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  1. 1
    Peer Reviewed

    Cervico-vaginal inflammatory cytokine alterations after intrauterine contraceptive device insertion: A pilot study.

    Sharma P; Shahabi K; Spitzer R; Farrugia M; Kaul R; Yudin M

    PloS One. 2018; 13(12):e0207266.

    In a prospective study of twenty sexually transmitted infection (STI)-free women, we examined the impact of an intrauterine contraceptive device (IUCD) insertion on cervico-vaginal cytokine levels. Nine women chose the levonorgestrel-containing IUCD and eight chose a copper IUCD. A cervico-vaginal swab was collected for cytokine analysis pre-insertion and four weeks post-insertion. Significant increases were noted in levels of IL-1alpha (median 483.4 versus 316.6 pg/mL, p = 0.046), IL-1beta (median 605.7 versus 147.3 pg/mL, p = 0.018), IL-6 (median 570.1 versus 157.3 pg/mL, p = 0.046), TNFalpha (median 1.19 versus 0.6 pg/mL, p = 0.029) and the chemokine MCP-1 (median 340.2 versus 135.2 pg/mL, p = 0.003). No significant changes were noted in the levels of GM-CSF, IL-8, MIG, MIP-3alpha, RANTES, IL-10, IL-17, IP-10, MIP-1beta. Whether this increase in pro-inflammatory cytokine levels decreases epithelial barrier integrity and enhances susceptibility to STIs, including HIV, merits further study.
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  2. 2

    Acute urticaria: an extremely rare adverse effect of levonorgestrel-releasing intrauterine system as a possible manifestation of progestogen hypersensitivity syndrome.

    Emeryk-Maksymiuk J; Grzywa-Celinska A; Wozniak S; Szkodziak P; Szczyrek M

    Postepy Dermatologii I Alergologii. 2018 Oct; 35(5):530-531.

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  3. 3

    Dynamics of postpartum IUD use in India. Quality of care received and interim results three months after insertion.

    Population Council. Evidence Project

    Washington, D.C., Population Council, The Evidence Project, 2018 Feb. 8 p. (Research Brief)

    This research brief explores the contraceptive use dynamics among 412 married women in India who received a postpartum intrauterine contraceptive device (PPIUD). The women were interviewed within one month of starting the method and again at a three-month follow-up. These preliminary findings should be of interest to program designers, policy makers and health service delivery professionals, especially family planning and antenatal care providers. Findings include reported quality of care received by PPIUD users at the time of insertion and dynamics of PPIUD use after three months, including method continuation, switching, and discontinuation. The brief also examines the role of husbands and frontline health workers in PPIUD use dynamics. This is the first in a series of briefs in a longitudinal study of the dynamics of contraceptive use among 2,699 married women aged 15-49 in Odisha and Haryana states in India. Future briefs will explore dynamics among IUD users, injectable users, and oral contraceptive pill users from enrollment through three-, six-, and twelve-month follow-up interviews.
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  4. 4

    Contraceptive Implant-Related Acute Ulnar Neuropathy: Prompt Diagnosis, Early Referral, and Management Are Key.

    Saeed A; Narayan N; Pandya A

    Eplasty. 2018; 18:e28.

    Objective: Subdermal contraceptive implants are a well-established method of contraception. Aside from common side effects such as irregular menstrual periods, headaches, and weight gain, rarer complications related to their insertion and removal have been reported. These include traumatic peripheral neuropathy after procedures to remove nonpalpable implants. Only 2 cases of ulnar neuropathy after insertion of a contraceptive implant have been described in the literature, one which resolved spontaneously and another in which postoperative recovery was not described. We report a case of acute ulnar nerve neuropathy in a patient postinsertion of a contraceptive implant who achieved symptom resolution after prompt referral and treatment at a specialist plastic surgery center. Methods: A 22-year-old, right-hand-dominant woman presented 1 day postinsertion of a contraceptive implant (Implanon) in her left arm with paresthesia along the ulnar distribution of her hand and forearm, as well as shooting pain on palpating the course of the ulnar nerve. Ultrasonography found the implant to be lying in the subfascial plane of the inner arm. Results: The implant was found lying in the perineurium of the ulnar nerve, causing ulnar nerve neuropathy. A review 3 months after removal of the implant showed near-complete resolution of her symptoms. Conclusions: Complications related to implantable contraceptives may lead to significant morbidity. Appropriate training for health care professionals administering the devices is essential, as well as early referral to a specialist center to prevent permanent damage.
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  5. 5

