Post-partum intrauterine device insertion: a good experience in a public Brazilian hospital
ESC Congress Library. Giovanelli S. May 10, 2018; 208245; ESC70
Silvana Giovanelli
Silvana Giovanelli
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Abstract
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INTRODUCTION: In many countries, intrauterine devices are a popular contraceptive method; in Brazil, only 3% of reproductive age women use it.  In 2016, a public maternity hospital in the state of Sao Paulo, Brazil, created a program to increase the use of post-partum intrauterine device (IUD). OBJECTIVES: To describe the acceptance of women 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 women delivered at a single hospital between 07/2016 and 05/2017 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 women signed an informed consent form; the study was approved by the IRB. RESULTS: There were 4743 deliveries during the study period; 622 women (13.1%) fulfilled the selection criteria and accepted the offer to have an IUD inserted immediately after delivery. Four weeks after, 326 (52.4%) returned for the follow-up visit. The IUD was not in the uterine cavity in 83 women, corresponding to a 25.5% overall expulsion rate. This rate was significantly higher among those who inserted the IUD after vaginal delivery than after cesarean section (43.8% versus 7.3%, p < 0 .0001). The rate of expulsion did not differ significantly according to parity (20.8% versus 27.4%, P=0,21, Para 1 versus Para 2, respectively) or age (24.8% versus 27.9%, p=0.59, adults versus adolescents, respectively). The vast majority (92%) of the women stated that they were satisfied with the method at 4 weeks CONCLUSION: The immediate post-partum period is an excellent opportunity to offer women the insertion of an IUD. After 4 weeks, nearly 75% of the IUDs are in place and nearly 100% of the women are satisfied with the method. 
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