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Transcript of IUCD: insertion after abortion Doctor Marie-Laure Brival Doctor Marie-Laure Brival MD,Medical...
IUCD: insertion after IUCD: insertion after abortionabortion
Doctor Marie-Laure BrivalDoctor Marie-Laure Brival MD,Medical Director of Maternity of the
Hospital Les Lilas
Moscow,International SeminarMoscow,International SeminarAbortion ,Contraception and Women’s
Health27-28 th October 2005
Definition
IUCD: reversible contraceptive method with high efficacy It concerns about 100 millions women all over the world
GeneralitiesGeneralities3 Types of IUCD3 Types of IUCD
Without CopperWithout Copper: Lippes Loop With CopperWith Copper: Copper T 200 (TCu 200)
Copper T 220 C(TCu 220 C) Copper T 380
( Gyne T380, TCu Ag 380) Multiload IUD NovaT Copper 7
Levonorgestrel releasing deviceLevonorgestrel releasing device : Mirena®
Lippes loopLippes loop
Type AType A Type DType D
T T 200200
T 220 CT 220 C T 380T 380
Multiload IUDMultiload IUD : MLCu 250 : MLCu 250 (normal,short) (normal,short) MLCu MLCu 375375
Nova TNova T
Copper 7Copper 7
Levonorgestrel releasing Levonorgestrel releasing devicedevice
LNG-IUS Mirena®LNG-IUS Mirena®
GeneralitiesGeneralitiesEfficacyEfficacy
ContraceptiContraception failureon failure
EctopicEctopic
PregnanPregnancycy
Copper Copper IUDIUD
0,6%0,6% 0,3%0,3%
LNG-IUSLNG-IUS
MirénaMiréna
0,09%0,09% 0,02%0,02%
GeneralitiesGeneralities
ComplicationsComplications Pelvic inflammatory disease: RR3,8 Perforation: 0,6 to 1,6 °/°° Expulsion: Copper 6,7%, LNG 5,8%
ContraindicationsContraindications Pregnancy STI, pelvic inflammatory disease cancer,Bleeding fibroma, copper allergy and CI for LNG
Author Nb interventionintervention PregnancyPregnancy%
ExpulsionExpulsion%
Perforation %
PID
Gillet1980
unicenter
259I.A.
I Trim
Copper 7 immediate/delayed insertion
2,3 / 0,02,3 / 0,0 15,4 /2,815,4 /2,8 NRNR NRNR
W.H.O.1983 a
multicent
2340
I.A.
I Trim
T 220C
Lippes loopD
Copper 7
I..insertion
1,71,7
3,73,7
3,63,6
4,44,4
9,69,6
8,48,4
0,10,1
0,00,0
0,30,3
0, 30, 3
0,30,3
0,70,7
W.H.O.1983 b
multicent
1060
SA. 13-20
T 220C
Lippes loopD
Copper 7
I.insertion
0,70,7
2,42,4
1,11,1
9,29,2
13,213,2
12,712,7
0,00,0
0,30,3
0,00,0
0,80,8
0,00,0
0,40,4
Randomized StudiesRandomized Studies
AuthorAuthor NbNb intervention pregnancy expulsion perforation PID
LimLim1985
unicenter
549 I.A. gesta?
ML250
375 I.insertion
0,80,8
2,12,1
1,9 1,9
1,81,8NR NR
MccarthyMccarthy
1985
unicenter
400
I.A.
gesta?
NovaT /MLCU250
I.insertion
1,8 1,8
0,60,6
6,5 6,5
6,3 6,3 NRNR NRNR
RandicRandic1991
multicent
400
I.A.
I Trim
Lippes loopD/
Lldcopper200
I.insertion
4,6 4,6
0,60,6
12,612,6
4,54,5
NRNR NRNR
PakarinenPakarinen
2003 multicent after 5 after 5 yearsyears
438 I.A.
I Trim
LNG-IUS/NovaT
I.insertion
0,80,8
9,59,5
10,510,5
15,415,4
NRNR 0,70,7
2,32,3
Randomized Randomized StudiesStudies
Nonrandomized Nonrandomized StudiesStudies
AuthorAuthor NbNb interventionintervention pregnancypregnancy expulsionexpulsion perforation medical reremovals
El TagyEl Tagy2003
unicenter
300 I.A. I Trim
Copper IUDimmediate/delayed insertion
+ + + +
MoussaMoussa2001
2 centers
100
S.A.
I Trim
Copper T 380
immediate/delayed insertion
+ + + +
LiLi2004
unicenter
20 I.A.
I Trim
LNG-IUSacceptability
+ + + +
Results Results IUCD insertion after abortionIUCD insertion after abortion
W.H.O CopperIUDsCopperIUDs have best contraceptive
efficacy TCU 220 C > Copper 7 >Lippes Loop Insertion of IUD immediatly after abortion or
miscarriage: safe and practicalsafe and practical Pelvic imflammatory : rare Perforation :similar to that of interval insertion
Results Results IUCD insertion after abortionIUCD insertion after abortion
Gillet Immediate and delayed Insertion with the same Immediate and delayed Insertion with the same
IUD: IUD: no difference no difference
Randic Copper sleeves improve efficacity of Lippes Loop
Mac Carthy MultiloadIUD > Nova T
Pakarinen LNG-IUS > Nova T
LiM MLCU 375/MLCU 250: no significant difference
immediate insertionimmediate insertion240 Women240 Women
Results 2004
3 weeks 6 months
Expulsion 8 (3,5%) 0
perforation 0 0
PID 1 0
pregnancy 0 0
HÔPITAL PRIVE LES LILASHÔPITAL PRIVE LES LILAS
Conclusion Conclusion (1)(1)
IUCD insertion after abortionIUCD insertion after abortion
Immediate post abortal IUCDImmediate post abortal IUCD
Safe and effectiveSafe and effectiveAddition of Copper sleevesAddition of Copper sleeves
Improves Contraceptive Improves Contraceptive efficacyefficacy
LNG-IUS more effective than LNG-IUS more effective than CopperIUCDCopperIUCD
Conclusion Conclusion (2) (2)
IUCD insertion after abortionIUCD insertion after abortionImmediate insertionImmediate insertion versus
delayed Insertion: perforation expulsion P.I.D
contraceptive failureNO SIGNIFICATIVE DIFFERENCENO SIGNIFICATIVE DIFFERENCE
Conclusion Conclusion (3)(3)
IUCD insertion after abortionIUCD insertion after abortion
BenefitsBenefits1.1. Abortion and contraception Abortion and contraception
at the same timeat the same time2.2. Opportunity for women who Opportunity for women who
have limited access to have limited access to cliniciansclinicians
3.3. Painless insertionPainless insertion