@2024 Afarand., IRAN

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ISSN: 2251-8215    Sarem Journal of Reproductive Medicine 2017;1(1):15-19

Background
Among the contraceptive methods, the use of intrauterine device (IUD) is one of the most effective, safe ‎and economical methods of preventing pregnancy.‎
Previous Studies
‎… [1]. In the use of IUD, as with any other prevention method, this method can also be associated with ‎complications and problems such as uterine perforation, which is related to how to place the IUD (it ‎happens approximately in 0.06 of cases of using CuT 380A IUD and 0.11% of using Progestasert IUD), ‎dysmenorrhea, and increased menstrual bleeding (which accounts for 10-15% of IUD containing ‎cupper), an increased risk of pelvic inflammatory diseases in the first 20 days of insertion, ‎displacement, ectopic pregnancy, actinomycosis and pregnancy (in the classic form less than 2% of ‎the cases) [2, 3]. Pregnancy is associated with problems such as increased risk of low child`s weight, ‎early delivery, and abortion in the presence of IUD [4]. In some cases bladder perforation has also been ‎reported [5]. Perhaps, the biggest failure in IUD, is person`s pregnancy [6]. Our personal experience, in ‎ultrasound evaluation of these individuals has shown that in most cases, a pregnancy sac has been ‎formed in the space between the fundus of uterus and the IUD. The Rotating withdrawal technique used ‎in this study by minimizing this distance would minimize the possibility of IUD displacement and ‎could be effective increasing the effectiveness of this device. ‎
Aim(s)
The aim of this study was to introduce Rotating withdrawal technique for the first time that was ‎studied to reduce the problems and complications of using IUD use. ‎
Research type
This research is a historical cohort study. ‎
Research society, place and time
This research was performed on women who referred to Sarem Medical Center between 1985 and 1995 ‎for whom IUD had been placed. ‎
Sampling method and number
The number of samples was 1199. All patients had a history of recurrent pelvic infections, severe ‎dysmenorrhea, menorrhagia, anemia, coagulation disorders, uterine anomalies and ectopic ‎pregnancies before IUD placement. The use of IYD was not recommended in women with the above ‎mentioned records, women who did not have a history of childbirth, and those who complained of ‎oligomenorrhea and polymenorrhea. ‎
Used devices&materials
Possible complications of IUD use were described in these patients and their informed consent was ‎obtained. Subsequently, gynecological examinations, pelvic examination (for examining the size and ‎condition of the pelvis) and the preparation of Pap smear carried out a month before the device was ‎inserted. In the meantime, if cervical swelling was present, necessary treatment was done and the ‎placement of IUD was delay until complete recovery. After these steps, patients were advised to come ‎for placement at day 4-5 of their menstruation. ‎ Method of placement: finally, placement was done precisely as follows. The patient was placed in ‎lithotomy position and the cervix was completely opened using the Speculum. Then, the vagina and ‎cervix was sterilized with 10% Povidone iodine solution and the anterior cervix was held by ‎Tenaculum. A gentle stretching was applied to remove the angle between the cervical canal and the ‎uterine cavity, and then the depth and internal length of the uterus was measured. IUD was placed in ‎the inserter and slowly slipped into the cervical and endometrial canal to be contacted with the uterine ‎fundus. Then, with a gentle and continuous rotation with stretching, the Inserter tube was released and ‎removed from plunger. ‎ The IUD was held in place be the rod while pulling the inserter tube, and the contact between the IUD ‎and fundus of womb was carefully preserved until the placement was complete. The IUD thread was ‎cut so that it was about 2 centimeter visible from the cervix. Then, the tenaculum was freed and ‎speculum was excreted and antiprostoglandin was prescribed for uterine pain and contractions, and a ‎‎5-day period of doxycycline was prescribed for prevention of possible infections. Patient follow up ‎was performed one month after placement on day 4-5 menstruation. In this way, transabdominal ‎sonography was performed for patients to examine the status of IUD in the uterine cavity. In this study, ‎if the device was not in contact with the fundus of the uterus, it was removed and a new IUD was ‎inserted. The position and place of the new