IMMEDIATE POST-PLACENTAL INSERTION OF LNG-IUS AND COPPER T380A UNDER ULTRASOUND GUIDANCE AT A TEACHING HOSPITAL Open Access

Abstract

Abstract
IMMEDIATE POST-PLACENTAL INSERTION OF LNG-IUS AND COPPER T380A UNDER ULTRASOUND GUIDANCE AT A TEACHING HOSPITAL

Objectives:
To determine whether risk of expulsion following ultrasound-guided post-placental IUD insertion is associated with provider level of training.

Methods:
We enrolled patients from the prenatal clinic at a teaching hospital who were planning vaginal delivery and desired a postpartum IUD. Patients selected the copper T380A IUD or Levonorgestrel IUS after comprehensive counseling. Women who underwent immediate postplacental insertion were seen in clinic at 4-6 weeks and contacted by telephone at 3 and 6 months. Insertions were performed by Obstetrics and Gynecology physicians at all training levels, PGY1 to attending, following a training session on postplacental IUD insertion technique.

Results:
Ninety-nine subjects were eligible and had successful post-placental placement. Ninety-seven insertions were performed by resident-physicians. Eighty-eight women had follow-up within the 6-month period. Overall, 17 expulsions were noted: 10 complete expulsions, all noted by the patient; and 7 partial expulsions, all noted on exam or ultrasound. All partially expelling IUDs were removed, with 5 out of 7 replaced per patient request. No significant association was found between expulsions and provider level of training though an association is suggested. Lower level physicians inserted 24 IUDs of which 2 expulsions (8.3%) were reported or diagnosed in 6 months; upper level physicians inserted 64 IUDs of which 15 expulsions (23.4%) were reported or diagnosed during follow-up. Analyses also suggest there may be an association between not receiving IV or regional anesthesia and expulsion.

Conclusion:
Postplacental IUD insertions can be safely performed within a training program under ultrasound guidance. The risk of expulsion among women who had their IUD inserted by an upper level physician were more than two times the risk of expulsion among women who had insertion performed by a lower level physician. This result was not statistically significant therefore we cannot rule out chance. Further studies are needed for this relationship and to evaluate a possible association between expulsions and lack of anesthesia.

Table of Contents

TABLE OF CONTENTS
Background...1
Methods...6
Results...11
Discussion...14
References...17
Appendix...18

List of Tables
Table 1. Characteristics of women receiving a postplacental IUD, by IUD type
Table 2. Characteristics of subjects with follow-up by Expulsion versus Non-Expulsion
Table 3. Characteristics of subjects with follow-up by Provider Level
Table 4. Effect of Provider Level on Expulsion Stratified by Provider Level and other Covariates
Table 5. Multivariate Analysis
Table 6. Collinearity Matrix

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	postpartum contaception intrauterine device
Committee Chair / Thesis Advisor	Marcus, Michele, Emory University
Committee Members	Cwiak, Carrie A, Emory University

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