Does Timing of Intrauterine Device Insertion Regarding The Application Day of Menstrual Cycle Make Sense for Unintentional Expulsion? A Retrospective Study

Abstract

Aim: The application time for intrauterine device IUD is recommended to be during menstrual period because the cervical canal would be open and the insertion would be easier with less pain. In this retrospective study we aimed to find out whether the day of insertion of IUD is related with the dislocation.Material and Methods: In this retrospective study, 185 patients who consulted to a family planning clinic of women’s hospital in Ankara for IUD insertion were observed. The patients were asked for follow-up for the coming month and they were checked by transvaginal ultrasound. IUDs located at the lower uterine segment and cervical canal were considered as dislocated IUDs.Results: One hundred and eighty five patients were included in this study. The patient’s age ranged between 17 and 53 mean±SD:31.5 +8.0 . Among 185 patients, 45 patients 24.3% had dislocated IUD, 140 patients 75.7% had normal localized IUD. Forty four patients 23.8% of total had IUD insertion on first three days of menstruation. Seven of these 44 patients 15.9% of insertions in first three days of menstruation were found to have dislocated IUDs. Thirty seven of them 84.1% had a normal localized IUD. Seventy one patients 38.4% of total had IUD insertion on 4 to 7th days of their menstruation. Twenty of these 71 patients 28.2% of insertions on 4th to 7th day were found to have dislocated IUDs. Fifty one of them 71.8% had a normal localized IUD. Thirty one patients 16.8% of total had IUD insertion on their random day of cycle without menstruation. Eleven of these 31 patients 35.5% had dislocated IUDs after one month while 20 64.5% of them had a normal localized IUD. Thirteen patients 7.0% of total had IUD insertion postpartum before 40 days. One of 13 patients’ IUDs 7.7% of insertions on postpartum before 40 days were found to have been dislocated while 12 92.3% of them had a normal localized IUD. Thirteen patients 7.0% of total had IUD insertion after postpartum 40th day. Three of 10 patients 23.1% of insertions on after postpartum 40th day were found to have dislocated IUDs while 10 76.9% of them had a normal localized IUD. Thirteen patients 7.0% of total had IUD insertion immediately after dilatation and curettage. Three of 13 patients 23.1% of insertions on after D/C were found to have dislocated IUDs while 10 76.9% of them had a normal localized IUD. Conclusion: IUD insertion is a safe, easily applicable and cost-effective contraceptive method exhibiting low failure and complication rates. Failure of IUDs is mostly associated with dislocation, malposition or expulsion. Dislocation incidence will be influenced by several factors like timing of insertion, parity, previous abortions or uterine operations, type of IUD used, uterine anomalies, leiomyomas and uterine position. Although the first three days of the menstrual cycle seem to be with the lowest probability of intrauterine device expulsion, the timing of IUD insertion does not affect the dislocation rates significantly.

Keywords

• Dislocation,intrauterine device,menstrual cycle,timing

Rahim İçi Araç Uygulanma Zamanında Menstrüel Siklus Günü Dislokasyon Riski Açısından Anlamlı mıdır? Retrospektif Çalışma

Abstract

Amaç: Rahim İçi Araç RİA uygulaması, uygulamanın daha kolay ve daha az ağrılı olacağından dolayı servikal kanalın açık olacağı menstrüel periyod döneminde yapılması önerilir. Bu retrospektif çalışmada RİA uygulanma zamanının dislokasyon ile ilgisi olup olmadığını araştırmayı amaçladık.Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ankara’da bir kadın hastalıkları hastanesinin aile planlaması kliniğine RİA uygulanması için başvuran 185 hasta dahil edildi. RİA uygulanan hastalar bir ay sonra kontrole çağrılarak transvajinal ultrason ile RİA lokalizasyonları belirlendi. Alt uterin segment ve servikal kanalda gözlenen rahim içi araçlar disloke kabul edildi.Bulgular: Çalışmaya 185 hasta dahil edildi. Hastaların yaş aralığı 17- 53 arasında idi ortalama±SD:31.5 +8.0 . 185 hastanın 45’inde %24.3 disloke RİA, 140 hastada %75.7 normal lokalizasyonlu RİA mevcuttu. Menstruasyonun ilk üç gününde RİA takılan 44 hastadan totalin %23.8’i , 7 hastada %15.9 disloke RİA; menstruasyonun 4. ve 7. günleri arasında RİA uygulanan 71 hastadan total hasta sayısının %38.4’ü 20 hastada 4.-7. gün insersiyonlarının %38.4’ü disloke RİA; herhangi bir günde RİA uygulanan 31 hastadan totalin %16.8’i 11 hastada %35 disloke RİA; postpartum ilk kırk gün içinde RİA uygulanan 13 hastadan totalin %7.0’i sadece bir hastada postpartum ilk 40 gün içinde RİA uygulananların %7.7’si disloke RİA; postpartum 40 günden sonra RİA uygulanan 13 hastadan totalin %7.0’i 3 hastada postpartum 40. günden sonraki uygulamaların%23.1’i disloke RİA ve D/C sonrası RİA uygulanan 13 hastadan totalin %7.0’si 3’ünde %23.1 disloke RİA izlendi.Sonuç: Dislokasyon insidansını uygulama zamanı, parite, abortus öyküsü, geçirilmiş uterin operasyonlar, kullanılan RİA çeşidi, uterin anomaliler, leiomyomlar ve uterin pozisyon gibi faktörler etkileyebilir. Menstruasyonun ilk üç günü RİA uygulandığında dislokasyon ihtimali daha düşük görünse de, RİA uygulamasının zamanlaması dislokasyon oranlarını anlamlı olarak etkilememektedir.

Keywords

• Rahim içi araç,dislokasyon,menstrüel siklus,zamanlama

References

1. Ertopçu K. Intrauterine device, review. Turkiye Klinikleri J Gynecol Obst-Special Topics 2012;5:37-42
2. Mwalwanda CS, Black KI. Immediate post-partum initiation of intrauterine contraception and implants: a review of the safety and guidelines for use. Aust N Z J Obstet Gynaecol. 2013;53:331-7.
3. Kulier R, O’Brien P. (2008), “Copper containing, framed intra- uterine devices for contraception (Review)”, The Cochrane Database of Systematic Reviews (4), doi:10.102/14651858. CD005347, PMID 17943851
4. Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health. 2010; 2: 211–220.
5. Brown WM, Trouton K.J. Intrauterine device insertions: which variables matter? Fam Plann Reprod Health Care. 2013 Jun 15. PMID: 23771917
6. Johri v, Vyas KC. Misplaced Intrauterine Contraceptive Devices: Common Errors; Uncommon Complications. J Clin Diagn Res. 2013;7: 905–907.
7. Braaten KP, Benson CP. Malpositioned intrauterine contraceptive devices: risk factors, outcomes, and future pregnancies. Obstet Gynecol. 2011;118:1014-20.
8. Anteby E, Revel A, Ben-Chetrit A, Rosen B, Tadmor O, Yagel S. Intrauterine device failure: relation to its location within the uterine cavity. Obstet Gynecol. 1993;81:112-4.

9. Soydinc HE, Evsen MS. Translocated intrauterine contraceptive device: experiences of two medical centers with risk factors and the need for surgical treatment. J Reprod Med. 2013;58:234-40.
10. Mbamara SU, Omojuwa IO. An Unusual Presentation of Perforated Intrauterine Contraceptive Device. Ann Med Health Sci Res. 2013; 3: 274–276.