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Objectives: To assess the value of misoprostol administration before IUD insertion. Search strategy: Screening of PubMed, Scopus, Web Of Science, ScienceDirect, and clinical trials registry till April 2024 using the keywords misoprostol, prostaglandin E1 analogue, IUD, IUCD, intrauterine device, IUD insertion, and their MeSH terms. Selection criteria: All RCTs that included misoprostol administration before IUD insertion. All doses, routes, and times of administration of misoprostol compared to placebo, analgesics, or other prostaglandins were included. This review included 19 RCTs including 2743 women (1333 had misoprostol administration and 1410 comparators (1281 received placebo, 16 received diclofenac, 43 received dinoglandin, and 70 received lignocaine). Data collection and analysis: The extracted data included location setting, number of participants randomized and analyzed, participants selection criteria, the exact intervention details (including misoprostol dose, route and timing of administration, the comparator group details, and type of IUD inserted), primary and secondary outcomes of the trial (including pain score, easiness of insertion score, the need for analgesics, the need for additional measures as cervical dilatation, failure of insertion, complications of the insertions process, and drug side effects), risk of bias of the included studies, and trial registration number and site. Main results: Failure of IUD insertion was evaluated in 9 studies with 1350 participants and revealed an odd ratio (OR) of 0.87 with 0.39–1.98 95% CI, P value = 0.75, and I2 score = 45%. The easiness score of insertion was evaluated in 7 studies with 780 participants and revealed an OR of − 1.12 with − 1.73 to 0.52 95% CI, P value < 0.001, and I2 score = 87%. The pain VAS was evaluated in 13 studies with 1776 participants and revealed a mean difference (MD) of − 0.23 with − 0.77 to 0.31 95% CI, P value = 0.41, and I2 score = 90%. The participants satisfaction score was evaluated in 3 studies with 366 participants and revealed a MD of 1.64 with 0.68–2.60 95% CI, P value < 0.001, and I2 score = 91%. The need for analgesics and additional measures as cervical dilatation were evaluated in 7 and 4 studies with 813 and 295 participants respectively. The reported OR (95% CI), P values, and I2 scores were 0.58 (0.32–1.03) and 0.79 (0.33–1.92), 0.06 and 0.61, and 48% and 35% respectively. Conclusion: Misoprostol administration before IUD insertion was associated with higher easiness score, higher women satisfaction score, and higher side effects named nausea, vomiting, cramps, shivering, headache, and fever compared to placebo administration. Registration number: CRD42022364291. [ABSTRACT FROM AUTHOR]

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017–2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency. [ABSTRACT FROM AUTHOR]

Background/Introduction: On June 24, 2022, the Supreme Court overturned the 1973 verdict in the Roe v. Wade legal suit that had established the constitutional right to medical abortion [1]. With the right to abortion now being left to the states, many restrictions regarding abortion procedures are being established [2]. We aim to evaluate whether this has led to an increase in the number of birth control prescriptions and sterilisation procedures at Cape Fear Valley Medical Centre in rural North Carolina. Methods: SlicerDicer program within EPIC medical records database was used to retrieve the records of all women that had an obstetrics and gynaecology appointment with Cape Fear Valley Health System between 11/01/21-12/31/2022 for contraception. The data was sorted into race/ethnicity, age, and types of birth control. Principal outcomes measured the trends in birth control prescription or sterilisation procedure appointments before and after the overturn of Roe v. Wade. Results: Contraceptive pill prescriptions decreased from 51.70% to 32.40%. IUD insertions decreased from 39.40% to 11.30%. Injectable birth control remained consistent, at approximately 16%. Nexplanon implantations dropped from 20.60% to 9.70%. Lastly, sterilisation procedures increased from 6.7% to 10.7%. Conclusion: Majority of birth control prescriptions decreased following the overturn of Roe v. Wade, except for sterilisation, which increased by 4.0%. This may indicate that women are now looking for more permanent birth control options after the overturn of Roe v. Wade. Future research should investigate whether similar trends of increasing prevalence of sterilisation procedures is seen throughout the United States. SHORT CONDENSATION: We aim to assess the impact of the Supreme Court overturn regarding the Roe v. Wade legal suit on contraceptive decisions in rural North Carolina. [ABSTRACT FROM AUTHOR]

ZhiLong Chen, Zhong Lv, YunFeng Shi Department of Urology, Wujin People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213100, People’s Republic of ChinaCorrespondence: Zhong Lv, Department of Urology, Changzhou Wujin People’s Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213017, People’s Republic of China, Tel +86-13584328748, Email lzabc0105@163.comBackground: Intrauterine devices (IUDs) are among the most popular contraceptive methods globally due to their convenience and cost-effectiveness. However, improper placement can lead to complications such as device migration and uterine perforation, with increased risk observed when IUDs are implanted within four to six weeks postpartum. Typically, patients are asymptomatic or experience mild lower abdominal discomfort or minor abnormal vaginal bleeding following IUD displacement. Advances in diagnostic techniques have resulted in an increased reporting of uterine perforations due to IUD migration. Although rare, secondary stone formation following IUD perforation has been noted. In 2023, cases of IUD perforation were reported in women with a history of multiple cesarean sections and in a young woman without detailed marital history.Prior Presentation: The 43-year-old patient, who had an IUD inserted three years prior, exhibited symptoms of frequent urination and painful urination unrelieved by anti-infective and analgesic treatments. The patient underwent cystotomy for foreign body removal, which revealed the IUD had perforated the uterus and bladder, with both arms of the device invaded into bladder wall and covered with concentric stone layers. Complete removal of the IUD and surrounding stones, followed by suturing and postoperative anti-infection analgesic treatment, led to significant symptom improvement.Conclusion: This case underscores the importance of regular IUD check-ups to prevent uterine perforation and the necessity of considering IUD migration in patients presenting with lower urinary tract symptoms without routine IUD examination. While self-examination by the patient through the strings in the vagina is possible, imaging studies are also indispensable. Surgery has proven to be an effective solution for such complications, but cystoscopy is not always the best option, and the decision to perform open surgery should be based on the patient’s perforation and the condition of the surrounding tissues. This paper emphasizes the need for vigilance and proper clinical management.Keywords: IUD, migration, bladder stone, cystoscopy, computed tomography