    Use of a novel suction cervical retractor for intrauterine device insertion: a pilot feasibility trial.

    Turok DK; Simmons RG; Cappiello B; Gawron LM; Saviers-Steiger J; Sanders JN

    BMJ Sexual and Reproductive Health. 2019 Jan; 45(1):47-53.

    Introduction: The Bioceptive suction cervical retractor (SCR) is a novel device that can replace the standard single-tooth tenaculum to place traction on the cervix. A feasibility trial was conducted on the device for intrauterine device (IUD) placement. Methods: Our three-stage feasibility process began with Stage 1, where the device was tested on in-vitro and ex-vivo samples. In Stage 2, 10 women received their IUD using the device. In Stage 3, a feasibility trial, we randomly assigned 25 consenting women to receive their IUD using either the Bioceptive SCR or the standard single-tooth tenaculum. In Stages 2 and 3, we collected pain scores using an electronically adapted 100-point visual analogue scale (VAS) at eight timepoints during and after the insertion procedure, as well as satisfaction and acceptability measures. The primary outcome was the pain score after attaching the SCR or tenaculum (VAS 3). Wilcoxon rank sum tests compared pain scores between devices. Results: In Stage 2, pain scores with the SCR were lower than historical controls with the single-tooth tenaculum. In Stage 3, the median VAS 3 pain scores were 31 and 57 for the intervention and control groups, respectively. The differences in pain scores were not statistically significant but the trend was to lower pain scores with the intervention. Reported patient satisfaction with the SCR device was 80% in Stage 2% and 90% in Stage 3. Conclusions: The Bioceptive SCR has potential as an atraumatic alternative to standard cervical retractor devices for gynaecological procedures. These findings can guide point estimates for future clinical studies.
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  6. 6
    Peer Reviewed

    Assessment of knowledge and attitude regarding intrauterine devices among auxiliary nurse midwife in two districts of North Bengal.

    Biswas R; Bhattacherjee S; Ray K; Roy JK; Sarkar TK; Chakraborty M

    International Journal of Community Medicine and Public Health. 2018 Nov; 5(11):4831-4834.

    Background: Despite being one of the most easily available and reversible methods of family planning, IUD utilization continue to remain low, as evident in the nationwide surveys. One of the reasons was poor knowledge and skills on IUD provision among health care providers. This study examined factors related to providers, by examining their IUD-related knowledge, and their attitudes toward recommending or inserting the IUD. Methods: A descriptive cross sectional study was conducted among 503 ANMs from Uttar Dinajpur and Darjeeling Districts using a semi-structured questionnaire exploring the service providers’ knowledge, current practices and experience with IUD insertion. Attitudes regarding IUDs were assessed by asking how much they agreed with a number of hypothetical statements about the IUD. Results: The proportion of good knowledge and favourable attitude was 57.5% and 60% respectively. The knowledge was found to be significantly higher among ANMs aged less than 30 years and who had graduate education than their counterparts. Better knowledge and favourable attitude was found among the ANMs posted in Darjeeling and had service experience of more than 5 years. Conclusions: The knowledge and attitude of the ANMs were found to be less than satisfactory. Addressing IUDs and other newer contraceptives in pre-service curriculum, within job training and peer group education in both public and private areas may help the situation.
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  7. 7

    Removal of intrauterine contraception with non-visible threads: a case series.

    Stephens EA

    BMJ Sexual and Reproductive Health. 2019 Jan; 45(1):44-46.

