Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil
Lassner, K.J.; Chen, C.H.; Kropsch, L.A.; Oberle, M.W.; Lopes, I.M.; Morris, L.
Bulletin of the Pan American Health Organization 29(3): 206-215
1995
ISSN/ISBN: 0085-4638 PMID: 8520606 Document Number: 372214
In the mid-1980s in Brazil, health workers randomly assigned 1711 women aged 15-48 requesting IUD insertion at the Center for Research on Integrated Maternal and Child Care clinic in Rio de Janeiro to have the Copper-T 200 IUD inserted by a physician or by a nurse. The study aimed to determine whether trained nurses could perform as safe and effective IUD insertions as physicians. Insertion failure was more common when performed by nurses than physicians (3.3% vs. 1.3%; p = 0.005). Severe pain at insertion was more common during physician insertions than nurse insertions (10.8% vs. 7.1%; p = 0.008) and in women who had menstrual bleeding, bleeding, dysmenorrhea, or pelvic pain than in women lacking these preinsertion symptoms (14.2% vs. 7.8%; p 0.001). History of pelvic inflammatory disease (PID) or a sexually transmitted disease (STD) increased the likelihood of severe pain at insertion (14.5% vs. 8.5%; p = 0.022). Nulliparous women were more likely to experience insertion failure than parous women regardless of provider, especially for nurse insertions (11.6% vs. 1.6%; p 0.01). The higher failure rate among nurses was probably due to a higher proportion of nulliparous women in the nurse insertion group (17.2% vs. 13.6%; p 0.05). The overall IUD use-effectiveness rate at 12 months was 98.8% (98.6% for physicians and 99% for nurses). The cumulative IUD continuation rate at 12 months was slightly better for nurse insertions than for physician insertions (75.2% vs. 74.4%). There were no significant differences between termination rates regardless of reason (pregnancy, expulsion, or removal) between physicians and nurses. The increases in complaint rates between preinsertion and postinsertion were the same for both physicians and nurses (25.8% and 25.1%, respectively). These results indicate the need to emphasize taking the client's medical history and diagnosing existing medical symptoms that are possibly linked to IUD insertion complications. Physicians or more experienced nurses should insert an IUD in nulliparous women. More counseling and care are needed for women with IUD insertion complications and those with a history of PID or STD.