IUD insertions following cesarean deliveries examined
Network 5(2): 4-6
1984
ISSN/ISBN: 0270-3637 PMID: 12265941 Document Number: 402184
A paper presented at the 111th annual meeting of the American Public Health Association in November 1983 reported on the performance of IUDs inserted immediately following cesarean deliveries as well as those inserted in interval women with previous cesarean sections. Physicians at Xuan Wu Hospital in Beijing, China manually inserted IUDs through the incisions of 52 cesarean-sectioned women immediately after delivery of the placenta. In 147 women the IUDs were inserted vaginally immediately after normal vaginal delivery. Delta T and Delta Loop IUDs were inserted in equal proportions in both groups of women. These IUDs are Family Health International's (FHI's) modifications of the standard Lippes Loop D and Copper T 220C. Biodegradable No. 2 chromic sutures are added to the upper crossarm to enhance IUD retention when inserted in the puerperium, thereby reducing the risk of expulsion as uterine involution occurs. All of the 199 study participants were currently married, admitted for delivery of their 1st birth, and between 25-29 years. All but 1 woman in the cesarean group but only 57% of the vaginal delivery group had their IUDs inserted by obstetricians/gynecologists. The follow-up rate at 6 months postinsertion exceeded 95% for both groups. Expulsion rates at 1, 3, and 6 months postinsertion were significantly lower and thus continuation rates significantly higher for the cesarean group than for the vaginal group. The difference in rates did not change substantially even when the 2 groups were compared considering only those women whose IUD was inserted by the obstetricians/gynecologists. There were no serious adverse effects with immediate postcesarean insertions. The 2 groups showed no statistically significant differences in pregnancy rates or in bleeding, pain, or other causes of removal. Another study from China and one from Mexico support this finding, but neither has provided a comparison group. 2 data sets were used to examine the effects of interval insertions with women with previous cesareans. 288 of the women who received locally designed Szontagh IUDs in a Hungarian Center had had 1 or more previous cesareans. Each was matched by age, parity, and date of insertion with 2 controls who each had at least 1 birth but not a cesarean. The cumulative expulsion rates were higher among the cesarean-sectioned women than among the nonsectioned women at 1, 3, 6, and 12 months postinsertion. The other data set used was a pooled file of over 32,000 IUD users from which 318 interval women reported 1 or more previous cesarean deliveries. 299 of these women, inserted with either the Lippes Loop, Copper T, or Multiload IUDs, were matched with two, and the remaining 19 with one, controls from the same data set by center, IUD type, and the other matching criteria of the Hungarian study. There were no significant differences in expulsion rates between the 2 groups.