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OBJECTIVES: The objective was to describe the ease and difficulty of removing intrauterine devices (IUDs). METHODS: We conducted a prospective study at the University of Campinas (UNICAMP), Faculty of Medical Sciences, UNICAMP. We included women who requested IUD removal. We excluded women with partial IUD expulsion in which the IUD was protruded at the external os. We identified difficult IUD removal when the removal was challenging, including the inability to visualize IUD strings extending from the cervical os. RESULTS: A total of 869 women participated. Women were aged 29.4 ± 8.0 years (mean ± SD; range 14-51) and the duration of IUD use at the time of removal was 4.3 ± 4.2 years. We found that 702 (80.8%) women had visible strings at the external os and the removals were performed at the first attempt without difficulty in 692 (79.6%) participants. The pain was more intense (>4) in cases of difficult removals. After multivariate logistic analysis, difficult removals were associated with users of IUD ≥3 years (3 times higher risk); for each previous cesarean delivery, the risk increased by 1.5 times. CONCLUSIONS: Our study showed that IUD removal is an easy and safe procedure, with only a small proportion of women reporting significant pain with IUD removal.

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OBJECTIVE: To compare the performance of the abdominal handheld point-of-care ultrasonography (POCUS) Butterfly-iQ to gold standard transvaginal ultrasonography (US) in identifying the position of intrauterine devices (IUDs) in the hands of a medical doctor specialised in ultrasonography. METHODS: In this diagnostic accuracy study, a single operator conducted abdominal POCUS followed by conventional transvaginal US. Seventy patients utilising copper or hormonal IUDs were assessed between June 2021 and October 2022. IUDs were categorised as entirely within the uterine cavity or malpositioned. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for detecting malpositioned IUDs, with conventional US results serving as the reference standard. Concordance rate and Kappa coefficient were computed to assess the agreement between the two ultrasound modalities. RESULTS: Among the 70 patients, 46 (65.7%) used copper IUDs, and 24 (34.3%) used hormonal IUDs. Conventional transvaginal US showed IUDs entirely within the uterine cavity in 56 (80%) patients and 14 (20%) IUDs were malpositioned. Of the 14 malpositioned IUDs seen by conventional US, POCUS identified 13 demonstrating a sensitivity of 92.9% (66.1-99.8). Of the 56 IUDs entirely within the uterine cavity shown by conventional US, only two cases were considered malpositioned by POCUS demonstrating a specificity of 96.4% (87.7-99.6). The concordance rate was 95.7%, and the Kappa value was 0.87 in differentiating between IUDs entirely within the uterine cavity and those that were malpositioned. CONCLUSION: Abdominal POCUS using Butterfly-iQ, when administered by an imaging specialist, exhibited excellent performance in confirming IUDs entirely within the uterine cavity.

Through a smartphone-based handheld point-of-care ultrasonography it was possible to correctly evaluate the position of intrauterine devices (IUDs) in a sample of 70 patients (46 using copper and 24 using hormonal IUDs).

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OBJECTIVES: To describe unmet desire for long-acting reversible contraception (LARC) after the Zika Contraception Access Network (Z-CAN) in Puerto Rico during the 2016-2017 Zika outbreak. STUDY DESIGN: Z-CAN patients completed surveys about contraception experiences over a 3-year period. RESULTS: Of 1809 respondents, 3% never used LARC but reported wanting it since their initial visit. As reasons for not getting LARC, nearly 50% indicated a provider-related reason and 25% reported cost. CONCLUSIONS: Few Z-CAN patients who never used LARC had unmet desire. Provider training in contraception guidelines and strategies to address costs can expand access to the full range of reversible contraception. IMPLICATIONS: Three years after a short-term program provided reversible contraception in Puerto Rico, few respondents had never used but wanted a long-acting reversible contraception method. Nearly half reported provider-related reasons for not receiving long-acting reversible contraception, and 25% reported cost. Provider awareness of contraceptive guidance and method availability can support client-centered care.

