Insertion of intrauterine devices after cesarean section: a systematic review update

Norman D Goldstuck, Petrus S Steyn, Norman D Goldstuck, Petrus S Steyn

Abstract

Background: Women who undergo a cesarean section (CS) are in a unique position to receive the intrauterine contraceptive device (IUD). They may also want to use the IUD as a long-acting reversible contraceptive method provided the IUD is safe and effective in the presence of a CS scar.

Search strategy: We researched and reviewed the MEDLINE, POPLINE, Google Scholar, and ClinicalTrials.gov databases from January 1968 to June 2015.

Selection criteria: Eligible studies reported event rates or practical problems relating to IUD usage in post-placental or interval insertion (>90 days) after CS. Studies with ≥20 subjects were included.

Data collection and analysis: Analysis of eligible data collected from the search followed the PRISMA guidelines.

Main results: Twelve eligible studies of post-placental IUD insertion after CS included four randomized controlled trials of post-placental versus delayed insertion. Women randomized to delayed insertion were less likely to receive a device. Six studies examined the problem of missing IUD threads at follow-up with only 30%-60% presence of strings observed.

Conclusion: The IUD is a long-acting reversible contraceptive method that is suitable for use in all women undergoing CS. The problems of device expulsion, missing threads at follow-up, and the tendency of increased puerperal bleeding need to be solved. Solutions are proposed.

Keywords: IUD expulsion; cesarean section; long-acting reversible contraception; missing IUD threads; post-placental IUD.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of selection of articles from December 2012 to June 2015 (PRISMA). Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

