Association of the Position of the Copper T 380A as Determined by the Ultrasonography Following its Insertion in the Immediate Postpartum Period with the Subsequent Complications: An Observational Study
- 61 Downloads
Incorrectly placed copper T 380A leads to increased contraception failure. This study aimed to find an association between the ultrasonographic position of the copper T 380A in the immediate postpartum period and the adverse effects observed during the period of 6 months after its insertion.
This descriptive study was carried out in the Department of Obstetrics & Gynaecology of a tertiary-care-center of India from September 2011 to February 2013. The women eligible for immediate postpartum copper T 380A insertion with previous regular menstrual cycles for at least 6 months before the current pregnancy, and those who were willing for follow-up visits and had easy accessibility to the hospital, were recruited. A clinical evaluation and ultrasonographic assessment of Intra-Uterine-Contraceptive-Device (IUCD) after insertion was carried out after enrolment. The complications (expulsions, vaginal discharge, menstrual irregularity, and lower abdominal pain) were subsequently assessed during a 6-month follow-up period. The primary objective was the ultrasonographic assessment of the placement of IUCD immediately after insertion. The incidence of complications and their association with the presence of malposition was also studied.
Hundred patients were evaluated during the study period. Forty-four (44 %) women were found to have malpositioned IUCDs on ultrasonographic evaluation done following insertion. The complications among the IUCD users included menstrual irregularity (27.17 %), pain in lower abdomen (20.65 %), vaginal discharge (7.6 %), and expulsions (9.7 %). The IUCD expulsions, menstrual irregularities, and pain were significantly more in patients with malpositions (p < 0.05).
Malpositioning of IUCD is common immediately following insertion and is significantly associated with more complications during the follow-up.
KeywordsIUCD Malposition Expulsion Menstrual irregularity Contraception
The authors are grateful to Dr. Puneet Jain (MD, DM) for help in the statistical analysis.
Conflicts of interest
- 1.Grimes DA, Lopez LM, Schulz KF, et al. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev Online. 2010;5:CD003036.Google Scholar
- 3.Rimmer E, Jamieson MA, James P. Malposition and expulsion of the levonorgestrel intrauterine system among women with inherited bleeding disorders. Haemophilia. 2013;19:933–8.Google Scholar
- 5.Shipp TD, Bromley B, Benacerraf BR. The width of the uterine cavity is narrower in patients with an embedded intrauterine device (IUD) compared to a normally positioned IUD. J Ultrasound Med Off J Am Inst Ultrasound Med. 2010;29:1453–6.Google Scholar
- 7.Peri N, Graham D, Levine D. Imaging of intrauterine contraceptive devices. J Ultrasound Med Off J Am Inst Ultrasound Med. 2007;26:1389–401.Google Scholar
- 8.Boortz HE, Margolis DJA, Ragavendra N, et al. Migration of intrauterine devices: radiologic findings and implications for patient care. Radiogr Rev Publ Radiol Soc North Am Inc. 2012;32:335–52.Google Scholar
- 10.WHO. Medical eligibility criteria for contraceptive use: a WHO family planning cornerstone [internet]. 4th ed. Geneva: World Health Organization; 2010. Available from http://www.ncbi.nlm.nih.gov/books/NBK138639/. Accessed 11 Sep 2013.