Immediate postpartum insertion of IUDs
Thiery, M.
Ippf Medical Bulletin 15(3): 1-2
1981
ISSN/ISBN: 0019-0357 PMID: 12278628 Document Number: 181760
The literature concerning immediate postpartum insertion of IUDs does not give the general impression that IUDs inserted immediately postpartum are well retained by the involuting uterus. Despite unfavorable expulsion rates, the procedure was not found to be dangerous in terms of uterine perforation, pyrexia, and infection or delayed uterine involution. With the goal of improving retention rates, new devices have been bio-engineered, and inserters have been lengthened in the effort to place the IUD high in the uterine fundus. The Multiload IUD (MLCu250) was evaluated for immediate post-placental insertions, and the results of a straight trial have shown a low expulsion rate. In order to determine whether the physical characteristics of the MLCu250 were responsible for its performance after insertion during the 4th stage of labor, this IUD was randomly compared with the Tcu200. It was found that at 2 years the cumulative expulsion rates of both IUDs were quite acceptable and did not differ significantly. Because the reason for discrepancy between these findings and the overall results in the literature are not evident, it seems relevant to focus on some technical details of the procedure. The standard technique used in this study is reported. Regarding criteria of ideal postplacental insertion, the IUDs should be completely safe and effective and not able to be expelled. The question that arises is how do present IUDs fulfill these criteria. The safety of the procedure has generally been found adequate, but inversion of stemmed devices theoretically remains a risk. Tolerance of the IUD models assessed for immediate postplacent insertion has been generally satisfactory. Effectiveness and expulsion of an IUD are not strictly related phenomena. The real problem continues to be the early diagnosis of expulsion.