Using laparoscope to remove an ectopic intrauterine device in the anterior wall of urinary bladder:A case report

BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intrauterine pressure and other factors.Ectopic IUDs are among the most serious complications.Ectopic IUDs are common in the myometrium and periuterine organs,and there are few reports of ectopic IUDs in the urinary bladder,especially in the anterior wall.CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography(CT)examination.The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain,accompanied by frequent urination,urgency,dysuria and other discomfort.Ultrasound examination revealed foreign bodies in the bladder cavity,with calculus on the surface of the foreign bodies.CT revealed a circular foreign body on the anterior wall of the urinary bladder,suggesting the possibility of an ectopic IUD.After laparoscopic exploration,an annular IUD was found in the anterior wall of urinary bladder,and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity.The IUD and calculus were successfully and completely removed.The patient recovered well after surgery.CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs.The IUD is located in the urinary bladder and requires early surgical treatment.The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer,the situation of complicated calculus,the situation of intravesical inflammation and medical technology and equipment.

非意愿妊娠女性人工流产后放置吉妮致美IUD效果

目的:探讨非意愿妊娠女性人工流产后放置吉妮致美宫内节育器(IUD)效果.方法:以2021年7月-2022年7月在本院自愿要求人工流产术的未育女性213例,对实行流产后关爱干预,其中选择IUD避孕103例为观察组,未选择IUD避孕方法110例为对照组,问卷调查比较两组干预前后对人工流产危害的知信行,比较流产后性生活恢复时间,随访1年非意愿妊娠及其妊娠原因、人工流产情况.结果:干预前后两组对人工流产危害性知识理论认知、态度信念、行为能力评分均提升(P<0.05),但两组间无差异;干预后观察组性生活恢复时间(3.7±0.1月)晚于对照组(3.2±0.9月),非意愿妊娠发生(8例,7.8%)低于对照组(24例,21.8%)(P<0.05),两组人工流产(0.9%、1.9%)发生无差异,观察组非意愿妊娠原因均为IUD脱落,对照组为避孕措施失败(11例,45.8%)和未避孕或避孕措施使用不正确(13例,54.2%).结论:吉妮致美IUD对降低人工流产后妇女非意愿妊娠有效,但需要重视IUD脱落率问题.

Postpartum Intrauterine Device: Use and Follow-Up of Users in the Maternity Ward of the Ratoma Communal Medical Center in Conakry, Guinea

Objective: The aim of this study was to describe the use of the postpartum intrauterine device in the maternity ward of the Ratoma communal medical center in Conakry. Methods: This was a descriptive cross-sectional study carried out between July 1st 2015 and June 30 2016, i.e. a duration of one year. Results: A total of 551 patients received advice on various contraceptive methods. Most of this advice was given in the post-partum period (40.2%) and during antenatal care (39.1%). Of the patients advised, 87 (15.8%) used the intrauterine device. The majority of users (93%) were married and uneducated (63.2%), and 39.1% were poor. The majority (56.3%) of intra-uterine devices were inserted in the immediate post-partum period. The majority of women had no adverse events either during the first six weeks (n = 57;65.5%) or at 3rd months (n = 75;86.2%) or 6th months (n = 76;87.4%) after IUD insertion. Most users remained complication-free throughout the follow-up period (n = 76;87.4% at 6th weeks and 3rd months, and n = 77;88.5% at 6th months). The continuation rate was 89.7% at 6 weeks and 3rd months, and 87.4% at 6th months after insertion. The majority of users (87.0%) were satisfied with the care they received. Conclusion: This study showed very few complications among intrauterine device users, and high continuation and satisfaction rates. The intrauterine device is a long-acting, effective, reversible and safe contraceptive that can be used by most women for birth spacing in Guinea, where women do not regularly visit health facilities.

