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Immediate postplacental insertion of the intrauterine device: A review of Chinese and the world's experiences

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Advances in Contraception

Abstract

The postpartum period is an ideal time to begin contraception, as women are more highly motivated to adopt contraception at this time and it is convenient for both patients and service providers. For intrauterine device (IUD) contraception, this period offers other advantages, such as ease of insertion and minimal adverse impacts on breastfeeding. Among early studies, most postpartum insertions were performed anywhere from a few hours to seven days or more after delivery, and retention of the IUD in the uterus was poor. Since the 1970s, immediate postplacental insertion (IPPI), i.e., IUD insertion performed within 10 minutes after placental delivery, has been advocated, and fairly low expulsion rates have been reported. Up to now, IPPI has not been widely accepted in clinics because its expulsion rate still appears to be higher than that of interval insertion. In order to further study IPPI and perfect this contraceptive technique, it is essential to comprehensively review IPPI results and compare the Chinese experience with that of the rest of the world.

Resumé

La période de post-partum est le moment idéal pour commencer la contraception, non seulement parce que les femmes sont à ce moment plus motivées pour adopter une méthode contraceptive mais aussi parce que cette période est plus pratique pour les patientes elles-mêmes et pour le personnel soignant. En ce qui concerne la contraception par les DIU, cette période offre d'autres avantages, tels que leur facilité d'insertion et un minimum de conséquences défavorables du point de vue de l'allaitement maternal. D'après les premières études réalisées, la plupart des insertions au cours du post-partum étainet pratiquées entre quelques heures et sept jours ou plus après l'accouchement et la rétention du dispositif par l'utérus laissait à désirer. Depuis les années 70, on préconise l'insertion d'un DIU immédiatement après l'expulsion du placenta (IPPI), c'est-à-dire dans les 10 minutes qui suivent, et on a observé des taux d'expulsion bien plus faibles. Jusqu'ici, cette méthode n'a pas été largement acceptée dans les cliniques car le taux d'expulsion semble encore être plus élevé que dans le cas de l'insertion après un intervalle de temps. Il est essentiel, pour la poursuite de l'étude de la méthode IPPI et pour perfectionner cette technique contraceptive, d'en réexaminer en profondeur les résultats et de comparer l'expérience chinoise à celle du reste du monde.

Resumen

El período de posparto es el momento ideal para iniciar el uso de anticonceptivos, no sólo porque las mujeres están en ese momento más motivadas a adoptar un método anticonceptivo sino también porque este período es más práctico para las pacientes mismas y para el personal que las atiende. En lo que respecta a la anticoncepción mediante el DIU, este período ofrece otras ventajas, tales como la inserción fácil y un mínimo de consecuencias desfavorables desde el punto de vista del amamantamiento. Entre los primeros estudios realizados, la mayoría de las inserciones durante el posparto se realizaban entre algunas horas y siete días o más después del parto y la retención del DIU en el útero era deficiente. A partir de los años 70 se recomendó la inserción del DIU inmediatamente después de la expulsión de la placenta (IPPI), es decir, en los 10 minutos siguientes, registrándose tasas de expulsión más bien bajas. Hasta ahora, este método no ha sido aceptado ampliamente en las clínicas porque las tasas de expulsión continúan pareciendo más altas que en el caso de la inserción después de un intervalo. A fin de continuar estudiando la IPPI y perfeccionar esta técnica anticonceptiva, es esencial examinar exhaustivamente los resultados de la IPPI y comparar la experiencia de China con la del resto del mundo.

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References

  1. Chi I-c, Farr G. Postpartum IUD contraception — a review of an international experience. Adv Contracept. 1989;5:127–46.

    Article  PubMed  Google Scholar 

  2. Zatuchni GI. Postpartum family planning. A report on the International Program. New York: McGraw Hill. 1970:275–306.

    Google Scholar 

  3. Rosenfeld AG, Castodot RG. Early postpartum and immediate post abortion intrauterine contraceptive device insertion. Am J Obstet Gynecol. 1974;118:1104.

    PubMed  Google Scholar 

  4. Edlman DA, Berger, GS, Keith LG. Intrauterine devices and their complications. Boston: CK Hall. 1979:40–1.

    Google Scholar 

  5. World Health Organization. Comparative multicenter trial of three IUDs inserted immediately following delivery of placenta. Contraception. 1980;22:9–18.

    Google Scholar 

  6. O'Hanley K, Huber DH. Postpartum IUDs: key for success. Contraception. 1992;45:351–61.

    Article  PubMed  Google Scholar 

  7. Cole LP, Edelman DA, Potts DM, Wheeler RG, Laufe LE. Postpartum insertion of modified intrauterine devices. J Reproduct Med. 1984;29:677–82.