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Los dispositivos intrauterinos de cobre son utilizados como métodos anticoncepcionales y es uno de los métodos más utilizados por su seguridad, reversibilidad y eficacia en la prevención de embarazos, que es superior al 97 %. Se presenta un caso de falla en la anticoncepción con dispositivos intrauterinos de cobre después de 5 años de uso en gestante de 26 años, que acudió al área de emergencias cursando con embarazo de 38 semanas y 4 días en periodo expulsivo; se obtuvo recién nacido a término sano. El periodo de alumbramiento patológico (prolongado) por presencia de dispositivo intrauterino de cobre en membranas ovulares(AU)

Copper intrauterine devices are used as contraceptive methods and are one of the most used methods due to their safety, reversibility and effectiveness in preventing pregnancy, which is greater than 97%. A case of failure in contraception with a copper intrauterine devices is presented after 5 years of use in a 26-year-old pregnant woman, who went to the emergency room with a pregnancy of 38 weeks and 4 days in the expulsive period; a healthy term newborn was obtained.The pathological (prolonged) delivery period due to the presence of copper intrauterine devices in ovular membranes(AU)

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OBJECTIVE: To evaluate gene expression associated with vaginal bleeding in the 52-mg hormonal intrauterine device (IUD) users. MATERIALS AND METHODS: We conducted a prospective study involving 100 women seeking to use the 52-mg hormonal IUD for contraception. We excluded women with a history or current condition of abnormal uterine bleeding and who were unable to attend a 1-year follow up. Women who expelled the device, removed it for reasons unrelated to vaginal bleeding, or were lost to follow up were discontinued. We collected endometrial biopsies immediately before IUD placement and assessed 20 selected genes using reverse transcription quantitative polymerase chain reaction. Users maintained a uterine bleeding diary for 12 months following IUD insertion. For statistical analysis, participants were categorized into groups with or without vaginal bleeding at 3 and 12 months. RESULTS: Women with elevated CXCL9 expression had an 8.15-fold higher likelihood of experiencing vaginal bleeding at 3 months (odds ratio [OR] 8.15, 95% confidence interval [CI] 2.24-29.61, P = 0.001). At 12 months of follow up, women with increased TIMP1 expression had a 2.74-fold higher chance of experiencing vaginal bleeding (OR 2.74, 95% CI 1.08-6.95, P = 0.033). CXCL9 ≥ 1.5 and IL17A ≥ 0.68 were associated with a higher probability of vaginal bleeding at 3 months, while TIMP1 levels ≥0.943 were linked to an increased risk of bleeding at 12 months. CONCLUSION: Users of the 52-mg hormonal IUD with elevated relative CXCL9 expression face an increased risk of vaginal bleeding at 3-month follow up, whereas those with heightened TIMP1 expression are more likely to experience vaginal bleeding at 12 months.

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Objetivo: Analizar el efecto sobre el peso corporal de la anticoncepción hormonal continua mediante implante sub-dérmico liberador de etonogestrel (ENG) en mujeres en edad reproductiva atendidas en la consulta de planificación familiar de un hospital venezolano. Métodos: Investigación comparativa, con diseño cuasi experimental, de casos y controles, a etiqueta abierta, y prospectivo; con una muestra intencionada de 60 mujeres separadas para recibir bien sea un implante subdérmico (Implanon NXT®; casos) o un dispositivo intrauterino (DIU) de cobre (T de cobre; controles). Se evaluaron el peso corporal e índice de masa corporal antes y posterior de doce meses del uso del contraceptivo; así como las características demográficas de las usuarias, efectos adversos y efectividad anticonceptiva de cada método. Resultados: Luego de un año con el implante de ENG no se encontraron variaciones significativas respecto a las mediciones iniciales del peso corporal (61,21±8,30 vs. 61,23±9,50, p>0,5) e IMC (25,23±3.89 vs. 25,26 ±4,30; p>0,05); contrariamente, a lo observado entre las usuarias del DIU donde tanto el peso corporal como el IMC tuvieron un aumento significativo (P<0,05). Asimismo, la mayoría de las usuarias se mantuvieron en el mismo rango de peso donde se encontraban al iniciar el método (p<0,001); mientras que la ganancia ponderal fue mayor entre las usuarias del DIU (1,530±2,04 vs. 3,700±3,02; p<0,05). Conclusiones: El implante de ENG no produce aumento del peso corporal luego de 12 meses de uso, con mínimos efectos adversos y alta efectividad contraceptiva.

