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IUCD: insertion after abortion

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IUCD: insertion after abortion Doctor Marie-Laure Brival MD,Medical Director of Maternity of the Hospital Les Lilas Moscow,International Seminar – PowerPoint PPT presentation

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Title: IUCD: insertion after abortion


1
IUCD insertion after abortion
  • Doctor Marie-Laure Brival MD,Medical Director of
    Maternity of the Hospital
  • Les Lilas
  • Moscow,International Seminar
  • Abortion ,Contraception and Womens Health
  • 27-28 th October 2005

2
Definition
IUCD reversible contraceptive method with high
efficacy It concerns about 100 millions women
all over the world
3
Generalities
  • 3 Types of IUCD
  • Without Copper Lippes Loop
  • With 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 device Mirena

4
Type A
Type D
Lippes loop
5
T 220 C
T 380
T 200
6
Multiload IUD MLCu 250 (normal,short)
MLCu 375
7
Nova T
8
Copper 7
9
Levonorgestrel releasing device
LNG-IUS Mirena
10
GeneralitiesEfficacy
Contraception failure Ectopic Pregnancy
Copper IUD 0,6 0,3
LNG-IUS Miréna 0,09 0,02
11
Generalities
  • Complications
  • Pelvic inflammatory disease RR3,8
  • Perforation 0,6 to 1,6 /
  • Expulsion Copper 6,7, LNG 5,8
  • Contraindications
  • Pregnancy
  • STI, pelvic inflammatory disease
  • cancer,Bleeding fibroma,
  • copper allergy and CI for LNG

12

Randomized Studies
Author Nb intervention Pregnancy Expulsion Perforation PID
Gillet 1980 unicenter 259 I.A. I Trim Copper 7 immediate/delayed insertion 2,3 / 0,0 15,4 /2,8 NR NR
W.H.O. 1983 a multicent 2340 I.A. I Trim T 220C Lippes loopD Copper 7 I..insertion 1,7 3,7 3,6 4,4 9,6 8,4 0,1 0,0 0,3 0, 3 0,3 0,7
W.H.O. 1983 b multicent 1060 SA. 13-20 T 220C Lippes loopD Copper 7 I.insertion 0,7 2,4 1,1 9,2 13,2 12,7 0,0 0,3 0,0 0,8 0,0 0,4
13
Randomized Studies
Author Nb intervention pregnancy expulsion perforation PID
Lim 1985 unicenter 549 I.A. gesta? ML250 375 I.insertion 0,8 2,1 1,9 1,8 NR NR
Mccarthy 1985 unicenter 400 I.A. gesta? NovaT /MLCU250 I.insertion 1,8 0,6 6,5 6,3 NR NR
Randic 1991 multicent 400 I.A. I Trim Lippes loopD/ Lldcopper200 I.insertion 4,6 0,6 12,6 4,5 NR NR
Pakarinen 2003 multicent after 5 years 438 I.A. I Trim LNG-IUS/ NovaT I.insertion 0,8 9,5 10,5 15,4 NR 0,7 2,3
14
Nonrandomized Studies
Author Nb intervention pregnancy expulsion perforation medical removals
El Tagy 2003 unicenter 300 I.A. I Trim Copper IUD immediate/delayed insertion
Moussa 2001 2 centers 100 S.A. I Trim Copper T 380 immediate/delayed insertion
Li 2004 unicenter 20 I.A. I Trim LNG-IUS acceptability
15
Results IUCD insertion after abortion
  • W.H.O
  • CopperIUDs have best contraceptive efficacy
  • TCU 220 C gt Copper 7 gtLippes Loop
  • Insertion of IUD immediatly after abortion or
    miscarriage safe and practical
  • Pelvic imflammatory rare
  • Perforation similar to that of interval
    insertion

16
Results IUCD insertion after abortion
  • Gillet
  • Immediate and delayed Insertion with the same
    IUD
  • no difference
  • Randic
  • Copper sleeves improve efficacity of Lippes Loop
  • Mac Carthy
  • MultiloadIUD gt Nova T
  • Pakarinen
  • LNG-IUS gt Nova T
  • LiM
  • MLCU 375/MLCU 250 no significant difference

17
immediate insertion240 Women
Results 2004 3 weeks  6 months
Expulsion 8 (3,5) 0
perforation 0 0
PID 1 0
pregnancy 0 0
HÔPITAL PRIVE LES LILAS
18
Conclusion (1) IUCD insertion after abortion
  • Immediate post abortal IUCD
  • Safe and effective
  • Addition of Copper sleeves
  • Improves Contraceptive efficacy
  • LNG-IUS more effective than CopperIUCD

19
Conclusion (2) IUCD insertion after abortion
  • Immediate insertion versus delayed Insertion
  • perforation
  • expulsion
  • P.I.D
    contraceptive failure
  • NO SIGNIFICATIVE DIFFERENCE

20
Conclusion (3)IUCD insertion after abortion
  • Benefits
  • Abortion and contraception at the same time
  • Opportunity for women who have limited access to
    clinicians
  • Painless insertion
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