    OBJECTIVES: (1) To review management of a series of women referred for removal of intrauterine contraception (IUC) with non-visible threads. (2) To establish whether the device was likely to have been placed at the fundus at insertion. (3) To document removal success rates in a community sexual health (CSH) setting. STUDY DESIGN: A retrospective review of a series of 76 women seen by the author between April 2016 and October 2017 in a specialist CSH clinic for removal of IUC with non-visible threads. RESULTS: After ultrasound scan (USS) assessment 67 women underwent a removal procedure. Sixty-two devices (92.5%) were successfully removed. Uterine instrumentation beyond the internal os was required in 43 removals, enabling comparison of uterine cavity length with the length of IUC and threads. Such comparison suggested 39/43 (91%) devices were not fundal at insertion and that non-visible threads were likely to have been caused by the device moving to the fundus post-insertion under the influence of uterine contractions, leading to retraction of the threads. CONCLUSIONS: Removal of IUC with non-visible threads can be successfully done in a CSH setting with ultrasound availability. Non-fundal placement of IUC at insertion is likely to be a significant cause of non-visible threads. (c) Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.
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  8. 8

    Essential anatomy: why anatomical words matter when it comes to subdermal implants.

    Barlow-Evans R; Jaffer K; Gupta JK

    BMJ Sexual and Reproductive Health. 2018 Oct; 44(4):315-316.

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  9. 9

    Efficacy of post placental insertion of intrauterine contraceptive device.

    Abro ST; Shaikh NA; Noonari H; Patujo YH; Brohi S

    Rawal Medical Journal. 2018; 43(3):456-458.

    Objective: To determine efficacy of post placental insertion of intrauterine contraceptive device (IUD). Methodology: This prospective study was carried our at Shaikh Zaid Women Hospital, Larkana from January 15, 2016 to January 14, 2017. A total of 220 subjects willing for birth control were inserted IUD at the time of delivery. IUD was inserted after 10 minutes of expulsion of placenta. Child and patients was followed till six months to record the expulsion of IUD. Efficacy of the IUCD was recorded. Results. The average age of the women was 29.66±3.89 years. Efficacy of post placental insertion of IUD was observed in 90.45% cases. Conclusion. Post placental insertion of IUCDs is an effective, useful, safe, convenient and low-cost procedure for early postpartum contraception. © 2018, Pakistan Medical Association. All rights reserved.
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  10. 10
    Peer Reviewed

    Clinical experience with a novel anchored, frameless copper-releasing contraceptive device for intra-caesarean insertion.

    Eser A; Unal C; Albayrak B; Wildemeersch D

    European Journal of Contraception and Reproductive Health Care. 2018 Aug; 23(4):255-259.

    OBJECTIVES: The primary objective of the study was to determine the expulsion rate of the newly developed frameless GyneFix Caesarean Section (Gyn-CS((R))) device, specifically developed to minimise expulsion when inserted immediately after delivery of the placenta during caesarean section. Secondary objectives included evaluation of side effects, patient's satisfaction with the method and continuation of use. METHODS: A prospective, non-randomised clinical trial was conducted at a single university hospital research centre in Istanbul, Turkey, with follow-up at 4-6 weeks and again at 3 months. The majority of participants ( approximately 80%) were planned for elective caesarean delivery. RESULTS: The study analysed 100 Gyn-CS devices inserted immediately after delivery of the placenta in a group of multiparous women undergoing planned or emergency caesarean section. One expulsion occurred early in the study, which was subsequently attributed to improper anchoring of the device. No serious adverse events (e.g. pelvic inflammatory disease or perforation) were reported. At the last follow-up visit, at approximately 90 d, 89 Gyn-CS devices were still in place (one participant was lost to follow-up). CONCLUSION: The study confirms that intra-caesarean implantation of the newly designed frameless Gyn-CS to the uterine fundus is a simple procedure that has no timing restraints, high patient acceptance and minimal risk of expulsion and displacement, while affording all the contraceptive benefits of a conventional copper-releasing intrauterine device. In addition, by preventing a shortened interpregnancy interval, the Gyn-CS can promote proper healing of the laparotomy wound. As insertion is easy, safe and quick, the Gyn-CS could significantly increase the use of immediate postplacental delivery intrauterine contraception, thus serving to reduce the number of unintended follow-on pregnancies.
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  11. 11
    Peer Reviewed

    Can pediatricians provide long acting reversible contraception?