Aim: To analyse the effect on body weight of continuous hormonal contraception by releasing subdermal implant etonogestrel (ENG) in women of reproductive age treated in the family planning consultation of a Venezuelan hospital. Methods: Comparative and applied research, with quasiexperimental, case-control, open label and prospective design, with an intentional sample of 60 women separated to receive the contraceptive implant (Implanon NXT®; cases) or a cooper intrauterine device (IUD) (Cooper T; controls) was carried out. Body weight and body mass index were evaluated before and after 12 months of contraceptive use; as well as demographic characteristics of users, side effects, and contraceptive effectiveness of each method. Results: After one year with the ENG implant, no significant variations were found with respect to initial measurements of body weight (61.21±8.30 vs. 61.23±9.50, p>0.5) and BMI (25.23±3.89 vs 25.26±4.30; p>0.05); on the contrary, to what was observed among IUD users where both body weight and BMI had a significant increase (P<0.05). Likewise, most users remained in the same weight range as when starting the method (p<0.001); while weight gain was greater among IUD users (1,530±2.04 vs. 3,700±3.02; p<0.05). Conclusions: The ENG implant does not produce an increase in body weight after 12 months of use, with minimal adverse effects and high contraceptive efficacy.

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Objetivo: Analisar o uso dos contraceptivos hormonais em mulheres com asma e a escolha desses métodos contraceptivos para essa população, com avaliação de eventuais repercussões sobre novos episódios de asma e sibilos. Métodos: Foram selecionados estudos longitudinais, ensaios clínicos, revisões sistemáticas e metanálises. As plataformas consultadas foram PubMed, Embase, Cochrane e SciELO, com a utilização dos descritores: "contracepção", "contracepção hormonal", "sistema intrauterino liberador de levonorgestrel" e "asma". Resultados: Dois grandes estudos demonstraram que o uso de contraceptivos hormonais esteve associado à redução do risco de novos episódios de asma. Uma revisão sistemática concluiu que os resultados para o uso de contraceptivos hormonais para mulheres com asma foram mistos, com aumento ou redução dos seguintes riscos: novo episódio de asma e aumento da frequência das crises e dos sibilos. O uso da contracepção hormonal em pacientes obesas portadoras de asma é controverso. Conclusão: Os resultados para o uso de contraceptivos hormonais em mulheres com asma são inconsistentes, com relatos de aumento ou de redução do risco de novos episódios. O uso do método contraceptivo deve ser discutido individualmente, levando-se em consideração outros fatores de risco associados e o desejo da mulher. A paciente deverá ser orientada se houver piora dos sintomas clínicos de asma na vigência do uso de qualquer método contraceptivo hormonal.

Objective: To analyze the use of hormonal contraceptives in women with asthma and the choice of this contraceptive method for this population, evaluating possible repercussions on new episodes of asthma and wheezing. Methods: Longitudinal studies, clinical trials, systematic reviews and meta-analyses were selected. Platforms consulted: PubMed, Embase, Cochrane, SciELO, using the descriptors: "contraception", "hormonal contraception", "levonorgestrel-releasing intrauterine system" and "asthma". Results: Two large studies demonstrated that the use of hormonal contraceptives was associated with a reduced risk of new episodes of asthma. A systematic review concluded that the results for the use of hormonal contraceptives for women with asthma were mixed, with increased or decrease in the following risks: new asthma episodes, increased frequency and wheezing. The use of hormonal contraception in obese patients with asthma is controversial. Conclusion: The results for the use of hormonal contraceptives in women with asthma are inconsistent, with reports of increased or reduced risk of new episodes. The use of the contraceptive method should be discussed individually, taking into account other associated risk factors and the woman's desire. The patient will be advised if there is a worsening of the clinical symptoms of asthma while using any hormonal contraceptive method.