IUD in the uterine cavity was followed by abdominal ‎ultrasonography during the next menstrual period. In cases where the device`s contact with fundus of ‎the uterus was reduced or replaced, IUD was removed and patients were advised to use other ‎contraceptive methods. In cases where the IUD position was normal, the patient was asked to refer ‎there every 6 months to follow up and visit. During these visits, gynecological examination was ‎carried out and the IUD thread was checked and probable problems such as infection, pregnancy, ‎bleeding, or patient complaint were investigated. Ultrasound scanning of the pelvis was also performed ‎to increase the confidence of the proper placement of IUD in the uterine cavity. Eventually, the IUD was ‎removed after 2 years on day 4-5 of menstruation and a new IUD was inserted into the women who ‎were willing to continue the contraception by this method, and then all the steps again went on. All ‎samples whose information was complete and followed up for 2 years were included in this study. ‎
Findings by Text
The mean age of the participant was 28.5±6.5 years. About half of the samples had used Copper T and ‎all IUDs contained copper (Table 1)‎ In follow-up, the amount of displacement in 2 years, was only 20 cases (1.67%) of IUDs, which ‎happened during the first month of placement (Table 2).‎ Of these 20 samples, after re-placement, 4 cases (0.35%) were displaced after a month again. During 2 ‎years, no cases of uterine perforation, spontaneous outflow, and IUD migration to the uterine wall were ‎seen and there was no pregnancy case. ‎
Main comparison to the similar studies
‎... [7-10]. One of the IUD problems is increased bleeding during menstruation. In Western women, the ‎average volume of menstrual blood is 32 ml which reaches to 52-75 ml with the use of Lipps loop or ‎other non-drug type IUDs. This increase in the use of copper IUD reaches 37-40 ml in the first month ‎which then diminishes its amount [11]. Ectopic pregnancy is another complication of IUD. Studies ‎have shown that among various prevention methods, 50% of pregnancies are ectopic [12].‎‏ ‏In another ‎study, for 5 years, those who use the types of (levonorgestrel-releasing intrauterine contraceptive ‎device) IUD were compared with those who used another type which was Nova T Copper-Releasing ‎Device. It was found that pregnancy was 5.8% for Nova T and it was 0.5% for LNG-IUD [13]. A case of ‎pregnancy and the consequent ectopic pregnancy was not seen in this study.‎ Displacement is one of the other complications of IUD use. In a widespread research conducted in ‎Yugoslavia, after 2 years, the IUD displacement was 4.49% and 13.29% in copper type and ‎standardized non-copper ones respectively [14]. This ratio was reported at 1.67% (once displacement) ‎after 2 years in this study and all cases were related to the first month after placement. 0.35% of the ‎cases had twice displacement during the first 2 months after placement. Thereafter, until the end of the ‎‎2 years, there was no case of displacement. ‎ The displacement of the IUD may be in or out of the uterus that the ectopic displacement is associated ‎with higher risk of pregnancy. In a hospital respective study, it was found that about 18% of cases of ‎IUD displacement has been ectopic that about 43% of ectopic displacement has led to the pregnancy ‎‎[15].‎ Pregnancy should be considered as the main complication or better to say, the IUD defeat. The failure ‎rate of various contraceptive methods in different countries was compared after one year [16] (Table ‎‎3). As it can be seen, IUD is one of the most successful methods of contraception. In some societies ‎such as China, the reasons for failure, are planned pregnancy to fight population control program. In ‎such a way that people become pregnant before using the preventing methods which not related to the ‎contraceptive methods [17]. … [18].‎
Suggestions
Conducting this project in form of prospective cohort and comparison of this technique with other IUD ‎types, and more samples are suggested.‎
Limitations

Conclusions
The use of Rotating withdrawal technique, with care and patience, can minimize the incidence of ‎pregnancy during IUD use. Therefore, in addition to the quality of the IUD, placement method can also ‎increase its effectiveness. ‎
Acknowledgments
Thanks and appreciation to all the staff at Sarem Medical Center who helped us with this research. ‎
Conflict of interest

Ethical Permissions

Funding Sources

TABLES and CHARTS

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