Lara RR, Menocal TG, Ramos PC, Velázquez RN

Language: Spanish
References: 22
Page: 306-311
PDF size: 231.66 Kb.

ABSTRACT

Objective: To evaluate safety and effectiveness of the intrauterine device Multiload Cu375 compared with the TCu 380A inserted in the postpartum period.
Patients and methods: In a randomized comparative study carried out in the National Perinatology Institute, intrauterine devices MLCu 375 and Tcu 380A were inserted to 157 patients who voluntary accepted, and previously signed informed consent. There were four instances for the intrauterine devices insertion: within 10 minutes after vaginal delivery, during cesarean section (immediate postplacental insertion) and postpartum-postcesarean insertion (in the time range of 10 min to 48 h). All insertions were made with ring forceps. From 1 h to 24 h later, abdominal ultrasound examinations were performed to assess the distances between the upper part of the device to the fundus of uterine cavity. Follow up visits were scheduled at 3, 6, 9 and 12 months. Net cumulative life table event rates of discontinuations were estimated at one year.
Results: The expulsion rates were 10.4 for the MLCu 375 and 7.7 for the TCu 380A and they were not influenced by the moment of the intrauterine device insertion, not by the cervical dilatation, neither by the distance of the intrauterine device to the fundus of uterine cavity. The removal rates for bleeding and pain were 4.9 and 4.8, the removal rates for non medical reasons were 3.7 and 4.9 respectively. There was one case of genital infection in the MLCu 375 group. There were no pregnancies, nor uterine perforation. The one year continuation rates were 77.1 and 82.6 respectively. There were no statistical significant differences in the comparative rates.
Conclusions: The intrauterine device MLCu 375 is as safe and effective as the TCu380A when they are inserted in the postpartum period.

REFERENCES

1. Reynoso L, Arévalo N, Lara R, Aznar R. Aplicación postplacenta de cinco tipos diferentes de dispositivos intrauterinos. Ginec Obstet Mex 1982;50:107-10.

2. World Health Organization, Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Intrauterine Devices for Fertility Regulation. Comparative multicenter trial of three IUDs inserted immediately following delivery of the placenta. Contraception 1980;22:9-15.

3. Lara RR. Complicaciones del DIU postparto. En: Acosta A. Publicaciones Científicas del XV Congreso Latinoamericano de Ginecoobstetricia. Asunción, 1996;pp:21-25.

4. Celen S, Möröy P, Sucak A, Aktulay A, Danisman N. Clinical autcomes of early postplacental insertion of intrauterine contraceptive devices. Contraception 2004;69:279-82.

5. Cole LP, Edelman DA, Potts D, Wheeler RW, Laufe LE. Postpartum insertion of modified intrauterine devices. J Reprod Med 1984;29:667-82.

6. Tatum HJ, Saavedra R, Ramos R, et al. Immediate postplacental insertion of GYNE-T 380 and GYNE-T 380 postpartum intrauterine contraceptive devices: Randomized study. Am J Obstet Gynecol 1996;175:1231-5.

7. Grimes D, Schultz K, van Vliet H, Standwood N. Immediate post-partum insertion of intrauterine devices: a Cochrane review. Hum Reprod 2002;17:549-54.

8. Thiery M, Van der Pas H, Van Kets H. The MLCu 375 intrauterine contraceptive device. Adv Contracept 1985;1:37-44.

9. Champion CB, Behlicovic B, Moreno AJ, et al. A Three-year evaluation of TCu 380Ag and Multiload Cu 375 intrauterine devices. Contraception 1988;38:631-35.

10. Thiery M, Van Kets H, Van der Pas H. Immediate postplacental IUD insertion: The expulsion problem. Contraception 1985;31:331-49.

11. Secretaría de Salud. Norma Oficial Mexicana de los Servicios de Planificación Familiar. NOM.005SSA2-1993:59-61.

12. Instituto Nacional de Perinatología. Normas y Procedimientos de Ginecología y Obstetricia 2002:147-50.

13. Azen SP, Roy S, Pike MC, Casagrande J, Mishell DR. A new procedure for the statistical evaluation of intrauterine contraception. Am J Obstet Gynecol 1977;128:329-35.

14. Hernández VM, Becerril FLC. Uso del DIU TCu 380 modificado con filamentos de cromo en el posparto inmediato. Ginec Obst Mex 2000;68:70-75.

15. O’Hanley K, Huber DH. Postpartum IUD: Keys for success. Contraception 1992;45:351-61.

16. Chi IC. What we have learned from recent IUD studies: A researcher’s perspective. Contraception 1993;48:81-108.

17. Bonilla RF, Aguilar ZMA, Cázares MML, Hernández OME, Luna RMA. Factores de expulsión del dispositivo intrauterino TCu 380A aplicado en puerperio inmediato y tardío. Rev Med IMSS 2005;43:5-10.

18. Chi IC, Ji G, Siemens AJ, Waszak CS. IUD insertion at cesarean section-the Chinese experience. Adv Contracept 1986;2:145-53.

19. Lara RR, Sánchez RA, Aznar R. Aplicación del dispositivo intrauterino a través de la incisión de la cesárea. Ginec Obstet Mex 1989;57:23-27.

20. Letti MAL, López RJG, Martines-Costa SH, et al. Transvaginal ultrasonographic assesment of the expulsion rate of intrauterine devices inserted in the immediate post partum period: a pilot study. Contraception 2005;72:192-95.

21. Aznar R, Guerrero A, Alvarado A, Arévalo N, Lara R. Relationship between expulsion rate of IUDs inserted postplacenta and their sites in uterine cavity: an X Ray study. Contracept Deliv Systems 1982;3:197-200.

22. Ortiz JD, Guerrero BC, Wheeler RG, Waszak CS. Use of echosonography to monitor uterine placement of intrauterine devices after immediate postpartum insertions. Int Gynaecol Obstet 1987;25:53-57.