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OBJECTIVE: To compare the continuation rates, expulsion, and other reasons for discontinuation of the hormonal intrauterine device with 52 mg of levonorgestrel (52 mg LNG-IUD) in adolescents and adult women. METHODS: We conducted a retrospective cohort study that included 393 women in whom we placed a 52 mg LNG-IUD and followed up to 5 years. We created two retrospective cohorts, one with 131 adolescents (aged between 12 and 19 years) and the other with 262 women aged ≥20 years. Each adolescent was paired with two adult women who had the same parity and who had a 52 mg LNG-IUD inserted on the same day. We used the Mann-Whitney test to compare numerical variables in both groups, the Kaplan-Meier method, and the log-rank test to compare the continuation, expulsion and other reasons for IUD discontinuation of the two groups. RESULTS: Age of the adolescents and adult women were mean ± SD 18.1 (±1.1) and 31 (±6.8) years, respectively (p = 0.015). Continuation rates by the fifth year of use were 55.6/100 women-years (W-Y) and 70.3/100 W-Y among adolescents and adult women (p = 0.106); and expulsion rates were 8.4/100 and 6.0/100 W-Y, respectively (p = 0.463). Adolescents had a lower continuation rate during 3 to 5 years of follow-up (p = 0.011) and a high rate of removals due to bleeding/pain (18.5 ± 5.7/100 W-Y vs 6.4/100 ± 2.1 W-Y, p = 0.039). CONCLUSION: Adolescents who used the 52 mg LNG-IUD showed a lower continuation rate 3-5 years after device placement than adult women. The expulsion rates were similar in both groups.

Adolescents who used the 52 mg LNG-IUD showed expulsion rates similar than adult women. Despite the good continuation rate, adolescents had a lower continuation rate within 3­5 years of follow-up and high rate of removals due to bleeding/pain than adult users.

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OBJECTIVES: To assess perimenopausal users of 52 mg levonorgestrel intrauterine devices (LNG-IUD) regarding the IUD impact after menopause. MATERIAL AND METHODS: a cross-sectional study with users aged 40 and 49 years old, without cognitive impairment that answered a questionnaire regarding worries and benefits after the menopause due to LNG-IUD use. RESULTS: Almost half of 221 users (52.9%) have concerns that LNG-IUD use could influence aspects after menopause, 111 (50.3%) that the post-menopause symptoms get worse and 92 (41.6%) that interfere with recognition of menopausal symptoms. CONCLUSION: Half of perimenopausal LNG-IUD users expressed concerns about how device use could affect post-menopause symptoms.

The 52 mg hormonal-IUD who were at menopausal transition reported worries that the use of the IUD can affect menopausal symptoms. It is important that health professionals can routinely guide these women.

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OBJECTIVE: To describe the feasibility of an ultrasound-guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation. METHODS: This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6-month follow-up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications. RESULTS: We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound-guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow-up. No uterine perforation or infection-related complications occurred within 6 months of the procedure. CONCLUSION: The ultrasound-guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

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ABSTRACT Objectives: to evaluate the outcomes of Interval Copper Intrauterine Device (IUD) insertion performed by certified midwives and obstetric nurse practitioners at a Peri-Hospital Birth Center. Methods: a cross-sectional study was conducted involving 75 women who underwent IUD insertion between January 2018 and February 2020. Data collection was carried out using medical records and telephone interviews. Results: no instances of uterine perforation were observed. Expulsion rates of the devices were 1.3% within 30 to 45 days of use and 5.3% within the first year of use. The follow-up removal rate was 4.0%. The average pain score reported was 4.2 (SD = 3.3). Among those who continued using the device, 93.1% expressed satisfaction. Conclusions: the findings demonstrate that IUD insertion by certified midwives and obstetric nurse practitioners is a safe procedure, yielding outcomes comparable to those reported in the existing literature.