    Norris AH; Pritt N; Berlan ED

    Journal of Pediatric and Adolescent Gynecology. 2018 Sep 29;

    STUDY OBJECTIVES: In the US, 40% of high-school students have sex; few use highly effective and safe long-acting reversible contraceptives (LARCs): intrauterine devices (IUDs) and implants. Pediatricians are key health providers for many adolescents, yet few provide LARC. Our objective was to understand the pragmatics of provision of LARC (rather than beliefs or attitudes) and identify barriers to and opportunities for LARC provision by community-practicing pediatricians. DESIGN: We conducted a qualitative descriptive study with semi-structured interviews; qualitative methods are valuable for generating conceptual models of complex phenomena. SETTING: Set in a mid-sized Midwestern city, our study was community-based. PARTICIPANTS: We interviewed 23 pediatricians to understand their views about providing contraception (including LARC) to adolescents. For analysis, we developed a coding schema and applied it using a priori and open coding. RESULTS: Several interrelated themes regarding challenges to provision of LARC emerged: limited motivation for onsite LARC provision or referral streams, low pediatric patient interest in LARC, lack of pediatrician training about LARC provision, and inadequate structural elements for onsite placement of LARC in pediatric offices. Each challenge could be remedied, as pediatricians were motivated to provide adolescent patients with high quality care. Improvements in these interrelated conditions could facilitate pediatrician provision of LARC. CONCLUSION: Pediatricians and their patients want to prevent pregnancy, but current practice norms limit LARC provision by pediatricians. To increase LARC access in pediatrician offices, we suggest training in LARC provision and patient education for medical students, residents, and pediatricians; communicating about LARC methods with adolescents to increase patient demand; and systemic changes to improve referral processes and/or allow on-site LARC placements. Copyright (c) 2018. Published by Elsevier Inc.
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  12. 12
    Peer Reviewed

    Successful implementation of immediate postpartum intrauterine contraception services in Edinburgh and framework for wider dissemination.

    Cooper M; Cameron S

    International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):56-61.

    Provision of immediate postpartum intrauterine device (PPIUD) insertion within maternity settings can overcome many of the barriers faced by women in accessing this method after childbirth. Uptake of PPIUD can help reduce the risk of a subsequent unintended pregnancy and improve spacing between births. PPIUD insertion is not yet routinely available in the UK and evidence to support the practical implementation of the service in this setting is lacking. Shared learning and experience of providers may assist in the wider availability of PPIUD. A routine PPIUD service has been successfully established within a public maternity setting in Edinburgh (UK) and this article utilizes an implementation framework to discuss the approach.
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  13. 13
    Peer Reviewed

    Impact of contraceptive counselling training among counsellors participating in the FIGO postpartum intrauterine device initiative in Bangladesh.

    Fatima P; Antora AH; Dewan F; Nash S; Sethi M

    International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):49-55.

    Objective: To evaluate the impact of structured training given to dedicated family planning counsellors on postpartum intrauterine device (PPIUD) services across six tertiary hospitals in Bangladesh. Methods: Family planning counsellors underwent structured training on postpartum family planning, PPIUD in particular, over a four-day period. Impact of training was evaluated by comparing PPIUD counselling rates, consent rates, insertion rates, and removal rates five months before and five months after the training, using data from women delivering in the participating facilities. Results: A total of 27 622 women were included in this analysis: 11 263 (40.8%) before the training intervention and 16 359 (59.2%) after it. There was an increase in the proportion of women who were counselled (from 75.3% to 83.8%, P<0.001), and a small decrease in the proportion of women agreeing to have a PPIUD inserted following counselling (13.7% vs 12.9%, P=0.03). Overall insertion rate was similar before and after training (9.5% vs 9.8%, P=0.42), while removal rate reduced from 2.8% to 1.8% (P=0.41). Conclusion: Structured training had no impact on overall PPIUD insertion rate. However, it did impact numbers of women receiving counselling, perceived quality of the counselling received, and overall removal rates.
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  14. 14
    Peer Reviewed

    Institutionalizing postpartum family planning and postpartum intrauterine device services in Nepal: role of training and mentorship.