瘢痕子宫人工流产术后即时放置元宫IUD与曼月乐IUD临床效果比较

目的:比较瘢痕子宫女性人工流产术后即时放置元宫IUD和曼月乐IUD临床效果。方法:选取2022年6月-2023年6月本院收治的瘢痕子宫行人工流产术女性104例,按照放置IUD种类的不同分组,分别放置元宫IUD(元宫组54例)、放置曼月乐IUD(曼月乐组50例)。随访6个月,比较两组IUD使用效果、阴道出血情况和不良反应。结果:曼月乐组放置1个月、6个月累计续用率(100.0%、90.0%)与元宫组(98.2%、81.5%)无差异(P>0.05);术后阴道出血时间(5.4±2.3 d)及阴道出血量(53.3±10.5 ml)均少于元宫组(7.8±3.1 d、75.7±11.4 ml),不良反应发生率(8.0%)低于元宫组(24.1%)(均P<0.05)。结论:瘢痕子宫女性人工流产术后即时放置两种IUD避孕效果相当,但曼月乐IUD可有效改善术后阴道流血情况,降低不良反应发生率。

常用IUD脱落或下移不良事件风险因素巢式病例对照研究

目的:探讨常用宫内节育器(IUD)发生脱落或下移不良事件的风险因素。方法:采用巢式病例对照研究方法,以2015-2020年参加IUD首诊排查登记且放置数量位为前10位的IUD类型的使用对象为基础建立队列,回顾或前瞻性的收集相应检查结果,其中发生IUD脱落或下移不良事件的对象994例,按照1∶3的方法匹配对照,采用条件logistic回归模型筛选出发生脱落或下移不良事件的可疑风险因素。结果:IUD类型、剖宫产史、副作用以及哺乳均为影响因素。脱落或下移的风险GCu200(OR=2.01,95%CI 1.36~2.96)、GCu220(OR=1.60,95%CI 1.08~2.37)、OCu200(OR=2.00,95%CI 1.25~3.22)、TCu220C(OR=1.56,95%CI 1.10~2.23)、固定式(OR=2.00,95%CI 1.36~2.95)、活性165(OR=2.43,95%CI 1.62~3.64)、活性γ(OR=1.77,95%CI 1.21~2.59)和元宫200(OR=1.45,95%CI 1.02~2.06)高于活性γ(记忆合金);GCu220(OR=1.67,95%CI 1.07~2.60)和固定式(OR=1.66,95%CI 1.06~2.61)高于HCu280;GCu220(OR=0.66,95%CI 0.45~0.97)、HCu280(OR=0.50,95%CI 0.31~0.79)、TCu220C(OR=0.64,95%CI 0.45~0.92)和元宫200(OR=0.60,95%CI 0.42~0.85)低于活性165;有剖宫产史(OR=1.29,95%CI 1.09~1.52)、置器后发生副作用(OR=3.55,95%CI 2.80~4.49)及哺乳使用者(OR=4.62,95%CI 1.09~19.63)发生脱落或下移的风险增高。结论:应针对风险因素选择适合的IUD种类、型号并重视后期随访,以提高育龄妇女生殖健康水平。

绝经妇女取IUD阿芬太尼复合丙泊酚对宫颈软化、取器效果影响

目的:探讨阿芬太尼复合丙泊酚用于绝经妇女取宫内节育器术对宫颈软化程度、取器成功率的影响.方法:将2021年1月-2023年3月在本院妇科要求取器的100例绝经妇女随机分成两组各50例,分别予以芬太尼复合丙泊酚麻醉(芬太尼组)或阿芬太尼复合丙泊酚麻醉(阿芬太尼组).观察两组生命体征变化、应激反应、宫颈软化程度、取器成功率以及并发症(疼痛、子宫出血、子宫内膜损伤、感染).结果:术中、术毕即刻的平均动脉压、心率两组均降低但阿芬太尼组高于芬太尼组,术后皮质醇、去甲肾上腺素两组均升高但阿芬太尼组低于芬太尼组;阿芬太尼组宫颈完全软化率(90.0%)高于芬太尼组(74.0%),取器成功率(100.0%)高于芬太尼组(92.0%),并发症发生率(2.0%)低于芬太尼组(14.0%)(均P<0.05).结论:阿芬太尼复合丙泊酚应用于绝经妇女取器术效果较好,可稳定受术女性术中生命体征,减轻应激反应,改善宫颈软化程度,提高取器成功率,减少并发症.