    Google Scholar 

  8. Chi I-c, Wilkins L, Rogers S. Expulsions in immediate postpartum insertions of Lippes Loop D and Copper T IUDs and their counterpart Delta devices — an epidemiological analysis. Contraception. 1985;32:119–34.

    PubMed  Google Scholar 

  9. Thiery M, Van Kets H, Van der Pas H. Immediate postplacental IUD insertion: the expulsion problem. Contraception. 1985;31:331–49.

    PubMed  Google Scholar 

  10. Thiery M, Van Der Pas H, Delbeke L, Van Kets H. Comparative performance of two copper-wired IUDs (MLCu250 and TCu200) immediate postpartum and interval insertion. Contracept Del Syst. 1980;1:27–35.

    Google Scholar 

  11. Zhuang LQ. Observation on different timings of IUD insertion. Shanghai Med J. 1979;2:14.

    Google Scholar 

  12. Li FN. A one-year observation of IUD insertion at Cesarean section in 80 cases. Congquig Med J. 1981;6:1.

    Google Scholar 

  13. Li HY. IUD insertion at Cesarean section — 180 cases. Sichuan Med J. 1983;4:285.

    Google Scholar 

  14. Yang DZ, Liu BH. Preliminary report of 144 cases of IUD insertion at Cesarean section. Wuhan Med J. 1984;8:22.

    Google Scholar 

  15. Liu BH, Zhang LY, Zhang BR, Sheng ZS. Intrauterine contraceptive device insertion with suture fixation at Cesarean section. Chin Med J. 1983;96:141–4.

    PubMed  Google Scholar 

  16. Chi I-c, Zhou SW, Balogh S, Ng K. Post-cesarean section insertion of intrauterine device. Am J Publ Health. 1983;74:1281–2.

    Google Scholar 

  17. Yu GL. Preliminary observation on the use of IUDs at the end of Cesarean section (A report of 735 cases). Chin J Obstet Gynecol. 1985;20:49.

    Google Scholar 

  18. Zhu SX, Zhang AR. The follow-up of a postpartum IUD insertion. Chin J Obstet Gynecol. 1990;25:44.

    Google Scholar 

  19. National IUD Clinical Research Group. Observations on the clinical efficacies and side effects of six different timing of IUD insertions. Chin J Obstet Gynecol. 1987;22:350.

    Google Scholar 

  20. Zhou SW, Chi I-c. Immediate postpartum IUD insertions in a Chinese hospital — a two year follow-up. Int J Gynecol Obstet. 1991;35:157.

    Article  Google Scholar 

  21. Ho J, Wu Z, Cai S, Han J, Liu M, Hu S, Lui Z. A randomized comparative trial of the MCCu375, TCu220C, Steel Ring and uterine cavity-shaped IUDs. Adv Contracept. 1992;8:161–6.

    Article  PubMed  Google Scholar 

  22. Hatcher RA, Stewart F, Trussel J, Knowal D, Guest F, Stewart GK, Cates W. Postpartum contraception and lactation. In: Contraceptive Technology 1990–1992, 15th edn. New York: Irvington Publishers Inc. 1990:461–2.

    Google Scholar 

  23. Zerzavy FM. Use of intrauterine contraceptive devices in the postpartum period. Am J Pub Health. 1967;57:28–32.

    Google Scholar 

  24. Aznar R, Reynoso L, Montemayor G, Giner J. Postplacental insertion of IUDs. Contracept Deliv Syst. 1980;1:143–8.

    PubMed  Google Scholar 

  25. Ruiz-Velasco V, Garcia C, Castro H. Cesarean section IUD insertion. Contracept Deliv Syst. 1982;3:21–4.

    PubMed  Google Scholar 

  26. Van Kets H, Thiery M, Van Der Pas H. IUD insertion during Cesarean section. Adv Contracept. 1985;1:337–9.

    Article  PubMed  Google Scholar 

  27. Lara R, Sanchez A, Aznar R. IUDs application through Caesarean section incision. Ginec Obstet Mex. 1989;57:23–7.

    PubMed  Google Scholar 

  28. Chi IC, Gao J, Siemens AJ, Waszak CS. IUD insertion at Cesarean section — the Chinese experience. Adv Contracept. 1986;2:145–53.

    Article  PubMed  Google Scholar 

  29. Echeverry G. Family planning in the immediate postpartum period. Stud Fam Plann. 1973;4:33–35.

    PubMed  Google Scholar 

  30. Kaufman J, Zhang Z, Qiao X, Zhang Y. The quality of family planning services in rural China. Stud Fam Plann. 1992;23:73–84.

    PubMed  Google Scholar 

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Xu, J.X., Reusché, C. & Burdan, A. Immediate postplacental insertion of the intrauterine device: A review of Chinese and the world's experiences. Adv Contracept 10, 71–82 (1994). https://doi.org/10.1007/BF01986532

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  • DOI: https://doi.org/10.1007/BF01986532

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