    Thapa K; Dhital R; Karki YB; Rajbhandari S; Amatya S; Pande S; Tunnacliffe E

    International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):43-48.

    Objective: To explore the perceptions of key stakeholders on different modalities of training and mentoring activities for healthcare providers of postpartum family planning and postpartum intrauterine devices (PPFP/PPIUD). Methods: In this qualitative study, data were collected from 40 participants in December 2017 via focus group discussions (FGD) and in-depth interviews (IDI) in three hospitals implementing PPFP/PPIUD services and government line agencies in Nepal. Data were analyzed through content analysis and grouped into themes and categories. Results: The majority of participants reported that PPFP/PPIUD training and mentoring was useful and contributed to their professional development. Most found that on- the- job training (OJT) was more effective than group-based training (GBT). Conclusion: Training and mentoring activities were perceived to be useful by health providers and OJT was the approach preferred by the majority. Further studies are necessary to explore the existing challenges and long-term effects of each modality of training and mentoring on health providers’ competency and attitudes and on the uptake of PPIUD by postpartum mothers.
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  15. 15
    Peer Reviewed

    Clinical outcomes of postpartum intrauterine devices inserted by midwives in Tanzania.

    Munganyizi PS; Kimario G; Ponsian P; Howard K; Sethi M; Makins A

    International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):38-42.

    Objective: To assess the rate of complications following immediate postpartum insertion of intrauterine devices (IUDs) by trained midwives in Tanzania. Methods: A prospective cohort study of women who underwent immediate postpartum IUD (PPIUD) insertions provided by midwives between December 31, 2016 and October 15, 2017. Midwives received standardized training via the FIGO initiative. Women who returned 6 weeks after delivery were evaluated for complications. Outcomes of interest were uterine infection, IUD expulsion, medical removal of IUD, and method discontinuation. Results: There were 40 470 deliveries, 2347 (5.8%) PPIUD insertions, and 1013 (43.2%) women with a PPIUD who returned for a follow-up visit in the program-affiliated clinics. Midwives were providers in 596 (58.8%) of these follow-up cases and clinicians in 417 (41.2%) cases. All PPIUD insertions by midwives were transvaginal and among them 43 (7.2%) had PPIUD-related complications by the end of sixth week. These complications included 16 (2.7%) cases of uterine infection, 14 (2.3%) IUD expulsions, 26 (4.4%) IUD removals, and 33 (5.5%) with overall method discontinuation. Only one case had uterine infection severe enough to warrant hospitalization. Conclusion: PPIUD insertion by trained midwives in Tanzania compares favorably with results reported from other settings.
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  16. 16
    Peer Reviewed

    FIGO postpartum intrauterine device initiative: complication rates across six countries.

    Makins A; Taghinejadi N; Sethi M; Machiyama K; Munganyizi PS; Odongo E; Divakar H; Fatima P; Thapa K; Perera G; Arulkumaran S

    International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):20-27.

