Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS®) versus the TCu380A: A randomized trial

“…The body of evidence included studies largely published in the past 10 years, from all World Health Organization regions, with levels of evidence of I, II-2, and II-3 and with quality ratings assessed most frequently as fair or poor (compared with good for three studies). 7,18,19 Twenty-two studies included only CuT380A IUDs, 8,16–18,20–37 13 included only LNG-IUS, 19,38–49 and nine included a mix of the two 7,9,10,14,50–54 ; the remaining four studies included CuT200 55–57 or Cu7 IUDs. 58 Twenty-eight studied women with IUDs placed only in the immediate postpartum period, 9,10,14,17,18,21,23,24,26–30,32–37,40–43,52–54,57,58 four studied only early postpartum placements, 44,47,55,56 and the remaining 16 studied more than one placement period.…”

Section: Resultsmentioning

confidence: 99%

“…7,18,19 Twenty-two studies included only CuT380A IUDs, 8,16–18,20–37 13 included only LNG-IUS, 19,38–49 and nine included a mix of the two 7,9,10,14,50–54 ; the remaining four studies included CuT200 55–57 or Cu7 IUDs. 58 Twenty-eight studied women with IUDs placed only in the immediate postpartum period, 9,10,14,17,18,21,23,24,26–30,32–37,40–43,52–54,57,58 four studied only early postpartum placements, 44,47,55,56 and the remaining 16 studied more than one placement period. 7,8,16,19,20,22,25,31,38,39,45,46,48–50,51 Similar numbers of studies evaluated vaginal and cesarean deliveries, with 14 including only vaginal deliveries, 14,16,19,20,22,31,34,39,42,44,45,48,53,5816 including only cesarean deliveries, 7,8,17,18,27–30,35,37,38,40,41,43,46,54 16 including both delivery methods, 9,10,21,…”

Section: Resultsmentioning

confidence: 99%

“…58 Twenty-eight studied women with IUDs placed only in the immediate postpartum period, 9,10,14,17,18,21,23,24,26–30,32–37,40–43,52–54,57,58 four studied only early postpartum placements, 44,47,55,56 and the remaining 16 studied more than one placement period. 7,8,16,19,20,22,25,31,38,39,45,46,48–50,51 Similar numbers of studies evaluated vaginal and cesarean deliveries, with 14 including only vaginal deliveries, 14,16,19,20,22,31,34,39,42,44,45,48,53,5816 including only cesarean deliveries, 7,8,17,18,27–30,35,37,38,40,41,43,46,54 16 including both delivery methods, 9,10,21,23–26,32,33,36,47,49,50,51,52,57 and two not reporting delivery method. 55,56 Sample sizes ranged from 7–2,733 women; follow-up duration ranged from 4 weeks–5 years, and follow-up rates ranged from 29–100%.…”

Section: Resultsmentioning

confidence: 99%

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Intrauterine Device Expulsion After Postpartum Placement

Jatlaoui

Whiteman

Jeng

et al. 2018

Obstetrics &Amp; Gynecology

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OBJECTIVE: To estimate expulsion rates among women with postpartum intrauterine device (IUD) placement by timing of insertion, IUD type, and delivery method. DATA SOURCES: We searched PubMed, Cochrane Library, and ClinicalTrials.gov from 1974 to May 2018. METHODS OF STUDY SELECTION: We searched databases for any published studies that examined post-partum placement of a copper IUD or levonorgestrel intrauterine system and reported counts of expulsions. We assessed study quality using the U.S. Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of IUD expulsion and estimated adjusted relative risks (RRs) for timing of postpartum placement, delivery method, and IUD type using log-binomial multivariable regression model. TABULATION, INTEGRATION, AND RESULTS: We identified 48 level I to II-3 studies of poor to good quality. Pooled rates of expulsion varied by timing of IUD placement, ranging from 1.9% with interval placements (4 weeks postpartum or greater), 10.0% for immediate placements (10 minutes or less after placental delivery), and 29.7% for early placements (greater than 10 minutes to less than 4 weeks postpartum). Immediate and early postpartum placements were associated with increased risk of expulsion compared with interval placement (adjusted RR 7.63, 95% CI 4.31–13.51; adjusted RR 6.17, 95% CI 3.19–11.93, respectively). Postpartum placement less than 4 weeks after vaginal delivery was associated with an increased risk of expulsion compared with cesarean delivery (adjusted RR 5.19, 95% CI 3.85–6.99). Analysis of expulsion rates at less than 4 weeks postpartum also indicated that the levonorgestrel intrauterine system was associated with a higher risk of expulsion (adjusted RR 1.91, 95% CI 1.50–2.43) compared with CuT380A. CONCLUSION: Postpartum IUD expulsion rates vary by timing of placement, delivery method, and IUD type. These results can aid in counseling women to make an informed choice about when to initiate their IUD and to help institutions implement postpartum contraception programs.

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“…This IUD is permanently secured by inserting an anchoring knot in the fundal wall using a specially designed inserter. Unal et al anchored a frameless IUD -GyneFix ® Cesarean Section IUD in an IPP uterus following a cesarean delivery, and reported a single expulsion (1.4%, n=70) [11]. Zhang et al inserted the GyneFix ® PP IUD during cesarean section and reported 4% expulsion rate (n=200) [12].…”

Section: Introductionmentioning

confidence: 99%

Novel Method and Device for Delivery and Retention of Intrauterine Devices in the Immediate Postpartum Period: Pilot Baboon Feasibility Study

Campbell

Rylander

Thaxton

et al. 2020

2020 Design of Medical Devices Conference

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The immediate post-partum period offers a convenient time to have an intrauterine device placed because of the co-location of a non-pregnant woman and her clinician; however, this practice is associated with increased expulsion rates of up to 30%, compared with a 3% expulsion rate for interval insertions. This paper presents a device and method to improve intrauterine device delivery and retention in the immediate postpartum period. This initial feasibility study illustrates that it is possible to temporarily tether a commercially available intrauterine device within the uterus of an immediately postpartum baboon. The results indicate this device and method are technically feasible, but further studies will be needed to evaluate safety and efficacy in reducing expulsion rates.

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Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS®) versus the TCu380A: A randomized trial

Cited by 12 publications

References 15 publications

IUCD Insertion and Fixation versus Insertion Only During Cesarean Section

IUCD Insertion and Fixation versus Insertion Only During Cesarean Section

Intrauterine Device Expulsion After Postpartum Placement

Novel Method and Device for Delivery and Retention of Intrauterine Devices in the Immediate Postpartum Period: Pilot Baboon Feasibility Study

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