未育女青年流产术后放置IUD与口服避孕药避孕效果及生命质量比较

目的:比较分析未育女青年人工流产术后放置吉妮致美宫内节育器(IUD)和复方口服避孕药(COC)避孕效果及对生命质量的影响。方法:前瞻性选择2018年7月-2021年7月在本院早孕要求人工流产后避孕的未育女青108例,随机分组原则分为IUD组和COC组,流产术后分别采取IUD避孕或COC避孕。分析两组术后阴道流血时间、术后及时避孕率、术后1年再次妊娠以及重复流产率、生命质量(SF-36评分)。结果:术后阴道流血时间COC组(5.1±1.2d)少于IUD组(9.0±1.1d)(P<0.05),两组术后及时避孕率均为100%;术后1年,COC组再次妊娠(1.8%)及重复流产率(0)均低于IUD组(12.7%、10.9%),SF-36评分生理功能(75.47±2.9分)、生理职能(74.4±3.0分)、躯体疼痛(86.7±2.0分)、一般健康(86.7±2.0分)、精力(86.2±2.5分)、社会功能(87.5±3.0分)、情感职能(75.8±2.8分)、心理健康(88.9±3.0分)均高于IUD组(65.5±2.9分、70.7±2.8分、80.5±2.6分、80.6±2.5分、80.3±2.9分、77.9±2.5分、70.4±2.7分、77.8±2.6分)(均P<0.05)。结论:育龄妇女人工流产术后使用口服避孕药避孕,术后恢复更快,避孕有效率高,且提升避孕期间的生命质量。

Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

BACKGROUND A cystic lesion arising from the myometrium of the uterus, termed as cystic adenomyosis, has chocolate-like, thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium. It is an extremely rare type of adenomyosis.CASE SUMMARY Herein, we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy. The patient complained of abnormal uterine bleeding and severe dysmenorrhea. After a levonorgestrel-containing intrauterine device(LNG-IUD) was inserted, her symptoms were greatly alleviated. However, the LNG-IUD was detected in the cystic cavity during the follow-up. For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed. Therefore, laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.CONCLUSION We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

Releasing of Cupric Ion of Three types of Copper-bearing Intrauterine Contraceptive Device in Simulated UterineFluid

Objective To compare the cupric ion releasing in vitro o.f the three IUDs. Methods The stability o.f cupric ion releasing o.f IUDs including TCu 380.4 IUD （TCu 380A）, Multiload Cu375 IUD （MCu 375） and Yuangong 365 copper-bearing indomethacin-releasing IUD （Yuangong 365） by the determination of cupric ion releasing in simulated uterine fluid. The simulated uterine fluid was used for releasing media. Copper ion was determined by flame atomic absorption spectrometer. Results The cupric ion releasing of three IUDs were instable at the beginning and tend to be stable gradually. In the stable phase, the average level of cupric ion releasing of TCu380A, MCu375 and Yuangong 365 were 4.25±2.71-7.62±6.42 μg, 4.92±1.23 -8.62±3.08 μg and 2.19±0.40-4.68±1.66 μg, respectively. TCu380A had higher instable releasing level than those of Yuangong 365 （P〈0. 05）. Conclusion TCu 380.4 and MCu 375 showed a ＂burst release＂ during the first few days and the.former was of great significance（P〈0.05）. The initial cupric ion releasing of Yuangong 365 appeared to be the lowest, followed by MCu375 and TCu380A in a releasing order

Pre-Clinical Experimental Studies of Indomethacin-Releasing Copper Intrauterine Device

Effects of two types of intrauterine device (IUD) on the prostaglandins and endothelin (ET) in uterus and on the endometrial morphology in rats and rabbits, and Cu 2+ releasing amounts of both IUDs in vitro were observed. The results showed that the inhibiting action of the indomethacin releasing copper IUD (FICu IUD) on the PGI 2 was stronger than that on the TXA 2, the ratio of 6 keto PGF 1α /TXB 2 was reduced with the increase of the doses. There were significant differences between the groups. The FICu IUD could inhibit the rising of the ET level and lighten the endometrial impairment caused by the FCu IUD, and promote copper ion release. It was suggested that indomethacin released by FICu IUD could effectively reduce abnormal uterine bleeding.

