Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a p...Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a primary reference hospital at Puebla City, Mexico. Sample: 396 women requiring CS signed informed consent and were randomly allocated to the post-placental application of LNG-IUS (198) or Copper T 380 A (198). Methods: Follow up visits at 6 weeks, and 6 and 12 months were performed. Main Outcomes Measures: IUDs expulsion, maternal and babies’ health conditions, breastfeeding and menstrual patterns, adverse effects and pregnancies. Differences between groups were analyzed by Fisher and X2 tests, Odds ratios, relative risk and 95% confidence limits, as appropriate. Results: After one year of follow up, no pregnancies were reported. The IUD expulsion rate was 4.5% in each group. LNG-IUS users had a higher incidence of amenorrhea (OR 2.5 95% CI 2.2 - 3) and menstrual patterns significantly brief and lighter than Copper T 380 A (p < 0.001) with lower incidence of dysmenorrhea (OR 0.1 95% CI 0.04 - 0.2). No detrimental effects of LNG-IUS on breastfeeding was observed and interestingly babies weights of LNG-IUS users was slightly above the average for age compared with Copper T 380 A users. This was probably related with a major proportion of women with normal ferritin serum levels (94% vs 68%) leading to better mother’s general condition. Conclusions: LNG-IUS inserted during CS provides high efficacy contraception with additional benefits, mainly reducing menstrual bleeding and doing so, faster recovery of ferrous homeostasis after CS.展开更多
文摘Objective: To assess levonorgestrel-releasing intrauterine system LNG-IUS (Mirena?) application at caesarean section (CS). Design: Randomized, comparative study. Setting: Department of obstetrics and gynecology in a primary reference hospital at Puebla City, Mexico. Sample: 396 women requiring CS signed informed consent and were randomly allocated to the post-placental application of LNG-IUS (198) or Copper T 380 A (198). Methods: Follow up visits at 6 weeks, and 6 and 12 months were performed. Main Outcomes Measures: IUDs expulsion, maternal and babies’ health conditions, breastfeeding and menstrual patterns, adverse effects and pregnancies. Differences between groups were analyzed by Fisher and X2 tests, Odds ratios, relative risk and 95% confidence limits, as appropriate. Results: After one year of follow up, no pregnancies were reported. The IUD expulsion rate was 4.5% in each group. LNG-IUS users had a higher incidence of amenorrhea (OR 2.5 95% CI 2.2 - 3) and menstrual patterns significantly brief and lighter than Copper T 380 A (p < 0.001) with lower incidence of dysmenorrhea (OR 0.1 95% CI 0.04 - 0.2). No detrimental effects of LNG-IUS on breastfeeding was observed and interestingly babies weights of LNG-IUS users was slightly above the average for age compared with Copper T 380 A users. This was probably related with a major proportion of women with normal ferritin serum levels (94% vs 68%) leading to better mother’s general condition. Conclusions: LNG-IUS inserted during CS provides high efficacy contraception with additional benefits, mainly reducing menstrual bleeding and doing so, faster recovery of ferrous homeostasis after CS.
