int. J. Gynaecol. Obstet.,18, 26–30PubMedGoogle Scholar
  19. 19.
    LavinP., WaszakC. and BravoC. (1983) Preliminary report on a postpartum CuT 200 study, Santiago, Chile.Int. J. Gynaecol. Obstet.,21, 71–75PubMedGoogle Scholar
  20. 20.
    BrennerP.F. and Women's Hospital. (1983). A clinical trial of the Delta-T intrauterine device: immediate postpartum insertion.Contraception,28, 135–147PubMedGoogle Scholar
  21. 21.
    ThieryM., LaufeL., ParewijckH. et al. (1983). Immediate postplacental IUD insertion: a randomized trial of sutured (Lippes Loop and TCu200C) and non-sutured (TCu220C) models.Contraception,28, 299–313PubMedGoogle Scholar
  22. 22.
    ChompootaweepS., ReinprayoonD., VirutamasenP. et al. (1983). A comparative study of Lippes Loop and Delta Loop intrauterine devices in early postpartum.Contraception,28, 399–404PubMedGoogle Scholar
  23. 23.
    ZhouS.W., LinL., LaufeL. and DixonB. (1983). The introduction of postpartum intrauterine devices in the People's Republic of China.Int. J. Gynaecol. Obstet.,21, 151–154PubMedGoogle Scholar
  24. 24.
    ChiI-c., ZhouS-w., BaloghS. and NgK. (1984). Postcesarean section insertion of intrauterine devices.Am. J. Publ. Health,74, 1281–1282Google Scholar
  25. 25.
    YanJ-s. and ChampionC.B. (1984). A comparative study of the Copper T and Delta T.Singapore J. Obstet. Gynaecol.,15, 44–47Google Scholar
  26. 26.
    KisnisciH. and ChampionC.B. (1985). A study of Delta intrauterine devices in Ankara, Turkey.Int. J. Gynaecol. Obstet.,23, 51–54PubMedGoogle Scholar
  27. 27.
    ApeloR. and WaszakC.S. (1985). Postpartum IUD insertions in Manila, Philippines.Adv. Contracept.,1, 319–328PubMedGoogle Scholar
  28. 28.
    ArandaM.C., WaszakC.S. and ColvenC.E. (1986). Estudio comparativo del DIU Y Delta y la T de Cobre 220 en Costa Rica.Ginecol. Obstet. Mex.,54, 164–167PubMedGoogle Scholar
  29. 29.
    MariscalJ.D.O., BarreraC.G., WheelerR.W. and WaszakC.S. (1987). Use of echosonography to monitor uterine placement of intrauterine devices after immediate postpartum insertions.Int. J. Gynaecol. Obstet.,25, 53–57PubMedGoogle Scholar
  30. 30.
    ColeL.P., EdelmanD.A., PottsD., WheelerR.W. and LaufeL.E. (1984). Postpartum insertion of modified intrauterine devices.J. Reprod. Med.,29, 677–682PubMedGoogle Scholar
  31. 31.
    ChiI-c., WilkensL.R. and RogersS. (1985). Expulsions in immediate postpartum insertions of Lippes Loop and Copper T IUDs and their counterpart Delta devices — An epidemiological analysis.Contraception,32, 119–134PubMedGoogle Scholar
  32. 32.
    World Health Organization. (1966). Basic and clinical aspects of intrauterine devices, Technical Report No. 332. Geneva, WHOGoogle Scholar
  33. 33.
    MishellD.R. and RoyS. (1982). Copper intrauterine contraceptive device event rates following insertion 4 to 8 weeks postpartum.Am. J. Obstet. Gynecol.,143, 29–35PubMedGoogle Scholar
  34. 34.
    RosenfieldA.G. and CastadotR.G. (1974). Early postpartum and immediate postabortion intrauterine contraceptive device insertion.Am. J. Obstet. Gynecol.,118, 1104–1114PubMedGoogle Scholar
  35. 35.
    BanharnsupawatL. and RosenfieldA.G. (1971). Immediate postpartum IUD insertion.Obstet. Gynecol.,38, 276–285PubMedGoogle Scholar
  36. 36.
    ColeL.P. and PottsD.M. (1983). Wider opportunities for IUD insertions.IPPF Med. Bull.,17 (1), 2–3Google Scholar
  37. 37.
    BhumichtirW. and LimtrakarnJ. (1970). Immediate post-partum IUD insertions at Women's Hospital, Bangkok. In:Postpartum Family Planning: A report on the international program, ZatuchniG.I., ed., McGraw-Hill, New York, P. 291Google Scholar
  38. 38.
    PedronN., MondragonH., MarcushamerB. and GallegosA. (1987). The effect of post-partum IUD insertion on post-partum bleeding.Contraception,35, 345–351PubMedGoogle Scholar
  39. 39.
    KarA.B., ChandraH., KambojkV.P. and ChowdhuryS.R. (1968). Effect of an intrauterine contraceptive device on postpartum involution of the rhesus monkey uterus.Am. J. Obstet. Gynecol.,101, 760–765PubMedGoogle Scholar
  40. 40.
    YounisM.N., HamedA.F., ArefI.T. et al. (1989). The effect of postplacental insertion of the spiked and the standard Lippes Loop on uterine involution.Int. J. Gynecol. Obstet.,28, 263–267Google Scholar
  41. 41.