RESUMEN Objetivos: evaluar los resultados de la inserción del dispositivo intrauterino de cobre (DIU) realizado por matronas certificadas y enfermeras obstétricas especializadas en un Centro de Nacimientos Peri-Hospitalario. Métodos: se realizó un estudio transversal que incluyó a 75 mujeres sometidas a la inserción del DIU entre enero de 2018 y febrero de 2020. La recopilación de datos se realizó mediante registros médicos y entrevistas telefónicas. Resultados: no se observaron casos de perforación uterina. Las tasas de expulsión del dispositivo fueron del 1,3% en los primeros 30 a 45 días de uso y del 5,3% durante el primer año de uso. La tasa de retirada durante el seguimiento fue del 4,0%. La puntuación promedio del dolor informada fue de 4,2 (DE = 3,3). Entre aquellas que continuaron utilizando el dispositivo, el 93,1% manifestó satisfacción. Conclusiones: los hallazgos demuestran que la inserción del DIU por parte de matronas certificadas y enfermeras obstétricas especializadas es un procedimiento seguro, que produce resultados comparables a los reportados en la literatura existente.

RESUMO Objetivos: avaliar os desfechos da inserção do Dispositivo Intrauterino de Cobre de Intervalo por obstetrizes e enfermeiras obstetras em um Centro de Parto Normal Peri-hospitalar. Métodos: estudo transversal conduzido com 75 mulheres que tiveram o dispositivo inserido entre janeiro de 2018 e fevereiro de 2020. A coleta de dados foi realizada a partir de prontuários e contato telefônico. Resultados: não houve nenhuma perfuração uterina; 1,3% dos dispositivos foram expulsos com 30 a 45 dias de uso e 5,3% no primeiro ano de uso; a taxa de necessidade de remoção no retorno foi de 4,0%; e a pontuação média de dor foi 4,2 (DP = 3,3). Entre aquelas que ainda usavam o dispositivo, 93,1% se consideraram satisfeitas. Conclusões: a inserção do dispositivo por enfermeiras obstetras e obstetrizes mostrou ser segura, com desfechos similares aos observados na literatura.

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Abstract Objective To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. Materials and Methods In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. Results There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Conclusion Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Resumo Objetivo Avaliar as taxas de expulsão e continuação do dispositivo intrauterino (DIU) de cobre inserido no pós-parto imediato em um hospital universitário brasileiro. Materiais e Métodos Neste estudo de corte transversal, foram incluídas parturientes submetidas à inserção de DIU de cobre no pós-parto imediato entre março de 2018 e dezembro de 2019. Foram coletados dados clínicos e da ultrassonografia (US) transvaginal realizada após seis semanas. As taxas de expulsão e de continuação foram avaliadas após seis meses por meio de dados do prontuário ou por contato telefônico. O resultado principal foi a proporção de DIUs expelidos em seis meses. Para análise estatística, utilizaram-se o teste t de Student, a distribuição de Poisson, e o teste do Qui quadrado. Resultados Houve 3,728 nascimentos no período, e foram inseridos 352 DIUs, em uma taxa de 9,4%. Com 6 semanas, o DIU estava bem posicionado em 65,1% dos casos, em 10,8%, houve expulsão parcial, e, em 8,5%, fora totalmente expelido. Aos 6 meses de pós-parto, foram obtidas informações de 234 mulheres, 74,4% das quais usavam DIU, com uma taxa de expulsão geral de 25,6%. A taxa de expulsão foi maior após o parto vaginal do que após cesariana (68,4% versus 31,6%, respectivamente; p = 0,031). Não houve diferenças quanto à idade, paridade, idade gestacional, índice de massa corpórea final, e peso do recém-nascido. Conclusão Apesar da baixa taxa de inserção e alta taxa de expulsão, a taxa de continuação em longo prazo da contracepção intrauterina com DIU de cobre foi elevada, o que indica que se trata de intervenção útil para prevenir gestações indesejadas em curto intervalo de tempo.

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BACKGROUND: Ensuring effective and long-term contraception in the immediate postpartum period is an effective strategy for reducing unplanned pregnancies. In the meantime, the intrauterine device (IUD) is an excellent option. The aim of our study was to evaluate the best way to insert post-placental IUDs in the immediate postpartum period. Discomfort during insertion, expulsion rate, uterine perforation rate, and proper positioning 40-60 days postpartum will be analyzed. METHODS: Randomized, controlled, open clinical trial. The study group will be composed of women between 18 and 43 years old who are admitted for vaginal birth at the Women's Hospital of the State University of Campinas and who wish to use the IUD as a contraceptive method. The sample will be randomized into two insertion groups: manual and forceps. To calculate the sample size, the method of comparing the proportion between 2 groups was used, setting the level of significance alpha at 5% (alpha=0.05) and the power of the sample at 80% (beta=0.20). Based on the results, it was estimated that a sample of n=186 women (n=93 with manual insertion and n=93 with forceps) would be representative for comparison of expulsion between the 2 groups. All participants will undergo a postpartum consultation 40-60 days after birth with transvaginal ultrasound to assess the proper placement of the IUD. DISCUSSION: Insertion of an IUD in the immediate postpartum period has been considered a good option to increase coverage and access to contraception, and its benefit outweighs the inconvenience of a higher expulsion rate. TRIAL REGISTRATION: This study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 50497321.4.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC) (number RBR-4j62jv6). This is the first version of the study protocol approved on 11/12/2021 prior to the start of participant recruitment.

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Pelvic actinomycosis is a rare condition, usually associated with intrauterine device (IUD) use. Its clinical presentation may vary from being asymptomatic to the mimicking of pelvic malignancy; it has been described as one of the most misdiagnosed diseases. A 78-year-old woman without a history of IUD use, arrived at our clinic complaining of chronic and intermittent postmenopausal bleeding associated with lower pelvic pain. An endometrial curettage was performed, and endometritis (caused by Actinomyces) identified. Treatment with intravenous piperacillin and tazobactam for 7 days, followed by 6 weeks of oral ampicillin, daily, decreased the bleeding and the pain. Although rare, it is important to consider Actinomyces-related endometritis as a differential diagnosis in cases of elderly woman with postmenopausal bleeding and without a history of IUD use.

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O Dispositivo Intrauterino (DIU) é um método contraceptivo que encontra vários entraves para a ampliação da sua oferta na Atenção Primária à Saúde (APS). Uma das principais barreiras à sua inserção é a falta de treinamento dos profissionais. Por isso, o presente estudo tem como objetivo descrever as dificuldades encontradas nos procedimentos de inserção do DIU na Atenção Primária e os fatores associados a essa dificuldade. Foi feita a tentativa de realizar a inserção do DIU nas Unidades Básicas de Saúde (UBS) em 152 mulheres em idade reprodutiva. Os dados foram coletados através de um questionário estruturado em amostragem não-probabilística por conveniência. A idade média das mulheres foi de 27 anos e 26,3% (40) dos procedimentos foram considerados com algum grau de dificuldade. O escore médio de dor foi maior nos procedimentos que apresentaram dificuldade, sendo de 4,59 e de 5,7 nas inserções sem e com dificuldade, respectivamente (p<0.0001). A média de tempo de formado entre os médicos que tiveram dificuldade foi de 33,5 meses e entre aqueles que não tiveram dificuldade foi de 64 meses (p< 0,0001). Entre as dificuldades, a mais referida foi o momento de realizar a histerometria. Outras dificuldades também foram encontradas: identificar e pinçar o colo uterino e identificar posição uterina.

The Intrauterine Device (IUD) is a contraceptive method that faces several obstacles to expanding its offer in Primary Health Care. One of the main barriers to its insertion is the lack of training of professionals. Therefore, this study aims to describe the difficulties found in IUD insertion procedures in Primary Care and the factors associated with this difficulty. An attempt was made to insert the IUD in the Basic Health Units in 152 women of reproductive age. Data were collected through a structured questionnaire in non-probabilistic convenience sampling. The mean age of women was 27 years and 26.3% (40) of the procedures were considered to have some degree of difficulty. The mean pain score was higher in procedures that presented difficulty, being 4.59 and 5.7 in insertions without and with difficulty, respectively (p<0.0001). The average time since graduation among physicians who had difficulty was 33.5 months and among those who had no difficulty, it was 64 months (p<0.0001). Among the difficulties, the most mentioned was the time to perform the hysterometry. Other difficulties were also encountered: identifying and clamping the cervix and identifying the uterine position

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OBJECTIVE: To compare the expulsion and continuation rates of the levonorgestrel (LNG) 52 mg intrauterine system (IUS) in a cohort of nulligravid and parous users. METHODS: We conducted a retrospective cohort study that included 996 participants in whom we placed an LNG-IUS, and the participants were monitored for up to 5 years after device placement. We identify 498 nulligravid participants in the medical record database between 2012 and 2020. Each nulligravida was paired with a parous users who had an LNG-IUS inserted on the same day, just before or after the nulligravida. The Kaplan-Meier method and the log-rank test were used to compare the survival curves of the two groups. RESULTS: By the fifth year of use, the expulsion rates were 7.6/100 and 8.2/100 women-years (W-Ys) and the continuation rates were 641/100 W-Ys and 65.4/100 W-Ys without difference among nulligravid and parous users, respectively (P = 0.782 and P = 0.564, respectively). We observed 29 and 31 expulsions among nulligravid and parous users, respectively. CONCLUSION: Nulligravid and parous participants who used the 52 mg LNG-IUS showed similar expulsion and continuation rates during five years of use.

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OBJECTIVE: To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative. STUDY DESIGN: LARC insertion data (682 implants and 681 intrauterine devices [IUDs]) were prospectively collected from January 1, 2017, through December 31, 2019, across 3 Adolescent Medicine practices. Follow-up data through December 31, 2020, were included to ensure at least 1 year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3 years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience. RESULTS: Implant and IUD insertion complications were uncommon and largely self-limited, with no IUD-related uterine perforations. Uterine bleeding was the most frequently reported concern at follow-up (35% implant, 25% IUD), and a common reason for early device removal (45% of implant removals, 32% of IUD removals). IUD malposition or expulsion occurred following 6% of all insertions. The pooled implant continuation rate at 1 year was 87% (range, 86%-91% across sites; P = .63), 66% at 2 years (range, 62%-84%; P = .01), and 42% at 3 years (range, 36%-60%; P = .004). The pooled IUD continuation rate at 1 year was 88% (range, 87%-90% across sites; P = .82), 77% at 2 years (range, 76%-78%; P = .94), and 60% at 3 years (range, 57%-62%; P = .88). CONCLUSIONS: LARC is successfully provided in Adolescent Medicine clinical settings, with continuation rates analogous to those of well-resourced clinical trials. Uterine bleeding after LARC insertion is common, making counselling imperative. Future analyses will assess whether the medical management of LARC-related nuisance bleeding improves continuation rates in our Adolescent Medicine patient population.

Assuntos

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OBJECTIVE: To compare the sociodemographic characteristics of users of the copper intrauterine device (Cu-IUD) and the levonorgestrel intrauterine system (LNG-IUS) at a family planning clinic in Campinas, SP, Brazil. METHODS: A retrospective audit study was conducted to analyze the characteristics of new users of IUDs at the clinic of the Department of Obstetrics and Gynecology, University of Campinas. Data covered insertions performed between 1979 and 2006 when only the Cu-IUD was offered at the clinic, and between 2007 and 2019 when the LNG-IUS was also offered, both free of charge to women. Logistic regression analysis was performed. RESULTS: There were 31 385 insertions. Cu-IUD: n = 17 156 (1979-2006) and n = 2013 (2007-2019); LNG-IUS n = 12 216 (2007-2019). Up to 2006, Cu-IUD users were less likely to be nulligravidas, more likely to be younger than 40 years of age, and with fewer years of schooling. Following introduction of LNG-IUS, the sociodemographic characteristics of users presented major changes over time. Comparing the period 1979-2006 with 2007-2019, new users of the LNG-IUS were more likely to be older than 40 years of age, with fewer years of completed schooling, and to be nulligravidas. CONCLUSION: Major changes in sociodemographic characteristics of users were noted according to preference over time. Introduction of the LNG-IUS presents a major opportunity to increase IUD use.

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OBJECTIVE: To identify clinical and demographic factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices (TCu380A IUD). METHODS: This is a secondary analysis of an implementation study. We followed participants who had a postplacental TCu380A IUD insertion, at two postpartum visits: 45-90 days (visit 1) and 6-9 months (visit 2). We used multiple log-binomial regression models to evaluate the demographic and clinical variables associated with missing strings and with IUD expulsion. RESULTS: We included 705 participants who had a postplacental IUD insertion. We observed missing strings in 275 (47.9%) participants at visit 1, and in 127 (34.2%) participants at visit 2. We identified 61 expulsions (8.9%) by visit 2. In the multiple regression models, only the delivery type was associated with missing strings and expulsion. Compared with vaginal delivery, cesarean delivery increased the risk of missing strings (adjusted relative risk [aRR] 6.21; 95% confidence interval [CI] 4.29-8.99) but reduced the risk of IUD expulsion (aRR 0.24; 95% CI 0.13-0.43). CONCLUSION: The delivery mode was the only factor associated with missing strings and expulsion after postplacental IUD insertion. Cesarean section was associated with an increased risk of missing strings but decreased risk of expulsion after postplacental TCu380A IUD insertion.

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BACKGROUND: To compare the effectiveness of 550 mg naproxen sodium versus 6 mL 2%-lidocaine intracervical block in pain lowering at the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) placement in young women. METHODS: In this randomized controlled trial, 100 women aged 15-24 years were block-randomized to receive either 6 mL 2%-lidocaine intracervical block 5 min before the LNG-IUS insertion or 550 mg naproxen 30 min before the procedure. Forty-nine women received 550 mg naproxen and 51 received intracervical block. The primary outcome was pain at LNG-IUS insertion. Secondary outcomes were ease of insertion, insertion failures, and correct IUS positioning. Neither participants nor doctors were blinded. Pain at insertion was assessed by using a Visual Analog Scale (VAS). RESULTS: Women randomized to lidocaine intracervical block presented lower mean pain score at insertion, when compared to women who received naproxen (5.4 vs. 7.3, respectively; p < 0.001). Parous women had a 90.1% lower chance of experiencing severe pain (p = 0.004). There was a 49.8% reduction in the chance of severe pain for every 1-cm increase in the hysterometry (p = 0.002). The only complication observed during insertion was vasovagal-like reactions (7%). The insertion was performed without difficulty in 82% of the women. Participants in the intracervical block group presented higher proportion of malpositioned IUS on transvaginal ultrasound examination compared to women in naproxen group. Nevertheless, all the malpositioned IUS were inserted by resident physicians. CONCLUSION: Lidocaine intracervical block was found to be more effective than naproxen in reducing LNG-IUS insertion pain. TRIAL REGISTRATION NUMBER: RBR-68mmbp, Brazilian Registry of Clinical Trials, Retrospectively registered (August 4, 2020), URL of trial registry record: https://ensaiosclinicos.gov.br/rg/RBR-68mmbp/ .

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