This article introduces a case of pelvic actinomycosis, which is easily confused with an ovarian malignant tumor. These images are from a 52-year-old woman who was admitted to hospital with difficulty defecating. Colonoscopy and biopsy indicated inflammatory changes within the intestinal tract, but the anti-inflammatory treatment was not effective. Later, she was readmitted due to abdominal pain and emaciation, and laboratory findings revealed mild anemia and inflammation. Various tumor markers are normal. CT suggested inflammatory lesions in the sigmoid colon and upper rectum. PET-CT considered a high metabolic mass originating from the mesentery. Ultrasound scan revealed a mixed-echo mass adjacent to the right side of the uterus, poorly demarcated from the rectum and right ovary, suggesting a neoplastic lesion. A biopsy of the right ovarian mass indicated suppurative inflammation, with negative antacid staining and microscopic observation of yellowish sulfur granules, suggestive of Actinomyces infection. Following a 12-month treatment regimen involving the removal of an intrauterine device and administration of penicillin, the patient's condition markedly improved. Pelvic actinomycosis is usually characterized by abdominal pain accompanied by an abdominal mass, which is often related to an intrauterine device (IUD), and is very difficult to distinguish from pelvic tumors and tuberculosis, so it is necessary for doctors to understand its clinical and imaging features. [ABSTRACT FROM AUTHOR]

A 54-year-old woman, who had been menopausal for over two years and had an Intrauterine Device (IUD) in place for over twenty years, requested a removal of the IUD. The IUD was found to be embedded during the removal process. Under ultrasound guidance, a hysteroscopic examination revealed the embedded IUD and additional uterine cavity content. Hysteroscopic removal of the IUD and the foreign body was performed, and the pathology report indicated fibrous tissue with hyaline degeneration. For postmenopausal women with IUDs, early removal is recommended to minimise complications. Hysteroscopic examination should be the first choice for the rare complication of embedded IUDs covered with fibrous tissue, with hysteroscopic removal as the preferred treatment. [ABSTRACT FROM AUTHOR]

The intrauterine device (IUD) as a long-acting reversible contraceptive technology is increasingly being marketed to younger women for whom hormonal therapies are deemed problematic. Focusing on the American College of Obstetricians and Gynecologists (ACOG) training materials for clinicians, we examine the biopolitics of reproductive counseling for the IUD among this population. Specifically, we interrogate how American clinicians are trained to engage young patients in the coproduction of reproductive biographies to determine their suitability for the IUD. Ostensibly recognizing the importance women's autonomy to reproductive justice, ACOG stresses the importance of 'shared decision-making'. However, we argue that ACOG's approach to shared decision-making still enrolls patients in processes that delineate forms to reproductive differences to be controlled. Specifically, obstetricians and gynecologists are instructed to categorize certain reproductive bodies as risky, differentiating them from those classified as timely and responsible. These categories, underpinned by constructions of normative readiness, reproduce forms of 'colorblind' difference under the rubric of reproductive risk. Our findings suggest clinicians are still trained to employ a gynecological gaze that differentiates patient populations based on perceived reproductive responsibility. Thus, we argue that beneath the surface of collaborative reproductive counseling, the gynecological gaze continues to differentiate treatment for those bodies classified as irresponsible. Our analysis highlights the enduring power relations that link the production of reproductive health knowledge and deeply gendered and implicitly racialized systems of categorizing populations. [ABSTRACT FROM AUTHOR]

Background: Intrauterine device (IUD) is one of the widely adopted contraceptive methods all over the world, especially in developing countries such as Egypt. The study aimed to assess the psychological effects and pain in Egyptian females on their first use of IUD. Subjects and Methods: Multicenter longitudinal cross-sectional study, started from June 2018 till July 2022, in the tertiary hospitals in 7 Egyptian governorates. About 553 participants were subjected to a pre-designed validated questionnaire including data on pain and psychological effect of IUD insertion with its different forms. Results: Psychological effects of IUD were felt more at insertion but later on they changed greatly from marked to not being detected, however, there was a slight increase in pain and discomfort later on after insertion (P<0.001). The absence of knowledge about IUD insertion was present in 44.3% of the participants. Knowing how IUD is inserted was associated with the presences of these psychological effects (P=0.014 and <0.001 respectively). There was an association between male doctor gender and less psychological effects and pain (P<0.001). Conclusion: There were negative psychological effects and pain among Egyptian women during the insertion of IUDs. Also, there was a low level of awareness about the IUD in most of the females. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health crisis. The increasing mortality rate warrants the identification and protection of vulnerable population in society. The knowledge gained from previous human coronavirus outbreaks, pregnant women, and their fetuses are particularly susceptible to poor outcomes e.g. IUGR, miscarriage, stillbirth, preterm, etc.This study aimed to identify the effect of COVID-19 on the outcome of pregnancy. Objectives: 1. To study the demographic characteristics of COVID-19 positive study participants who were admitted for delivery at tertiary care hospital.2. To evaluate the outcomes of delivery and vertical transmission of COVID-19 in pregnant women. Method: The present hospital based observational study was carried out at a tertiary care teaching hospital in western Maharashtra, from September 2021 to May 2023. All pregnant women admitted to tertiary care hospitals for delivery and willing to give written consent were included in the study. Result: Out of 220 study participants, 157 (71.3%) study participants, belong to the 18 to 25 age groups. In the present study, 212 (96.3%) were live births, 2 (0.9%) were IUDs, and 5 (2.3%) were abortions. Out of 220, 131 (61.5%) weight of the baby after delivery was normal while LBW was seen in 78 (36.7%) and VLBW was seen in 4 (1.8%) study subjects. Of the total swabs tested for COVID-19 infection, 12 (5.8%) were positive, 196 (94.2%) were negative. Conclusion: It is concluded in our study, that vertical transmission of COVID-19 infection from mothers to their babies was very low or negligible. [ABSTRACT FROM AUTHOR]

Intra-uterine devices (IUDs) are a safe and effective method to delay or space pregnancies and are available for free or at low cost in the Indian public health system; yet, IUD uptake in India remains low. Limited quantitative research using national data has explored factors that may affect IUD use. Machine Learning (ML) techniques allow us to explore determinants of low prevalence behaviors in survey research, such as IUD use. We applied ML to explore the determinants of IUD use in India among married women in the 4th National Family Health Survey (NFHS-4; N = 499,627), which collects data on demographic and health indicators among women of childbearing age. We conducted ML logistic regression (lasso and ridge) and neural network approaches to assess significant determinants and used iterative thematic analysis (ITA) to offer insight into related variable constructs generated from a series of regularized models. We found that couples' shared family planning (FP) goals were the strongest determinants of IUD use, followed by receipt of FP services and desire for no more children, higher wealth and education, and receipt of maternal and child health services. Findings highlight the importance of male engagement and family planning services for IUD uptake and the need for more targeted efforts to support awareness of IUD as an option for spacing, especially for those of lower SES and with lower access to care.