References

    1. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Eng J Med. 2012;366(21):1998–2007.
    1. Mavranezouli I, LARC Guideline Development Group The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod. 2008;23(6):1338–1345.
    1. Glasier A. Implantable contraceptives for women: effectiveness, discontinuation rates, return of fertility, and outcome of pregnancies. Contraception. 2002;65(1):29–37.
    1. Funk S, Miller MM, Mishell DR, Jr, et al. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception. 2005;71(5):319–326.
    1. Betrán AP, Merialdi M, Lauer JA, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98–113.
    1. Goldstuck ND, Steyn PS. Intrauterine contraception after cesarean section and during lactation: a systematic review. Int J Womens Health. 2013;5:811–818.
    1. Bhutta SZ, Butt IJ, Bano K. Insertion of intrauterine contraceptive device at caesarean section. J Coll Physicians Surg Pak. 2011;21(9):527–530.
    1. Santos AR, Bahamondes MV, Hidalgo MM, Atti A, Bahamondes L, Monteiro I. Pain at insertion of the levonorgestrel-releasing intrauterine system in nulligravida and parous women with and without cesarean section. Contraception. 2013;88(1):164–168.
    1. López-Farfan JA, Hernandez-Gonzalez A, Vélez-Machorro IJ, Vázquez-Estrada LA. A comparative, randomized study of levonorgestrel intrauterine system (LNG-IUS) vs Copper T 380 A intrauterine device applied during cesarean section. Open J Obstet Gynecol. 2012;2(2):151–155.
    1. Elsedeek MS. Puerperal and menstrual bleeding patterns with different types of contraceptive device fitted during elective caesarean section. Int J Gynaecol Obstet. 2012;116(1):31–34.
    1. Elsedeek MS. Five-year follow-up of two types of contraceptive device fitted during elective cesarean delivery. Int J Gynaecol Obstet. 2015;130(2):179–182.
    1. Lester F, Kakaire O, Byamugisha J, et al. Intracesarean insertion of the Copper T380A versus 6 weeks postcesarean: a randomized clinical trial. Contraception. 2015;91(3):198–203.
    1. Braniff K, Gomez E, Muller R. A randomised clinical trial to assess satisfaction with the levonorgestrel-releasing intrauterine system inserted at caesarean section compared to postpartum placement. Aust N Z J Obstet Gynaecol. 2015;55(3):279–283.
    1. Ragab A, Hamed HO, Alsammani MA, et al. Expulsion of Nova-T380, Multiload 375, and Copper-T380A contraceptive devices inserted during cesarean delivery. Int J Gynaecol Obstet. 2015;130(2):174–178.
    1. Levi EE, Stuart GS, Zerden ML, Garrett JM, Bryant AG. Intrauterine device placement during caesarean delivery and continued use 6 months postpartum: a randomized controlled trial. Obstet Gynecol. 2015;126(1):5–11.
    1. Ibrahim ZM, Sayed Ahmed WA. Sublingual misoprostol prior to insertion of a T380A intrauterine device in women with no previous vaginal delivery. Eur J Contracept Reprod Health Care. 2013;18(4):300–308.
    1. Whitaker AK, Endres LK, Mistretta SQ, Gilliam ML. Postplacental insertion of the levonorgestral intrauterine device after cesarean delivery vs. delayed insertion: a randomized controlled trial. Contraception. 2014;89(6):534–539.
    1. Stoddard AM, Xu H, Madden T, Allsworth JE, Peipert JF. Fertility after intrauterine device removal: a pilot study. Eur J Contracept Reprod Health Care. 2015;20(3):223–230.
    1. Gueye M, Gaye YF, Diouf AA, et al. [Trancesarean intra-uterine device. Pilot study performed at Dakar teaching hospital]. Dispositif intra-uterin mis en place en cours de cesarienne. Etude pilote realisee au centre hospitalier universitaire de Dakar. J Gynecol Obstet Biol Reprod (Paris) 2013;42(6):585–590. French.
    1. Tjahjanto H, Haryuni IT. Hang-up IUD, new technique for suturing CuT-380A IUD to uterine fundus in immediate postplacental insertion during cesarean delivery: twelve months follow up. Indones J Obstet Ginecol. 2014;2–31:132–139.
    1. Singal S, Bharti R, Dewan R, et al. Clinical outcome of postplacental Copper T 380A insertion in women delivering by caesarean section. J Clin Diagn Res. 2014;8(9):OC01–OC04.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
    1. Zhang H, Fang G, Zhou C, et al. Study on GyneFix PP IUD insertion during cesarean section. Chinese J Fam Plann. 2004;12(8):481–482. Chinese.
    1. Quin LJ. Fix Cu220C-M and Delta-T-Cu220C inserted immediately during cesarean section: a comparative randomised clinical study. Chinese J Fam Plann. 1994;1(9):16–18. Chinese.
    1. Sastrawinata S, Haswidi E. Pemasangan IUD sewaktu sectio caesarea di RS Hasan Sadikin Bandung selama periode 3 tahun (1975–1977). [The application of IUD during Cesarean Section at Hasan Sadikin Hospital, Bandung, during the three year period (1975–1977)] In: Lukman PD, editor. Naskah lengkap sidang ilmiah Kongres Obstetri Ginekologi Indonesia Ke IV, Yogyakarta, 10–15 Juni 1979. 1979. pp. 84–91.
    1. Tao S. IUD insertion at 42–90 days after caesarean section: a two year prospective study of safety and efficacy. Chinese J Fam Plann. 1994;2(10):91–94. Chinese.
    1. Puzey M. Mirena at caesarean section. Eur J Contracept Reprod Health Care. 2005;10(3):164–167.
    1. Ruiz-Velasco V, Garcia C, Castro H. Cesarean section IUD insertion. Contracept Deliv Syst. 1982;3(1):21–24.
    1. Lara R, Sanchez RA, Aznar R. [Application of intrauterine device through the incision of the cesarean section]. Aplicacion del dispositivo intrauterino a traves de la incision de la cesarea. Ginecol Obstet Mex. 1989;57:23–27. Spanish.
    1. Alvarez Pelago J, Borbolla Sala ME. [IUD insertion during cesarean section and its most frequent complications]. DIU transcesarea y sus complicaciones mas frecuentes. Ginecol Obstet Mex. 1994;62:330–335. Spanish.
    1. Van Kets H, Thiery M, Van der Pas H. IUD insertion during cesarean section. Adv Contracept. 1985;1(4):337–339.
    1. Celen S, Sucak A, Yildez Y, Danisman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Contraception. 2011;84(3):240–243.
    1. Letti Müller AL, Lopes Ramos JG, Martins-Costa SH, et al. Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception. 2005;72(3):192–195.
    1. Levi E, Cantillo E, Ades V, Banks E, Murthy A. Immediate postplacental IUD insertion at caesarean delivery: a prospective cohort study. Contraception. 2012;86(2):102–105.
    1. Celen S, Moroy P, Sucak A, Aktulay A, Danisman N. Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices. Contraception. 2004;69(9):279–282.
    1. Nelson A, Chen S, Eden R. Intraoperative placement of the Copper T-380 intrauterine devices in women undergoing elective caesarean delivery: a pilot study. Contraception. 2009;80(1):81–83.
    1. Chi IC, Zhou SW, Balogh S, Ng K. Post-cesarean section insertion of intrauterine devices. Am J Pub Health. 1984;74(11):1281–1282.
    1. Chi IC, Ji G, Siemens AJ, Waszak CS. IUD insertion at cesarean section – the Chinese experience. Adv Contracept. 1986;2(2):145–153.
    1. Liu BH, Zhang LY, Zhang BR. Intrauterine contraceptive device insertion with suture fixation at cesarean section. Chin Med J (Engl) 1983;96(2):141–144.
    1. Zerzavy FM. Use of intrauterine contraceptive devices in the postpartum period. Am J Public Health Nations Health. 1967;57(1):28–33.
    1. Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet. 1992;339(8796):785–788.
    1. Goldstuck ND, Wildemeersch D. Prevention of intrauterine contraceptive device expulsion and intolerance: Determination of the anchor mechanism. Clin Obstet Gynecol Reprod Med. 2017;3(1):1–8.
    1. Wildemeersch D, Goldstuck ND, Hasskamp T. Current status of frameless anchored IUD for immediate intracesarean insertion. Dev Period Med. 2016;20(1):7–15.
    1. Goldstuck ND, Wildemeersch D. Role of uterine forces in intrauterine device embedment, perforation and expulsion. Int J Womens Health. 2014;6:735–744.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться