IUCD: insertion after IUCD: insertion after abortionabortion

Doctor Marie-Laure BrivalDoctor Marie-Laure Brival MD,Medical Director of Maternity of the

Hospital Les Lilas

Moscow,International SeminarMoscow,International SeminarAbortion ,Contraception and Women’s

Health27-28 th October 2005

Definition

IUCD: reversible contraceptive method with high efficacy It concerns about 100 millions women all over the world

GeneralitiesGeneralities3 Types of IUCD3 Types of IUCD

Without CopperWithout Copper: Lippes Loop With CopperWith 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 deviceLevonorgestrel releasing device : Mirena®

Lippes loopLippes loop

Type AType A Type DType D

T T 200200

T 220 CT 220 C T 380T 380

Multiload IUDMultiload IUD : MLCu 250 : MLCu 250 (normal,short) (normal,short) MLCu MLCu 375375

Nova TNova T

Copper 7Copper 7

Levonorgestrel releasing Levonorgestrel releasing devicedevice

LNG-IUS Mirena®LNG-IUS Mirena®

GeneralitiesGeneralitiesEfficacyEfficacy

ContraceptiContraception failureon failure

EctopicEctopic

PregnanPregnancycy

Copper Copper IUDIUD

0,6%0,6% 0,3%0,3%

LNG-IUSLNG-IUS

MirénaMiréna

0,09%0,09% 0,02%0,02%

GeneralitiesGeneralities

ComplicationsComplications Pelvic inflammatory disease: RR3,8 Perforation: 0,6 to 1,6 °/°° Expulsion: Copper 6,7%, LNG 5,8%

ContraindicationsContraindications Pregnancy STI, pelvic inflammatory disease cancer,Bleeding fibroma, copper allergy and CI for LNG

Author Nb interventionintervention PregnancyPregnancy%

ExpulsionExpulsion%

Perforation %

PID

Gillet1980

unicenter

259I.A.

I Trim

Copper 7 immediate/delayed insertion

2,3 / 0,02,3 / 0,0 15,4 /2,815,4 /2,8 NRNR NRNR

W.H.O.1983 a

multicent

2340

I.A.

I Trim

T 220C

Lippes loopD

Copper 7

I..insertion

1,71,7

3,73,7

3,63,6

4,44,4

9,69,6

8,48,4

0,10,1

0,00,0

0,30,3

0, 30, 3

0,30,3

0,70,7

W.H.O.1983 b

multicent

1060

SA. 13-20

T 220C

Lippes loopD

Copper 7

I.insertion

0,70,7

2,42,4

1,11,1

9,29,2

13,213,2

12,712,7

0,00,0

0,30,3

0,00,0

0,80,8

0,00,0

0,40,4

Randomized StudiesRandomized Studies

AuthorAuthor NbNb intervention pregnancy expulsion perforation PID

LimLim1985

unicenter

549 I.A. gesta?

ML250

375 I.insertion

0,80,8

2,12,1

1,9 1,9

1,81,8NR NR

MccarthyMccarthy

1985

unicenter

400

I.A.

gesta?

NovaT /MLCU250

I.insertion

1,8 1,8

0,60,6

6,5 6,5

6,3 6,3 NRNR NRNR

RandicRandic1991

multicent

400

I.A.

I Trim

Lippes loopD/

Lldcopper200

I.insertion

4,6 4,6

0,60,6

12,612,6

4,54,5

NRNR NRNR

PakarinenPakarinen

2003 multicent after 5 after 5 yearsyears

438 I.A.

I Trim

LNG-IUS/NovaT

I.insertion

0,80,8

9,59,5

10,510,5

15,415,4

NRNR 0,70,7

2,32,3

Randomized Randomized StudiesStudies

Nonrandomized Nonrandomized StudiesStudies

AuthorAuthor NbNb interventionintervention pregnancypregnancy expulsionexpulsion perforation medical reremovals

El TagyEl Tagy2003

unicenter

300 I.A. I Trim

Copper IUDimmediate/delayed insertion

+ + + +

MoussaMoussa2001

2 centers

100

S.A.

I Trim

Copper T 380

immediate/delayed insertion

+ + + +

LiLi2004

unicenter

20 I.A.

I Trim

LNG-IUSacceptability

+ + + +

Results Results IUCD insertion after abortionIUCD insertion after abortion

W.H.O CopperIUDsCopperIUDs have best contraceptive

efficacy TCU 220 C > Copper 7 >Lippes Loop Insertion of IUD immediatly after abortion or

miscarriage: safe and practicalsafe and practical Pelvic imflammatory : rare Perforation :similar to that of interval insertion

Results Results IUCD insertion after abortionIUCD insertion after abortion

Gillet Immediate and delayed Insertion with the same Immediate and delayed Insertion with the same

IUD: IUD: no difference no difference

Randic Copper sleeves improve efficacity of Lippes Loop

Mac Carthy MultiloadIUD > Nova T

Pakarinen LNG-IUS > Nova T

LiM MLCU 375/MLCU 250: no significant difference

immediate insertionimmediate insertion240 Women240 Women

Results 2004

3 weeks  6 months

Expulsion 8 (3,5%) 0

perforation 0 0

PID 1 0

pregnancy 0 0

HÔPITAL PRIVE LES LILASHÔPITAL PRIVE LES LILAS

Conclusion Conclusion (1)(1)

IUCD insertion after abortionIUCD insertion after abortion

Immediate post abortal IUCDImmediate post abortal IUCD

Safe and effectiveSafe and effectiveAddition of Copper sleevesAddition of Copper sleeves

Improves Contraceptive Improves Contraceptive efficacyefficacy

LNG-IUS more effective than LNG-IUS more effective than CopperIUCDCopperIUCD

Conclusion Conclusion (2) (2)

IUCD insertion after abortionIUCD insertion after abortionImmediate insertionImmediate insertion versus

delayed Insertion: perforation expulsion P.I.D

contraceptive failureNO SIGNIFICATIVE DIFFERENCENO SIGNIFICATIVE DIFFERENCE

Conclusion Conclusion (3)(3)

IUCD insertion after abortionIUCD insertion after abortion

BenefitsBenefits1.1. Abortion and contraception Abortion and contraception

at the same timeat the same time2.2. Opportunity for women who Opportunity for women who

have limited access to have limited access to cliniciansclinicians

3.3. Painless insertionPainless insertion