BackgroundThe most widely used copper intrauterine device (IUD) in the world (the TCu380A), and the only product available in many countries, causes side effects and early removals for many users. These problems are exacerbated in nulliparous women, who have smaller uterine cavities compared to parous women. We compared first-year continuation rates and reasons/probabilities for early removal of the TCu380A versus a smaller Belgian copper IUD among nulliparous users.MethodsThis 12-month interim report is derived from a pre-planned interim analysis of a sub population and focused on key secondary comparative endpoints. In this participant-blinded trial at 16 centres in the USA, we randomised participants aged 17-40 in a 4:1 ratio to the NT380-Mini or the TCu380A. In the first year, participants had follow-up visits at 6-weeks and 3, 6, and 12-months, and a phone contact at 9 months; we documented continued use, expulsions, and reasons for removal. Among participants with successful IUD placement, we compared probabilities of IUD continuation and specific reasons for discontinuation using log-rank tests. This trial is registered with ClinicalTrials.gov number NCT03124160 and is closed to recruitment.FindingsBetween June 1, 2017, and February 25, 2019, we assigned 927 nulliparous women to either the NT380-Mini (n = 744) or the TCu380A (n = 183); the analysis population was 732 (NT380-Mini) and 176 (TCu380A). Participants using the NT380-Mini, compared to the TCu380A, had higher 12-month continuation rates (78·7% [95% CI: 72·9-84·5%] vs. 70·2% [95% CI: 59·7-80·7], p = 0·014), lower rates of removal for bleeding and/or pain (8·1% vs. 16·2%, p = 0·003) and lower IUD expulsion rates (4·8% vs. 8·9%, p = 0·023), respectively.InterpretationThe NT380-Mini offers important benefits for a nulliparous population compared to the TCu380A in the first twelve months, when pivotal experiences typically occur. Higher continuation rates with the NT380-Mini may avert disruptions in contraceptive use and help users avoid unintended pregnancy.FundingBill & Melinda Gates Foundation, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Mona Lisa, N.V. (Belgium).

Despite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYAs) by leading professional organizations and demonstrated acceptance and desirability by AYAs, clinicians may worry about the procedural difficulty of IUD device placement in younger patients. The aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history. We performed a retrospective cohort study of patients under 25 years old at reproductive health clinics with an IUD placement attempt between January 1 and August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first-attempt IUD placement by VD history. We also assessed the frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications. We included 1325 participants (median age = 21.3 years), including 42 (3.2%) with a previous VD. Nearly all IUD placements were successful on the first attempt (n = 1301, 98.2%) and performed by advanced practice clinicians (n = 1314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (P >.999). Ancillary measures other than nonsteroidal anti-inflammatory drugs were used infrequently (n = 16, 3.6%). Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within 6 months of placement were rare (n = 29) and mostly comprised expulsions (n = 27, 93.1%). IUD placement success among AYAs at community-based reproductive health clinics is high and is not associated with a history of VD. [ABSTRACT FROM AUTHOR]

Adiguna Wibawa Gurnita, Eppy Darmadi Achmad Obstetrics and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Adiguna Wibawa Gurnita, Obstetrics and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Pasteur, Kec. Sukajadi, Kota Bandung, Jawa Barat, 40161, Indonesia, Tel +62 821-1867-0482, Email adiguna.gurnita@gmail.comIntroduction: Uterocolon fistula is one of the complications of intrauterine device (IUD) insertion. Not only may IUD materials cause perforation, but some other risk factors may contribute to its development including uterine abnormalities, thus IUD is contraindicated in patients with anatomical anomaly.Case: P3A1 woman, 50 years old with a history of IUD use for 16 years presented with complaints of fecal discharge from the vagina 8 months ago which worsened after IUD extraction. Physical examination revealed no abdominal tenderness. Speculum examination found feces in the cervical canal. CT scan examination showed multiple uterocolon fistulas and uterine didelphys. Diagnostic laparoscopy and hysteroscopy were carried out and found a recto-uterine fistula, then the patient was scheduled for colostomy and reanastomosis with the stapler method.Conclusion: Diagnosis was very difficult to establish despite proper imaging modalities. The use of direct visual diagnostics (hysteroscopy and laparoscopy) can be a good alternative for the diagnosis of uterocolon fistula. To the best of our knowledge, this is the first case report on recto-uterine fistula in a patient with long-term use of IUD and uterine didelphys.Keywords: uterocolon fistula, IUD, uterine didelphys, diagnostics

Objective: Comparing two cases of the management of bladder calculi caused by Intra Uterine Device (IUD) migration with other similar cases worldwide. Case(s) Presentation: A forty-eight-year-old woman diagnosed by Abdominal Non-contrast Computed Tomography (NCCT), already done IUD extraction through the bladder approach also hysteroscopy to evaluate the position from the womb side, and continued with the stone removal by vesicolithotripsy. The second case revealed a bladder stone with IUD tail presence based on Kidney Ureter Bladder (KUB), performed vesicolithotomy, and IUD was found attached to the stone. Both patients’ conditions improved after surgeries. IUD migration into the bladder causes perforation, stone formation, and Urinary Tract Infection (UTI). NCCT, KUB, and Ultrasonography can be used as imaging modalities for initial screening when IUD migration is suspected. Discussion: The managements consist of open cystolithotomy, transurethral grasping forceps, or minimally invasive laparoscopy. Open and laparoscopic surgery should be considered for the IUD removal with partial penetration due to vesicouterine fistula and high-risk stone removal, especially for the large stone with IUD embedded inside. Conclusion: Minimally invasive methods are efficient, safe, and frequently preferred for the bladder stone caused by IUD migration. Keywords: Bladder stone, IUD, migration.

