Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery

Objective: The objective was to describe the sonographic position of copper intrauterine devices (IUDs) 6 months after insertion during cesarean delivery. Study design: This prospective, observational study followed participants who received a copper IUD during cesarean delivery. We performed pelvic...

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Main Authors: Elizabeth P. Gurney, Arden McAllister, Britt Lang, Courtney A. Schreiber, Sarita Sonalkar
Format: Article
Language:English
Published: Elsevier 2020-01-01
Series:Contraception: X
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S259015162030023X
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author Elizabeth P. Gurney
Arden McAllister
Britt Lang
Courtney A. Schreiber
Sarita Sonalkar
author_facet Elizabeth P. Gurney
Arden McAllister
Britt Lang
Courtney A. Schreiber
Sarita Sonalkar
author_sort Elizabeth P. Gurney
collection DOAJ
description Objective: The objective was to describe the sonographic position of copper intrauterine devices (IUDs) 6 months after insertion during cesarean delivery. Study design: This prospective, observational study followed participants who received a copper IUD during cesarean delivery. We performed pelvic examination at 6 weeks and 6 months and sonography at 6 months to determine IUD position. Patients had additional examinations as needed to address complications. Results: Sixty-nine participants provided outcomes through 6 months: 41 (59%) had correctly positioned IUDs, 21 (30%) had malpositioned intrauterine IUDs, 5 experienced expulsion (3 partial, 2 complete), and 2 had elective removal; 52 (75%) had missing strings. Missing strings at 6 weeks predicted an incorrect IUD position in 22 of 52 participants (positive predictive value 42%), and visible or palpable strings predicted a correct IUD position in 7 of 12 participants (negative predictive value 58%). Conclusion: Although 59% of copper IUDs placed during cesarean were correctly positioned at 6 months, nearly one third were malpositioned. Implications: Ultrasound may be indicated for patients receiving a copper IUD during cesarean delivery as checking IUD strings alone does not assure correct placement. Providers offering postpartum IUDs should ensure that appropriate processes for the evaluation and management of devices with missing strings or abnormal position are available to all patients regardless of insurance status.
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spelling doaj.art-d01a95a5b2aa470db3d77cc67680d28a2022-12-21T20:33:38ZengElsevierContraception: X2590-15162020-01-012100040Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean deliveryElizabeth P. Gurney0Arden McAllister1Britt Lang2Courtney A. Schreiber3Sarita Sonalkar4Perelman School of Medicine at the University of Pennsylvania, Family Planning Division, Department of Obstetrics and Gynecology, 1000 Courtyard, 3400 Spruce St., Philadelphia, PA 19104Corresponding author at: 3400 Spruce Street, 1000 Courtyard, Philadelphia, PA 19104, United States. Tel.: +1 215 662 3532.; Perelman School of Medicine at the University of Pennsylvania, Family Planning Division, Department of Obstetrics and Gynecology, 1000 Courtyard, 3400 Spruce St., Philadelphia, PA 19104Perelman School of Medicine at the University of Pennsylvania, Family Planning Division, Department of Obstetrics and Gynecology, 1000 Courtyard, 3400 Spruce St., Philadelphia, PA 19104Perelman School of Medicine at the University of Pennsylvania, Family Planning Division, Department of Obstetrics and Gynecology, 1000 Courtyard, 3400 Spruce St., Philadelphia, PA 19104Perelman School of Medicine at the University of Pennsylvania, Family Planning Division, Department of Obstetrics and Gynecology, 1000 Courtyard, 3400 Spruce St., Philadelphia, PA 19104Objective: The objective was to describe the sonographic position of copper intrauterine devices (IUDs) 6 months after insertion during cesarean delivery. Study design: This prospective, observational study followed participants who received a copper IUD during cesarean delivery. We performed pelvic examination at 6 weeks and 6 months and sonography at 6 months to determine IUD position. Patients had additional examinations as needed to address complications. Results: Sixty-nine participants provided outcomes through 6 months: 41 (59%) had correctly positioned IUDs, 21 (30%) had malpositioned intrauterine IUDs, 5 experienced expulsion (3 partial, 2 complete), and 2 had elective removal; 52 (75%) had missing strings. Missing strings at 6 weeks predicted an incorrect IUD position in 22 of 52 participants (positive predictive value 42%), and visible or palpable strings predicted a correct IUD position in 7 of 12 participants (negative predictive value 58%). Conclusion: Although 59% of copper IUDs placed during cesarean were correctly positioned at 6 months, nearly one third were malpositioned. Implications: Ultrasound may be indicated for patients receiving a copper IUD during cesarean delivery as checking IUD strings alone does not assure correct placement. Providers offering postpartum IUDs should ensure that appropriate processes for the evaluation and management of devices with missing strings or abnormal position are available to all patients regardless of insurance status.http://www.sciencedirect.com/science/article/pii/S259015162030023XIntrauterine device complicationIntrauterine device expulsionPostpartum contraceptionPostpartum intrauterine devicePostplacental intrauterine deviceCopper intrauterine device
spellingShingle Elizabeth P. Gurney
Arden McAllister
Britt Lang
Courtney A. Schreiber
Sarita Sonalkar
Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery
Contraception: X
Intrauterine device complication
Intrauterine device expulsion
Postpartum contraception
Postpartum intrauterine device
Postplacental intrauterine device
Copper intrauterine device
title Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery
title_full Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery
title_fullStr Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery
title_full_unstemmed Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery
title_short Ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery
title_sort ultrasound assessment of postplacental copper intrauterine device position 6 months after placement during cesarean delivery
topic Intrauterine device complication
Intrauterine device expulsion
Postpartum contraception
Postpartum intrauterine device
Postplacental intrauterine device
Copper intrauterine device
url http://www.sciencedirect.com/science/article/pii/S259015162030023X
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