Should we offer immediate post-partum insertion of IUDs to Brazilian adolescents?
ESC Congress Library. Giovanelli S. May 10, 2018; 208234
Silvana Giovanelli
Silvana Giovanelli
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Abstract
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INTRODUCTION: In many countries, IUDs are a popular contraceptive method but it is only used by 3% of Brazilian women.  In 2016, a public maternity hospital in the state of Sao Paulo, Brazil, created a program to increase the use of post-partum IUDs. Objectives: To describe the acceptance of adolescents to the offer of inserting an IUD in the immediate post-partum period, users´ satisfaction and IUD expulsion rate after four weeks. METHODS. This retrospective cohort assessed the records of all adolescents delivered at a single hospital between 07/2017 and 05/2016 who inserted a TCu380 IUD immediately after placental delivery. All women admitted to the labor ward were informed about the possibility of inserting a free IUD immediately after delivery and about the benefits/risks of this method. We excluded women with current or recent uterine infection, temperature > 37.8º C during labor, uterine atony after placental delivery, rupture of membranes > 24 hours before delivery or manual/surgical placental extraction. The IUD was inserted using standard technique during the first 10 minutes after placental delivery, after the use of oxytocin to prevent post-partum hemorrhage. All participants were scheduled for a follow-up visit 4 weeks after discharge (for a pelvic exam, a transvaginal sonogram and to assess satisfaction). All adolescents signed an informed consent form; the study was approved by the IRB. RESULTS:. Among the 1121 teenagers delivered during the study period, 116 (10,3%) accepted the offer to have an IUD inserted immediately after delivery and 68 (58%) returned for the follow-up visit. Age ranged from 14 to 19 years and parity from 0 to 3; most participants (63.2%, n=43) were delivering their first baby. The overall IUD expulsion rate at 4 weeks was 27.9% (n=19); this was significantly higher among those who inserted the IUD after vaginal delivery than after cesarean section (38.4% versus 11.5%, p=0.02). The rate of expulsion did not differ according to parity: 25.6% versus 32.0%, p=0.56, for Para 1 versus Para 2 or more, respectively. All adolescents except one stated that they were satisfied with the method at 4 weeks (98% satisfaction rate). CONCLUSION: The immediate post-partum period is an excellent opportunity to offer adolescents the insertion of an IUD; the rate of acceptance is close to 10,3%. After 4 weeks, over 70% of the IUDs are in place and nearly 100% of the adolescents are satisfied with the method. 
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