    Objective: To record and analyze complication rates following postpartum intrauterine device (PPIUD) insertion in 48 hospitals in six countries: Sri Lanka, India, Nepal, Bangladesh, Tanzania, and Kenya. Methods: Healthcare providers were trained in counselling and insertion of PPIUD via a training-the- trainer model. Data were collected on methodology, timing, cadre of staff providing care, and number of insertions. Data on complications were collected at 6-week follow-up. Statistical analysis was performed to elucidate factors associated with increased expulsion and absence of threads. Results: From May 2014 to September 2017, 36 766 PPIUDs were inserted: 53% vaginal and 47% at cesarean delivery; 74% were inserted by doctors. Follow-up was attended by 52%. Expulsion and removal rates were 2.5% and 3.6%, respectively. Threads were not visible in 29%. Expulsion was less likely after cesarean insertion (aOR 0.33; 95% CI, 0.26–0.41), following vaginal insertion at between 10 minutes and 48 hours (aOR 0.59; 95% CI, 0.42–0.83), and when insertion was performed by a nurse (aOR 0.33; 95% CI, 0.22–0.50). Conclusion: PPIUD has low complication rates and can be safely inserted by a variety of trained health staff. Given the immediate benefit of the one-stop approach, governments should urgently consider adopting this model.
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  17. 17
    Peer Reviewed

    Birth Control Implant.

    Journal of Midwifery and Women's Health. 2018 Jul 10;

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  18. 18

    Reply: LNG-IUDs in treating dysmenorrhea.

    Iacovides S; Polo-Kantola P; Baker FC

    Human Reproduction Update. 2016 Apr; 22(3):405-6.

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  19. 19

    Frameless versus classical intrauterine device for contraception.

    O'Brien PA; Marfleet C

    Cochrane Database of Systematic Reviews. 2001; (4):CD003282.

    BACKGROUND: The frameless intrauterine device (IUD) dispenses with the frame in the classical IUD and holds the device in the uterus by anchoring one end of a nylon thread in the fundal myometrium, to which copper sleeves are attached. The introducer for the frameless device was modified following reports of early expulsions of the device. OBJECTIVES: This review examines the hypothesis that the frameless device reduces risk of expulsion and pregnancy, and the problems of bleeding and pain necessitating early removal. SEARCH STRATEGY: We searched the Cochrane Controlled Trial Register (Cochrane Library Issue 1, 2001), MEDLINE, EMBASE and Popline to Dec 2000, and reference list of articles. SELECTION CRITERIA: We selected for the review randomised trials that compared the frameless device to a classical framed device for contraception. DATA COLLECTION AND ANALYSIS: Both authors extracted data independently. We contacted study author for additional data. We calculated rate ratios and rate differences for cumulative rates for each outcome at yearly intervals. We used the general variance-based method to combine trials, and tested the results for heterogeneity. MAIN RESULTS: Three trials were included in the review involving over 5,800 women randomised to either a frameless device or TCu380A, with data up to eight years for the largest, and with a total experience of 23,000 women-years. All three trials excluded nulliparous women. The two earlier trials used a prototype introducer and there was a higher expulsion rate at one year (relative risk 2.48, 95% confidence intervals 1.89 to 3.26). However, between two and six years in the large WHO trial the risk of pregnancy was lower with the frameless device (relative risk 0.53, 95% confidence intervals 0.32 to 0.91). In a recent trial using GyneFix with a new introducer early expulsions and pregnancies were not statistically different from the control device; by the third year the expulsion rate with the frameless device was lower (relative risk 0.41, 95% confidence intervals 0.19 to 0.87) with no difference in pregnancy rate. Removals rates for excessive bleeding and/or pain were no different between the devices (relative risks 0.92, 95% confidence intervals 0.74 to 1.14, at one year and 1.13, 0.93 to 1.37, at six years). There was a tendency towards fewer removals for pain in early years but no difference at six years (relative risk 1.13, 95% confidence intervals 0.93 to 1.37). REVIEWER'S CONCLUSIONS: There are insufficient data to show that problems of early expulsions have been overcome with the new introducer used in GyneFix. Apart from that, the frameless device performs similarly to TCu380A, and appears to have a lower pregnancy rate in later years, although the absolute difference is small.
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  20. 20
    Peer Reviewed

    Establishing and Conducting a Regional, Hands-on Long-Acting Reversible Contraception Training Center in Primary Care.

    Rubin SE; Maldonado L; Fox K; Rosenberg R; Wall J; Prine L

    Women's Health Issues. 2018 Sep - Oct; 28(5):375-378.