    CastadotR.G. (1975). Insertion prococe des dispositifs intrauterins en postpartum.Union Med. Can.,104 (8), 1233–1236PubMedGoogle Scholar
  42. 42.
    EmensA.M., GusafsonR.C. and JordonJ.A. (1978). The use of an intrauterine device in early postpartum period.Br. J. Fertil. Contracept.,2, 38–41Google Scholar
  43. 43.
    TatumH.J. (1973). Metallic copper as an intrauterine contraceptive agent.Am. J. Obstet. Gynecol.,117, 602–614Google Scholar
  44. 44.
    ThieryM. (1981). Immediate postpartum insertion of IUDs.IPPF Med. Bull.,15, 1–2Google Scholar
  45. 45.
    BurnhillM.S. and BirnbergC.H. (1966). Contraception with an intrauterine bow inserted immediately postpartum.Excerpta Medica International Congress Series,133, 1158–1164Google Scholar
  46. 46.
    WeinbergG. and BalinC. (1973). Postpartum insertion of the safety filament bow.Obstet. Gynecol.,41, 925–928PubMedGoogle Scholar
  47. 47.
    ApeloR., RamosR. and ThomasM. (1976). The LEM device in an immediate postpartum contraception program.Fertil. Steril.,27, 517–522PubMedGoogle Scholar
  48. 48.
    VanKetsH., ThieryM., Van DerPasH. and ParewijckW. (1987). Immediate postpartum insertion: performance of the Nove-T-PP and randomized comparison with the Nova-T.Adv. Contracept.,3, 63–69PubMedGoogle Scholar
  49. 49.
    Ruiz-VelascoV., GarciaC. and CastroH. (1982). Cesarean section IUD insertion.Contracept. Deliv. Syst.,1, 21–24Google Scholar
  50. 50.
    VanKetsH., ThieryM. and Van DerPasH. (1985). IUD insertion during cesarean section.Adv. Contracept.,1, 337–340PubMedGoogle Scholar
  51. 51.
    ChiI-c., JiG., SiemensA.J. and WaszakC.S. (1986). IUD insertion at cesarean section — the Chinese experience.Adv. Contracept.,2, 145–153PubMedGoogle Scholar
  52. 52.
    HeartwellS.F. and SchlesselmanS. (1983). Risk of uterine perforation among users of intrauterine devices.Obstet. Gynecol.,61, 31–36PubMedGoogle Scholar
  53. 53.
    SivinI. (1984). The intrauterine device and uterine perforation. Letter to the Editor.Obstet. Gynecol.,64, 744–746PubMedGoogle Scholar
  54. 54.
    World Health Organization. (1987). Mechanism of action, safety and efficacy of intrauterine devices. Geneva, WHO. (Technical Report Series 753), p. 91Google Scholar
  55. 55.
    LippesJ. (1975). The importance of insertion technique for improving results with the Copper T.J. Obstet. Gynaecol. India,25, 102–105PubMedGoogle Scholar
  56. 56.
    Potts, M. and Whitehorne, E. (1980). Contraception and lactating women. In: Zatuchni, G.I., ed.,Research Frontiers in Fertility Regulation. Harper and Row, pp. 384–388Google Scholar
  57. 57.
    Huber, D. (1989). Observations about postpartum IUD services of Instituto Mexicano de Segura Social (IMSS). Personal communicationGoogle Scholar
  58. 58.
    RandicL., VlasicS., MatrijanI. and WaszakC.S. (1985). Return to fertility after IUD removal for planned pregnancy.Contraception,32, 253–259PubMedGoogle Scholar
  59. 59.
    SandmireH.F. (1986). Fertility after intrauterine device discontinuation.Adv. Contracept.,2, 327–335PubMedGoogle Scholar
  60. 60.
    SkeldestadF. and BrattH. (1988). Fertility after complicated and non-complicated use of IUDs. A controlled prospective study.Adv. Contracept.,4, 179–184PubMedGoogle Scholar
  61. 61.
    WilsonC.W. (1989). A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices for conception and because of complications. A four-year study.Am. J. Obstet. Gynecol.,160, 391–396PubMedGoogle Scholar
  62. 62.
    CramerD.W., SchiffI. and SchoenbaumS.C. (1985). Tubal infertility and the intrauterine device.N. Engl. J. Med.,312, 937PubMedGoogle Scholar
  63. 63.
    DalingJ.R., WeissN.S., MetchB.N. et al. (1985). Primary tubal infertility in relation to the use of an intrauterine device.N. Engl. J. Med.,312, 937PubMedGoogle Scholar
  64. 64.
    LiebermanE., LangJ.M., RyanK.J., MonsonR.R. and SchoenbaumS.C. (1989). The association of inter-pregnancy interval with small for gestational age births.Obstet. Gynecol. 74, 1–5PubMedGoogle Scholar
  65. 65.
    TorresA. and ForrestJ.D. (1983). The costs of contraception.Family Plann. Perspect.,15, 70–72Google Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • I-Cheng Chi
    • 1
  • G. Farr
    • 1
  1. 1.Family Health InternationalResearch Triangle ParkUSA

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