Background: Contraception is a strategy of choice for spacing births but also for avoiding early and unwanted pregnancies. However, through hormonal modification, this contraception constitutes a favorable state for the proliferation in the genital tract of agents responsible for vaginal infections. The objective of this study was to evaluate the prevalence of genital infections in women on contraception followed up at the bacteriology-virology laboratory of Aristide Le Dantec Hospital. Methods: This is a retrospective descriptive study conducted over a one-year period between January 2019 and December 2020. Microbial assessemnets were performed on genital secretions according to standard bacteriology laboratory procedures. Sociodemographic data and bacteriological examination results obtained were entered using File Maker Pro Advanced (version 16) software. Statistical analyses were performed using SPSS software (version 20). Results: This research studied 1771 women, of whom 1609 were on contraceptives. The most represented age group was over 40 years (27.06%). The majority of patients were women on oral contraceptives (32.07%). Women with secondary education (31.45%) and women with 1 to 3 children (43.03%) were most often on contraception. The germs most frequently detected in women on contraception were Gardnerella vaginalis (51.78%) and Candida albicans (24.19%) and the use of intrauterine device (IUD) as a means of contraception was statistically associated with vaginal infection (p=0.0004). Conclusion: This study showed a high frequency of vaginal infections in women on contraception and that the intrauterine device was significantly associated with the occurrence of these infections. [ABSTRACT FROM AUTHOR]

Abstract Background Intrauterine devices are a widely used method of contraception worldwide. These devices are reliable, cost-effective, long-acting, and reversible. Their placement in the uterus is usually simple and safe. Forgotten IUDs carry some complications and can adversely affect the health of women. Therefore, appropriate counseling during insertion and timely removal are crucial. Case summary We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. The loop was removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days. Conclusion Different works of the literature showed that retained Lippes loop IUD carries some complications. Our case was also presented with postmenopausal pelvic pain. Therefore, we recommend the removal of IUDs at their expiry date or menopause.

Objectives: The World Health Organization (WHO) supports increasing the availability and acceptability of long-acting reversible contraception including intra-uterine device (IUD), but its insertion includes certain risks (uterine perforation). The objective was to develop and validate an IUD insertion performance assessment checklist. Material and methods: This prospective study took place in hospitals and simulation center of the Poitou-Charentes region, France. The checklist content reached consensus among 10 experts solicited by a Delphi method. A modified gynecologic mannequin Zoe (Gaumard® ) was used for simulations. Psychometric testing included 30 multi-professional participants for internal consistency and reliability between two independent observers, and 27 residents for assessment of score evolution over time and reliability. Cronbach alpha (CA) and intraclass coefficient (ICC) were used. Progression of performance was carried out using ANOVA for repeated measures. The data collected were used to plot receiver operating characteristic (ROC) curves for the score values and the area under the curve (AUC) was determined. Results: The checklist included 27 items (2 sections, total score = 27). Psychometric testing showed CA = 0.79, ICC = 0.99, and good clinical relevance. The checklist is discriminative, showing a significant increase in performance scores when the simulations were repeated (F = 77.6, p < 0.0001). ROC curve [AUC: 0.792 (95% CI: 0.71-0.89); p < 0.0001] revealed the best score cutoff predictive of 100% sensitivity, i.e., true positive rate or success rate. Performance score was highly correlated to success rate. The cut-off score guaranteeing successful IUD insertion was 22/27. Conclusions: This coherent and reproducible checklist for IUD insertion provide an objective assessment of the procedure during SBT, with the aim of obtaining a score ≥ 22/27. [ABSTRACT FROM AUTHOR]

ObjectivesTo provide updated and more detailed pooled intrauterine device expulsion rates and expulsion risk estimates among women with postpartum intrauterine device placement by timing of insertion, delivery type, and intrauterine device type to inform current intrauterine device insertion practices in the United States.Data sourcesWe searched PubMed, Cochrane Library, and ClinicalTrials.gov through June 2019.Study eligibility criteriaWe included all studies, of any study design, that examined postpartum placement of Copper T380A (copper) or levonorgestrel-containing intrauterine devices that reported counts of expulsion.Study appraisal and synthesis methodsWe evaluated intrauterine device expulsion among women receiving postpartum intrauterine devices in the "immediate" (within 10 minutes), "early inpatient" (>10 minutes to

ObjectiveWe sought to test whether participation in an online group including IUD users influenced IUD-related knowledge, attitudes, and behavior among IUD non-users, as a proof-of-concept evaluation of information dissemination for less commonly used or novel contraceptives.Study designWe conducted a blinded, randomized controlled trial on the effect of online communication with IUD users within an online program called Birth Control Connect. Participants were women age 18-45 living in the United States who had never used an IUD. We invited participants randomized to the intervention to join two-week, nine-member discussion groups including four satisfied IUD users and five IUD non-users; we invited control participants to groups including nine IUD non-users. We performed chi-squared tests on IUD knowledge, information-seeking, informational support and use in immediate post-surveys, and t-tests comparing change in IUD attitudes and frequency of logins to discussion groups.ResultsWe invited 488 IUD non-users and enrolled them into 70 groups between October 2015 and April 2016. We found increased positive attitudes towards the IUD in the intervention arm (0.65-point increase between pre- and post-surveys, versus 0.05 mean change for control arm, p = 0.03 for hormonal IUD, with a trend in the same direction for the non-hormonal IUD). Informational support also increased, with 70.3% of intervention arm participants self-reporting that they gained a better idea of what the IUD would be like, compared to 51.3% in control arm (p

The family planning policy implemented by the government in tackling the population makes women have to use contraception to reduce pregnancies. Use of contraceptives such as Intra Uterine Device (IUD) and 1 monthly KB injection can cause anemia. This study uses a comparative analysis and a pre-experimental one-shot case study approach. the target population is married women or couples and the actual population is mothers using intrauterine contraception devices (IUDs) and 1-month injectable birth control. With a sample requirement of 44 respondents. There is a difference in the incidence of anemia in the use of intrauterine device (IUD) contraception and 1-month contraceptive injection in Joho Village, Mojolaban District, Sukoharjo Regency, Central Java with the average hemoglobin level of 1-month contraceptive injection users being higher than IU users.