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  21. 21
    Peer Reviewed

    Consenting to invasive contraceptives: an ethical analysis of adolescent decision-making authority for long-acting reversible contraception.

    Behmer Hansen RT; Arora KS

    Journal of Medical Ethics. 2018 Sep; 44(9):585-588.

    Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception (LARC) methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk-benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents' unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents' ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted. (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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  22. 22

    Outcome of immediate postpartum insertion of intrauterine contraceptive device: Experience at tertiary care hospital.

    Wasim T; Shaukat S; Javed L; Mukhtar S

    JPMA. Journal of the Pakistan Medical Association. 2018 Apr; 68(4):519-525.

    OBJECTIVE: To determine the outcome of immediate post-placental intrauterine contraceptive device insertion in women. METHODS: This quasi-experimental study was conducted at Services Hospital Lahore, Pakistan, from August 2015 to January 2017.Postpartum intrauterine contraceptive device was inserted within 10 minutes of the delivery of the placenta in patients who gave informed consent. They were followed up at 6 weeks and 6 months and those who completed the follow-up were enrolled as study subjects. Data regarding safety, efficacy and continuation was collected at 6 months. Primary outcome measures were safety in terms of associated complications and secondary outcome measure was continuation rates. Efficacy was measured in terms of prevention of pregnancy. SPSS 23 was used for data analysis. RESULTS: A total of 8,000 eligible patients were counselled, out of whom 3,012(37.6%) exhibited a positive response and had postpartum intrauterine contraceptive device inserted. Of them, 1,250(41.5%) were followed up at 6 months and 833(66.6%) had no complications. Mean age was 30.2+/-11.4 years. Menstrual disturbances, vaginal discharge, lost string, misplaced device and expulsion were seen in 238(19%), 193(15.4%), 268(21.4%), 14(1.8%) and 75(6%) of the patients respectively. These complications except lost strings were comparable in vaginal and caesarean section insertions (p<0.05). Lost strings were more frequently observed in caesarean section group (p=0.001). Besides, 1,058(84.3%) patients wanted to continue this method of contraception. CONCLUSIONS: Postpartum intrauterine contraceptive device was found to be an effective, acceptable contraception with fewer complications for the patients.
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  23. 23
    Peer Reviewed

    Early IUD insertion after medically induced abortion.

    Dewan R; Bharti N; Mittal A; Dewan A

    European Journal of Contraception and Reproductive Health Care. 2018 Jun; 23(3):231-236.

    OBJECTIVE: There is insufficient evidence on the continuation, safety and acceptability of immediate insertion of the intrauterine device (IUD) after medical abortion. The objective of the present study was to evaluate clinical outcomes of early IUD insertion, compared with those of delayed IUD insertion, following medical abortion. METHODS: Women undergoing medical abortion with mifepristone and misoprostol up to 49 days' gestation and opting for Copper T 380A IUD contraception underwent early (5-14 days after mifepristone) or delayed insertion (3-4 weeks after mifepristone). The primary outcome measure was 6 month IUD continuation rate after medical abortion. Secondary outcome measures included user acceptability and safety. RESULTS: Between October 2015 and October 2016, post-medical abortion IUD insertion was performed in 120 eligible women fulfilling the inclusion and exclusion criteria. There was no statistically significant difference in the continuation rates of the early and delayed IUD insertion groups at 6 months (76.7 versus 83.3%, p = .75). The 6 month IUD expulsion rates were 6.7 and 3.3% in the early and delayed insertion groups, respectively (p = .56). There were 10 (16.7%) removals in the early and eight (13.3%) in the delayed insertion groups (p = .77). Level of satisfaction with postabortal IUD use was comparable in both groups. Adverse events were rare and did not differ significantly between the two groups. CONCLUSION: We demonstrated high continuation rates, safety and acceptability of early IUD insertion after medical abortion.
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  24. 24
    Peer Reviewed

    Uterine or paracervical lidocaine application for pain control during intrauterine contraceptive device insertion: a meta-analysis of randomised controlled trials.

