الفهرس | Only 14 pages are availabe for public view |
Abstract Background: Intrauterine devices (IUDs) are one of the most effective methods of preventing pregnancy. Studies have shown that immediate postpartum initiation of long-acting reversible contraception (LARC) methods leads to increased utilization of LARC and prevention of unintended pregnancies, with effect on breastfeeding success. Recent changes to reimbursement policies and clinical guidelines encourage increased access to immediate post placental initiation of IUDs. Objectives: A comparison of the complications rate at 6 weeks after post placental insertion of the LNG IUD. Second, a comparison of breastfeeding after LNG IUD post placental insertion Methods: A study investigator will explain the study procedure for all women seeking post placental insertion of an LNG IUD at the time of caesarean section and the effect of breast feeding. All women will receive an LNG 52-mg IUD (Mirena®; Bayer Healthcare Pharmaceuticals, Whippany, NJ). After discharge, participants will be contacted for the first 6 weeks postpartum. Surveys will include questions regarding IUD expulsion, displacement, cramps, infection, bleeding, perforation, removal, and breastfeeding. Participants will return for a 6-week postpartum visit with their obstetric provider and a study investigator will attend each visit. The provider will perform a speculum examination, and if IUD strings are not visible, a transvaginal ultrasound (TVUS) will be performed at the time of the visit to confirm the IUD location. An abdominal radiograph will be performed if a patient does not report a clinical history of expulsion and no IUD is seen in the uterus by TV. Results: A total of 50 pregnant women seeking post-placental insertion of intrauterine devices at the time of caesarean section were enrolled. Participants returned for 3 postpartum visits with their obstetric provider and the study investigator attended each visit. The first visit was 7– 10 days, the second one was 40 days, and the third one was 3 months after delivery. All women were asked about breast feeding and bleeding patterns after previous deliveries compared with the current delivery. Statistical analysis of the current study showed that regarding the flow of breast milk and its comparison with breast feeding after last delivery, and regarding bleeding patterns and their comparison with bleeding after delivery, and regarding intrauterine device position and expulsion rates. Conclusion: There was no contraindication. All women seeking an effective postpartum contraceptive method and treatment of associated abnormal uterine bleeding, menorrhagia should use this device as an adjuvant modality for all women seeking an effective postpartum contraceptive method and treatment of menorrhagia. |