Pada saat ini, selain hanya untuk tanda pengenal seseorang, e-KTP masih jarang dimanfaatkan sebagai kartu pintar. Salah satu pemanfaatan e-KTP adalah sebagai sistem kunci elektrik berbasis RFID (radio frequency identification) maupun NFC (near field communication). Pada penelitian ini, dirancang sebuah sistem akses kontrol kunci elektrik untuk keamanan rumah dengan e-KTP berbasis RFID yang dilengkapi dengan keypad untuk memasukkan password. Sensor hall effect digunakan untuk mengaktifkan dan mengnonaktifkan solenoid yang bekerja untuk membuka dan menutup pintu. Proses kerja sistem adalah dengan mencocokkan nomor unik pada ID e-KTP dan memasukkan password yang sudah tersimpan pada database mikrokontroler. Hasil dari proses tersebut akan menampilkan nama, UID (unique identification) e-KTP dan waktu akses pada LCD. Hasil dari pengujian menunjukkan bahwa sensor RFID memiliki batas pembacaan maksimal yakni 2 cm untuk membaca sebuah e-KTP dengan jeda waktu pembacaan e-KTP selanjutnya dalam selang waktu 1 detik

Background: Contraception is a strategy of choice for spacing births but also for avoiding early and unwanted pregnancies. However, through hormonal modification, this contraception constitutes a favorable state for the proliferation in the genital tract of agents responsible for vaginal infections. The objective of this study was to evaluate the prevalence of genital infections in women on contraception followed up at the bacteriology-virology laboratory of Aristide Le Dantec Hospital. Methods: This is a retrospective descriptive study conducted over a one-year period between January 2019 and December 2020. Microbial assessemnets were performed on genital secretions according to standard bacteriology laboratory procedures. Sociodemographic data and bacteriological examination results obtained were entered using File Maker Pro Advanced (version 16) software. Statistical analyses were performed using SPSS software (version 20). Results: This research studied 1771 women, of whom 1609 were on contraceptives. The most represented age group was over 40 years (27.06%). The majority of patients were women on oral contraceptives (32.07%). Women with secondary education (31.45%) and women with 1 to 3 children (43.03%) were most often on contraception. The germs most frequently detected in women on contraception were Gardnerella vaginalis (51.78%) and Candida albicans (24.19%) and the use of intrauterine device (IUD) as a means of contraception was statistically associated with vaginal infection (p=0.0004). Conclusion: This study showed a high frequency of vaginal infections in women on contraception and that the intrauterine device was significantly associated with the occurrence of these infections.

This article explores the reception of the contraceptive implant, Implanon, by healthcare workers and patients in family planning units in South Africa's public health sector. Based on observations conducted at public health facilities in the Eastern Cape Province, and on interviews with nurses and patients in the same province, the study explored real-world experiences of the implant. This article examines the strategies used by nurses to promote use of the device, and explores how patients themselves responded to a widescale, national rollout of the implant within government family planning services. The study examines the reception of Implanon in the context of the post-Apartheid era in South Africa, in which the vestiges of Apartheid-era healthcare provision, and lack thereof, continue to animate personal experiences of contraception. [ABSTRACT FROM AUTHOR]

Background: Despite recommendations, long-acting reversible contraceptives (LARC) are not always offered as first-line contraceptives in general practice. This study aimed to describe pathways used by women for insertion of LARC. Methods: This is a secondary analysis of data from the Australian Contraceptives ChOice pRoject (ACCORd), a cluster randomised controlled trial set in 57 general practices in Melbourne, Australia. We investigated whether an educational intervention for general practitioners (GPs) and a rapid LARC insertion clinic increased LARC uptake. The main outcome measures were the type of health service, location/provider of intrauterine device (IUD) insertion; time to insertion; and distance travelled for IUD insertion. Results: During ACCORd, 149 women had LARC insertion. IUD training was reported by 37% of GPs, but only 12% inserted them. In contrast, 70% of GPs inserted implants and 95% of women accessed implant insertion through their own general practice. LARC rapid referral clinics were used by 52% (13/25) of intervention GPs, where 71% (41/56) of IUD insertions occurred in these clinics (but no implants). There was no difference in the mean time from referral to IUD insertion between women attending intervention and control GPs (mean days 37.6 vs 32.7; P = 0.61). GPs (including IUD inserters) used a variety of referral pathways for IUD insertion, including public and private clinics, and other GPs. Women travelled up to 90 km for IUD insertion. Conclusions: Although implant insertion has been integrated into general practice, few GPs insert IUDs. Where the option exists for GPs to refer to a LARC rapid referral clinic, the majority of IUD insertions will take place there. Establishing a network of such clinics Australia wide may both increase IUD uptake and address the extensive need for GP training in IUD insertion. LARC uptake is low in Australia compared with less effective contraceptives. The ACCORd study found that GP online education and availability of rapid referral to LARC insertion clinics results in increased IUD uptake by women. In contrast to implants, few GPs insert IUDs. Most women will have their IUDs inserted in rapid referral clinics when these are made available. Establishing a network of such clinics could address training needs and increase LARC uptake in Australia. [ABSTRACT FROM AUTHOR]

Background: The intrauterine contraceptive device TCu380Ag when compared with TCu380A at 1 year of use had better acceptability and continuation rates. Objectives: To study the continuation rate, efficacy, and acceptability of TCu380Ag in three sizes versus TCu380A at 5 years of use. Methods: A total of 600 women opting for intrauterine contraceptive devices were randomized equally into two groups. Group 1 received the TCu380Ag device (Normal, Maxi, and Mini for uterocervical length 7–8.5 cm, 8–9 cm, and 6–7.5 cm, respectively) and Group 2 received the TCu380A device. Follow‐up was performed at 5 years to assess efficacy, acceptability, and continuation. Frequency data comparisons was performed across categories using χ2/Fisher exact test. Results: At 5 years of use, Kaplan–Meier survival analysis showed that TCu380Ag compared with TCu380A had a higher continuation rate (45% vs. 35%, P = 0.010) with 100% efficacy each. TCu380Ag had fewer side effects, including heavy menstrual bleeding (16.6% vs. 34.1%, P < 0.001), abdomen pain (12.1% vs. 23.0%, P = 0.001), and expulsions (4.4% vs. 8.7%, P < 0.050), and fewer discontinuations attributable to contraceptive side effects (42.7% vs. 56.9%, P = 0.012). The mini TCu380Ag had the highest continuation rates and least menstrual irregularity (P < 0.050). Conclusions: The TCu380Ag device in three sizes is an alternative to TCu380A for women desiring 5 years of contraception with equal efficacy, better continuation, and acceptability. The mini size is preferred for women with a uterocervical length of 6 to 7.5 cm. Synopsis: Acceptance of TCu380Ag at 5 years was significantly better than TCu380A with fewer side effects, better continuation rates, and similar efficacy. [ABSTRACT FROM AUTHOR]

