Expulsion of Nova‐T380, Multiload 375, and Copper‐T380A contraceptive devices inserted during cesarean delivery

Abstract

Despite a comparable risk of expulsion following IUCD insertion during cesarean delivery, the Multiload 375 device showed the lowest risk of displacement.

Insertion of intrauterine devices after cesarean section: a systematic review update

“…These two studies have been added to the ten (PPIUDCS) from the later search and are presented in Table 2. There was one RCT of three different devices, Nova T 380, TCu380A, and MLCu 375 (Multiload Copper375; Multilan SA, Fribourg, Switzerland), with significantly lower expulsion rates for the MLCu 375 14. This RCT is the first three-way study that attempts to evaluate which type of IUD is superior, and not assume they behave generically in this situation unless they are tethered to the uterine fundus 20.…”

“…This was true in both developed countries like Australia,13 and GS countries like Uganda 12. One study described a new technique to anchor the IUD to the fundus (hang up) to prevent expulsion,20 while one examined elongating threads to help prevent the problem of missing threads 14. Expulsion rates were very variable, with no expulsions in studies with very small numbers13,17 and where the device was sutured into the uterus,20 while in other studies it varied between 10% and 15%.…”

“…The information that is available is presented in Table 3 and its importance is discussed later. Elongating the threads and guiding them through the cervix results in strings being visible in all cases 14,36. For IUDs that have long threads eg, ML Cu375, simply pushing the threads through the cervix at the time of CS produces a 92% visibility rate at 6 weeks and 6 months 7.…”

“…Techniques for lengthening threads to ensure their presence in the vagina exist, but often necessitate trimming and so may require an extra post-partum follow-up. However, this is easier to undertake than referral for ultrasound, and post-partum evaluation should be conducted anyway, but even this can create difficulties in the GS 14,36. The problem of missing strings after PPIUDCS insertion is of considerable importance with regard to advancing this method in the GS.…”

“…There have been various approaches to attempt to resolve this problem. In one study vicryl was used to lengthen the threads 14. The use of absorbable material which ensures that the strings remain visible, but subsequently absorb so that they are not too long, may be a solution.…”