    Perez-Lopez FR; Martinez-Dominguez SJ; Perez-Roncero GR; Hernandez AV

    European Journal of Contraception and Reproductive Health Care. 2018 Jun; 23(3):207-217.

    OBJECTIVE: Systematic review and meta-analysis to assess the effects of uterine or paracervical lidocaine application on pain control during IUD insertion. METHODS: PubMed and five other electronic research databases were searched through 15 November 2017 for RCTs comparing lidocaine treatment vs. a control (placebo or no-intervention) to prevent pain during IUD insertion. Searched terms included 'IUD insertion', 'lidocaine' and 'randomised controlled trial'. RCTs evaluating lidocaine treatment before IUD insertion without restriction of language, age and IUD type. Pain measured by visual pain scales at tenaculum placement, IUD insertion and immediate post-IUD insertion. Results of random effects meta-analyses were reported as mean differences (MDs) of visual pain scale (VPS) scores and their 95% confidence intervals (CIs). RESULTS: Eleven RCTs (n = 1458 women) reporting paracervical lidocaine block or uterine mucosa lidocaine application before IUD insertion. Lidocaine produced lower VPS scores during tenaculum placement (MD -0.99, 95% CI: -1.73 to -0.26), IUD insertion (MD -1.26, 95% CI: -2.23 to -0.29) and immediate post-IUD insertion period (MD -1.25, 95% CI: -2.17 to -0.33). CONCLUSION: Lidocaine treatment was associated with modest reduction of pain during tenaculum placement and after IUD insertion.
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  25. 25
    Peer Reviewed

    Satisfaction With the Intrauterine Device Insertion Procedure Among Adolescent and Young Adult Women.

    Akers AY; Harding J; Perriera LK; Schreiber C; Garcia-Espana JF; Sonalkar S

    Obstetrics and Gynecology. 2018 Jun; 131(6):1130-1136.

    OBJECTIVE: To evaluate satisfaction with intrauterine device (IUD) insertion procedures among adolescent and young adult women. METHODS: This secondary analysis of data from a multisite, single-blind, sham-controlled randomized trial of women having a levonorgestrel 13.5-mg IUD inserted enrolled participants from March 2015 through July 2016 at three family planning clinics in Philadelphia, Pennsylvania. Eligible participants were 14-22 years of age, nulliparous, not pregnant, and English-speaking. Randomization was computer-generated allocation in block sizes of four to a 1% lidocaine paracervical or sham block. Only patients were blinded. Satisfaction was measured with three items that assessed overall satisfaction with the procedure, whether participants would recommend the IUD to a friend, and the perception that the IUD was worth the discomfort. Predictors included demographics, sexual and reproductive history, pain after IUD insertion, and treatment group. RESULTS: Ninety-five women enrolled; 93 (97.9%) were included in the analysis. Forty-five (47.4%) were white, 34 (36.0%) were black, 62 (66.0%) were privately insured, and 75 (79.0%) had used contraception previously. Most (n=73 [76.8%]) reported high overall satisfaction with the procedure, 64 (67.4%) would recommend an IUD to a friend, and 79 (83.2%) perceived the IUD was worth the discomfort. The odds of reporting high overall satisfaction were lower among adolescents compared with young adults (odds ratio [OR] 0.07, 95% CI 0.008-0.68); those who never had a gynecologic examination compared with those who had (OR 0.26, 95% CI 0.07-0.99); and decreased as pain score increased (OR 0.96, 95% CI 0.94-0.99). Higher pain scores were negatively correlated with the odds of recommending an IUD to a friend and perceiving the IUD was worth the discomfort. CONCLUSION: Adolescent and young adult women report high levels of satisfaction after the IUD insertion procedure. Young age, lack of experience with gynecologic examinations, and high pain were inversely related to satisfaction. CLINICAL TRIAL REGISTRATION:, NCT02352714.
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