BACKGROUND:The recent focus on increasing access to long-acting reversible contraceptive methods has often overlooked the diverse reasons why women may choose less effective methods even when significant access barriers have been removed. While the copper intrauterine device (IUD) is considered an acceptable alternative to emergency contraception pills (ECPs), it is unclear to what extent low rates of provision and use are due to patient preferences versus structural access barriers. This study explores factors that influence patients' choice between ECPs and the copper IUD as EC, including prior experiences with contraception and attitudes toward EC methods, in settings where both options are available at no cost. METHODS:We telephone-interviewed 17 patients seeking EC from three San Francisco Bay Area youth-serving clinics that offered the IUD as EC and ECPs as standard practice, regarding their experiences choosing an EC method. We thematically coded all interview transcripts, then summarized the themes related to reasons for choosing ECPs or the IUD as EC. RESULTS:Ten participants left their EC visit with ECPs and seven with the IUD as EC option. Women chose ECPs because they were familiar and easily accessible. Reasons for not adopting the copper IUD included having had prior negative experiences with the IUD, concerns about its side effects and the placement procedure, and lack of awareness about the copper IUD. Women who chose the IUD as EC did so primarily because of its long-term efficacy, invisibility, lack of hormones, longer window of post-coital utility, and a desire to not rely on ECPs. Women who chose the IUD as EC had not had prior negative experiences with the IUD, had already been interested in the IUD, and were ready and able to have it placed that day. CONCLUSIONS:This study highlights that women have varied and well-considered reasons for choosing each EC method. Both ECPs and the copper IUD are important and acceptable EC options, each with their own features offering benefits to patients. Efforts to destigmatize repeated use of ECPs and validate women's choice of either EC method are needed to support women in their EC method decision-making.

Abstract Background Intrauterine devices (IUDs) are commonly used as contraceptives worldwide. However, pregnancies in patients carrying this kind of device may occur. IUD removal when the woman wishes to continue their pregnancy may be very challenging. Only 9 manuscripts in literature reported such similar procedure. Case presentation We report the case of an hysteroscopic removal of IUD in a young woman at 6 weeks of gestation. Discussion The case reported highlights safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy, although other different methods have been reported in literature. In our opinion, maintaining a low infusion pressure during the procedure may help avoiding potential gestational sac damage and IUD displacement for better grasping.

Background: Mothers' lack of interest in using IUD contraception is influenced by several factors, namely mother's education, knowledge, parity, economy, husband's support, culture and religion. Objective: To determine the factors related to the mother's interest in using IUD contraception at PMB Endang Yuniyati Napitupulu, Berau Regency. Methods: This study used a descriptive analytical method, with a crosssectional approach, which was conducted on October 13 - November 13, 2022. The sampling technique was accidental sampling, with 62 respondents. Collecting data using a questionnaire. Data analysis was performed with univariate analysis and bivariate analysis with Chi Square test and Maan Whitney test. The results showed that the variables that had a significant relationship with the mother's interest in using IUD contraception were income (p = 0.000), knowledge (p = 0.007), and husband's support (p = 0.029), while those that did not have a significant relationship with the mother's interest in use of IUD contraceptives were age (p = 0.67), education (Asymp.Sig = 0.949), parity (p = 0.760). Conclusion: factors related to the mother's interest in using IUD contraception in this study were income, knowledge, and husband's support. to increase public understanding, especially couples of childbearing age (PUS) about IUD contraception, counseling and outreach about IUD contraception can be carried out at PMB Endang Yuniyati Napitupulu. [ABSTRACT FROM AUTHOR]

Temesgen Tilahun,1 Asfaw Tadesse,2 Rut Oljira3 1Department of Obstetrics & Gynecology, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia; 2Department of Obstetrics & Gynecology, Nekemte Specialized Hospital, Nekemte, Ethiopia; 3Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, EthiopiaCorrespondence: Temesgen Tilahun, Department of Obstetrics & Gynecology, Institute of Health Sciences, Wollega University, P.O Box 395, Nekemte, Ethiopia, Tel +251912057186, Email ttamuko@yahoo.comObjective: Intrauterine devices are a widely used method of contraception worldwide. These devices are reliable, cost-effective, long-acting, and reversible. Their placement in the uterus is usually simple and safe. Forgotten IUDs carry some complications and can adversely affect the health of women. Therefore, appropriate counseling during insertion and timely removal is crucial.Case Summary: We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. Speculum exam showed part of loop at external cervical os. The loop was easily removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days.Conclusion: In the absence of embedment of an IUD into the uterine wall or uterine perforation, spontaneous expulsion of an IUD after prolonged use is possible.Keywords: Lippes loop, IUD, retained, contraception, pelvic pain, Western Ethiopia

To describe long acting reversible contraception (LARC) initiation in emergency contraception (EC) visits. EC clients age 18–35 years at four Utah family planning clinics between February 2021 and April 2023 chose between oral EC and three LARC options. Of 2106 EC clients approached, 306 (14.5%) requested LARC and 293 initiated a device: 160 (55%) an etonogestrel implant + oral levonorgestrel (LNG), 72 (25%) a copper intrauterine device (IUD), and 61 (21%) a 52 mg levonorgestrel IUD (p < 0.001). In this observational study, one in seven EC clients initiated a LARC method and more frequently selected the etonogestrel implant with oral levonorgestrel over an IUD. Clinicaltrials.gov NCT04678817; registered 12/16/20. [ABSTRACT FROM AUTHOR]

While hormonal contraceptives (HCs) like oral contraceptive pills (OCs) and intrauterine devices (IUDs) can reportedly influence mood, the evidence is mixed, and the mechanisms remain unclear. Emotion reactivity and regulation processes may be hormone-sensitive and underlie these mood changes. This study sought to investigate the role of the menstrual cycle and HC use in emotion regulation using ERP measures during an emotion regulation paradigm. Participants with a natural cycle (NC) were measured in the mid-follicular and mid-luteal phase (within-subject design, n = 26), and compared with OC (n = 36) and IUD (n = 25) users. The centroparietal late positive potential (LPP) reflected negative emotion reactivity and its modulation by cognitive reappraisal served as a marker for emotion regulation processing. NC participants had a lower LPP amplitude in the mid-luteal compared to the mid-follicular phase. Reactivity to negative emotional stimuli decreased over time in the mid-luteal phase, whereas the HC groups showed sustained LPP activation. Reappraisal led only to significant LPP changes in the mid-follicular phase, and not in the mid-luteal phase or HC groups. Our results showed a specific left frontal activity (FR-LPP) in the contrast that reflected emotion regulation processing. This activity was highest in the mid-follicular phase, and was significantly different from the OC users but not from the IUD group. Higher self-reported PMS symptoms were associated with stronger effects on the reduced mid-luteal LPP activity and with lower FR-LPP amplitude in the mid-follicular phase. No effect of OC phase (active pill use versus pill pause) was found. These findings add insights into the neurophysiological underpinnings of hormone-related mood changes and demonstrate the importance of considering hormonal status and PMS symptoms in emotion research. • Blunted LPP reactivity in the luteal phase, driven by high PMS ratings. • Emotion regulation modulated LPP only in the follicular phase, mostly with low PMS. • Highest frontal regulation LPP (FR-LPP) in the follicular phase, lowest in OC users. • OC users, but not IUD users, show altered FR-LPP compared to NC participants. • No differences in subjective emotion ratings between NC individuals and HC users. [ABSTRACT FROM AUTHOR]

HIGHLIGHTS 1. HIV transmission from HIV positive mothers to their children should be reduced by strengthening family planning programs. 2. Characteristics of contraceptive methods among women with HIV infection delivered in a tertiary hospital were investigated. 3. IUD was the most common contraceptive method used by women with HIV infection. Its use was related to age, gravida and method of delivery. ABSTRACT Objectives: The aim of this study was to describe characteristics of contraceptive methods among women with HIV infection who delivered in a tertiary hospital. Materials and Methods: This was a cross-sectional study. The inclusion criteria were pregnant women with HIV infection who delivered in Cipto Mangunkusumo General Hospital (RSCM), Jakarta, Indonesia, from January 2016 to December 2020. Data were retrieved from medical records, registered HIV and laboratory result. The included data were demographic data, obstetric data, mode of delivery, contraception method, ARV history, and laboratory history of the mothers. Results: From January 2016 to December 2020 there were 119 HIV patients who delivered at the RSCM. Most of the subjects were 35 years old (84%), had low education (52.9%) and worked as housewives (76.5%). A total of 79.8% of the subjects were gravida >2 and most of the subjects delivered by caesarean section (87.3%). The choice of contraceptive methods were IUD (72.4%), tubectomy (26.8%) and implants (0.8%). There was a statistically significant relationship between contraceptive method with age (p 0.040), gravida (p 0.016) and delivery method (p 0.049) Conclusion: The most common contraceptive method was IUD. The choice of this method of contraception was related to age, gravida and method of delivery.

Unprotected intercourse is common, especially among teens and young women. Access to intrauterine device (IUD) as emergency contraception (EC) can help interested patients more effectively prevent unintended pregnancy and can also offer ongoing contraception. This study evaluated young women's awareness of IUD as EC and interest in case of need. We conducted a secondary analysis of data from young women aged 18-25 years, not desiring pregnancy within 12 months, and receiving contraceptive counseling within a cluster-randomized trial in 40 US Planned Parenthood health centers in 2011-2013 (n=1500). Heath centers were randomized to receive enhanced training on contraceptive counseling and IUD placement, or to provide standard care. The intervention did not focus specifically on IUD as EC. We assessed awareness of IUD as EC, desire to learn more about EC and most trusted source of information of EC among women in both intervention and control groups completing baseline and 3- or 6-month follow-up questionnaires (n=1138). At follow-up, very few young women overall (7.5%) visiting health centers had heard of IUD as EC. However, if they needed EC, most (68%) reported that they would want to learn about IUDs in addition to EC pills, especially those who would be very unhappy to become pregnant (adjusted odds ratio [aOR], 1.3; 95% confidence interval, 1.0-1.6, p

ObjectiveUnderstanding the effect of contraceptives on the development of precancerous lesions of the cervix and cervical cancer may provide information that is valuable to women in contraceptive decision-making. The purpose of this study was to evaluate the association between recent intrauterine device (IUD) use (by type) and cervical intraepithelial neoplasia 2, 3, adenocarcinoma in situ or cancer (CIN2+ or CIN3+).Study designCase-control study of 17,559 women age 18-49 with incident CIN2+ cases and 5:1 age-matched, incidence-density selected controls (N=87,378) who were members of Kaiser Permanente Northern California Healthcare System from 1996 to 2014. Recent IUD use, within 18 months prior to index, was the exposure of interest.ResultsWe identified 1,657 IUD users among the cases and 7,925 IUD users among controls. After adjusting for sexually transmitted infection testing, smoking, HPV vaccination, hormonal contraceptive use, parity, race and number of outpatient healthcare system visits, IUD use was associated with an increased rate of CIN2+ [rate ratio (RR) 1.12, 95% confidence interval (1.05-1.18), p

Background: Intrauterine devices are a widely used method of contraception worldwide. These devices are reliable, cost-effective, long-acting, and reversible. Their placement in the uterus is usually simple and safe. Forgotten IUDs carry some complications and can adversely affect the health of women. Therefore, appropriate counseling during insertion and timely removal are crucial. Case summary: We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. The loop was removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days. Conclusion: Different works of the literature showed that retained Lippes loop IUD carries some complications. Our case was also presented with postmenopausal pelvic pain. Therefore, we recommend the removal of IUDs at their expiry date or menopause. [ABSTRACT FROM AUTHOR]

Long Term Contraceptive Methods (MKJP), one of which is the IUD (Intra Uterine Device), still has a low attainment rate. In the working area of the Long Ikis Health Center, there are 351 IUD users in 2021 out of the target of 4,951 couples of childbearing age, even though IUD use rarely concedes pregnancy. The aim of the study was to determine the effect of information from health workers, parity and family income on the intention to use IUD contraception in couples of childbearing age. Cross-sectional design. The population of women of childbearing age in the working area of the Long Ikis Health Center in 2021 has not used an IUD, totaling 4,951 people. Lemeshow sample as many as 84 people. The sampling technique to represent the sample uses proportional random sampling and is selected using simple random sampling. Data analysis used the chi-square test. Most of the respondents stated that the information from health workers was not good (60.7%), parity > 3 children (61.9%), family income was balanced between the minimum wage and not suitable (50%), lack of interest in using IUD contraception (57, 1%). There is an influence of information from health workers (p value : 0.009), parity (p value : 0.047) and family income (p value : 0.001) on the interest in using IUD contraception in women of childbearing age. Good information from health workers about IUDs makes it easy for respondents to understand the advantages of IUDs, the greater the number of living children the greater the possibility of limiting births, family income affects the use of IUDs which are quite expensive. There is an influence of information from health workers, parity and family income on interest in using IUD contraception. [ABSTRACT FROM AUTHOR]

Objectives: To assess the rates of failed insertion, expulsion, and perforation when intrauterine device (IUD) insertions were done by newly trained clinicians, and to examine factors that may affect these outcomes. Study design: We evaluated skill-based outcomes following IUD insertion at 12 African sites in a secondary analysis of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial. Before trial initiation, we provided competency-based IUD training to clinicians and offered ongoing clinical support. We used Cox proportional hazards regression to examine factors associated with expulsion. Results: Among 2582 IUD acceptors who underwent first attempted IUD insertion, 141 experienced insertion failure (5.46%) and seven had uterine perforation (0.27%). Perforation was more common among breastfeeding women within three months postpartum (0.65%) compared with non-breastfeeding women (0.22%). We recorded 493 expulsions (15.5 per 100 person-years, 95% confidence interval [CI] 14.1─16.9): 383 partial and 110 complete. The risk of IUD expulsion was lower among women older than 24 years (aHR 0.63, 95% CI 0.50─0.78) and may be higher among nulliparous women. (aHR 1.65, 95% CI 0.97─2.82). Breastfeeding (aHR 0.94, 95% CI 0.72─1.22) had no significant effect on expulsion. IUD expulsion rate was highest during the first three months of the trial. Conclusions: IUD insertion failure and uterine perforation rates in our study were comparable to those reported in the literature. These results suggest that training, ongoing support, and opportunities to apply new skills were effective in ensuring good clinical outcomes for women receiving IUD insertion by newly trained providers. Implications: Data from this study support recommendations to program managers, policymakers, and clinicians that IUDs can be inserted safely in resource-constrained settings when providers receive appropriate training and support.

Background: Intrauterine devices (IUDs) are commonly used as contraceptives worldwide. However, pregnancies in patients carrying this kind of device may occur. IUD removal when the woman wishes to continue their pregnancy may be very challenging. Only 9 manuscripts in literature reported such similar procedure.Case Presentation: We report the case of an hysteroscopic removal of IUD in a young woman at 6 weeks of gestation.Discussion: The case reported highlights safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy, although other different methods have been reported in literature. In our opinion, maintaining a low infusion pressure during the procedure may help avoiding potential gestational sac damage and IUD displacement for better grasping. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare postpartum hemoglobin (Hb) between postpartum intrauterine device (PPIUD) and non‐PPIUD users. Methods: A sample of 3697 postpartum women (475 PPIUD users, 3222 non‐PPIUD users) from 5 tertiary referral hospitals in Bangladesh were assessed at multiple time points between 6 weeks and 12 months postpartum. Non‐inferiority linear regression analysis compared changes in Hb levels at 29–52 weeks postpartum between the two groups. Non‐inferiority was declared if the lower 95% confidence interval of the estimated difference in Hb change since delivery between PPIUD and non‐PPIUD users was greater than −0.05 g/dl. Results: At approximately 9 months postpartum, 276 women in the PPIUD group (58.1%) and 1086 women in the comparison group (33.7%) attended follow‐up. In total, 57.9% of PPIUD users and 61.0% of non‐PPIUD users had taken iron supplementation. Change in Hb was 0.02 g/dl (95% CI: −0.16, 0.19) higher in the PPIUD users than the comparison group. The lower limit of the 95% CI was greater than −0.05 g/dl, providing good evidence that PPIUD users were non‐inferior to the comparison group in their Hb levels. Conclusion: In the presence of offering iron supplementation, and an uptake of just over 60%, no difference in anemia was observed between the PPIUD and control group. In the presence of offering iron supplementation and an uptake of 60%, PPIUD use does not cause anemia or impede postpartum Hb recovery in the first 12 months postpartum. [ABSTRACT FROM AUTHOR]

In this clinical recommendation, we review the evidence supporting the use of the copper intrauterine device, levonorgestrel intrauterine devices and etonogestrel subdermal implant beyond the Food and Drug Administration approved duration of use for contraception (extended use). Clinicians should discuss effectiveness as well as other clinical considerations with patients to allow them to make contraceptive decisions that support their reproductive goals and clinical needs. Extended use of long acting reversible contraception may be a safe, effective and desirable option for many patients. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the timing of placement of long acting, reversible contraception (LARC) methods postpartum (immediate postpartum (IPP) or interval (within 6 months postpartum) is associated with higher removal rates by 12 months postpartum.Study Design: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data (n = 313,849) from Oregon and South Carolina from January 1, 2010 to December 31, 2018. Our primary outcome was LARC (intrauterine device (IUD) or implant) removal by 12 months postpartum. We compared crude proportions and rates of removal and used a multivariable survival analysis to compare removal over 12 months between IPP and interval LARC placement controlling for sociodemographic and clinical factors and clustered at the woman level.Results: Our sample included 313,849 births to 247,884 women; a majority did not receive any postpartum contraception (207,058 [66.0%]). Out of the 54,018 (17.2%) of births followed by an immediate postpartum or interval LARC placement, 11.8% discontinued by 12 months. In multivariable analyses, births followed by IPP LARC were 10% more likely to experience discontinuation at any point up to 12 months compared with interval LARC (HR: 1.10, 95% CI: 1.00-1.22), but this was not statistically significant.Conclusion: IPP LARC devices are removed at similar rates as LARC placed within 6 months postpartum.Implications: Timing of postpartum long acting reversible contraception- interval or immediately postpartum- was not associated with 12 month removal rates. [ABSTRACT FROM AUTHOR]

The role of exogenous progestin in the development of acne is unclear. Progestins are known for their androgenic potential, but newer generations of progestins have low or anti-androgenic activity. This review will evaluate the association between progestins found in hormonal long-acting reversible contraceptives (intrauterine devices and subdermal implants) and acne, as well as the role of oral contraceptives in acne management. Our review demonstrates that the cause and effect relationship between progestins and acne is difficult to establish and future studies that seek to understand how progestins modulate acne are necessary.