不同分娩史妇女早孕负压吸宫术后即时放置吉妮致美IUD的多中心临床观察

目的:观察不同分娩史妇女早孕负压吸宫术后即时放置吉妮致美IUD的效果。方法:将2017年1月-2019年10月在15家医院自愿要求于负压吸宫术后即时放置吉妮致美IUD的2994例作为观察对象,根据既往分娩方式分为阴道分娩组(1617例)和剖宫组(1377例),随访12个月。结果:共有2610例观察对象纳入12个月生命表分析,剖宫产组(1129例)放置12个月的帶器妊娠、脱落相关终止、因症取出和IUD相关终止的比尔指数分别为每百妇女年0.39、2.70、2.21、5.22,均高于阴道分娩组(1481例)的每百妇女年0.07、1.90、1.73、3.67,但两组间差异无统计学意义(P>0.05)。结论:不同分娩史对早孕负压吸宫术后即时放置吉妮致美IUD的效果无明显影响。

Ectopic intrauterine device in the bladder causing cystolithiasis:A case report

BACKGROUND An intrauterine device(IUD)is a commonly used contraceptive among women in China.It is widely used because it is safe,effective,simple,economic,and reversible.Among the possible complications,an ectopic IUD in the bladder is rare.It occurs insidiously,has a long course,is associated with a high risk for injury,and is difficult to treat.CASE SUMMARY A 44-year-old woman was admitted for repeated episodes of urinary frequency,urgency,and dysuria over three months.Laboratory tests revealed significantly elevated urine leukocytes and bacteria.Urine culture suggested colonization with Enterococcus faecalis.Abdominal computed tomography images suggested an abnormally positioned IUD that was protruding into the bladder.Cystoscopy revealed a metallic foreign body with multiple stones on its surface in the left posterior bladder wall.The foreign body measured approximately 1 cm.Hysteroscopy revealed the arm of a V-type metal IUD embedded in the middle and upper sections of the anterior wall of the cervical canal.The majority of the IUD was located in the uterine cavity.Cystoscopy was performed,and a holmium laser was utilized to break the stones attached to the portion of the IUD in the bladder.The IUD was then removed through hysteroscopy.CONCLUSION Ectopic IUDs in the bladder can be diagnosed with thorough imaging and safely removed through cystoscopy or hysteroscopy.

Barriers to Intrauterine Device Use at an University-Based Women’s Clinic

Objective: The purpose of this study was to determine the barriers to intrauterine device (IUD) use at a University-Based Women’s Clinic. Methods: This study is a cross-sectional survey of a convenience sample of subjects receiving obstetrical care at a University-Based Women’s Clinic. Eligible women who consented to participate self-administered a 16-question survey during a routine prenatal visit. Descriptive statistics were used to report participants’ demographics and history of contraception use. Additionally, subjects were asked if they would consider IUD use in the future. Results: A total of 160 women participated in this study. The average age of this sample was 24.9 (SD = 6.3). The majority were in low income and low education categories. Only 5% of women reported previous IUD use. 27% of women surveyed desired more information regarding IUD contraception. 19% of participants would consider using an IUD in the future and 25% would consider?IUD in the future if they knew more about them. Insurance and financial constraints were cited as barriers to IUD use. 4% of the sample reported that they had used an IUD previously and were unhappy with it due to pain and discomfort. 18% would not consider an IUD because they had heard about side effects. 68%?of the surveyed sample reported unintended pregnancies. Conclusion: The two most common barriers to IUD use in this patient population was lack of knowledge?and concern about side effects. Increasing patients’ knowledge of IUDs has the potential to increase IUD utilization in this clinic population which reported a 68% rate of unintended pregnancy.

Effect of Domestically-made Levonorgestrel-releasing Intrauterine Device on the Endocrine System and Mensentruation in Monkeys

Effect of domestically-made levonorgestrel-releasing intrauterine device (LNG, release rate: 6 μg/day) on the endocrine system and menstruation in mondeys was investigated. The results showed that the Estradiol (E2) and progesterone (P) levels were significantly decreased 2 ovulatory cycles after iusertion of the devices as compared with those before insertion in 3 monkeys (P>0. 001) ,suggesting an evident ovulation-suppressing effect. In 1 monkey, the E2 and P levels were the same before and after insertion,and expulsion of device was found in the monkey later. The plasma LNG concentration in 3 animals was 493. 69-454. 60 pg/ml and plasma LNG was not detected in 1 monkey. The hormone level returned to normal level after removal of the devices.

Vaginitis in Intrauterine Contraceptive Device Users

Objectives: This study aimed to assess clinical, microbial changes in IUD users and other contraceptive methods in referent to urban health centers in Hamadan city, Iran. Methods: Detailed history and gynecological examination were conducted on women (IUD users, n = 100) or other contraceptive methods (controls, n = 160) in the health centers. Results: Frequencies of the different vaginal pathogens, high indices of infection by bacterial vaginosis (12.0%) candida albicance (7.0%) and low indices of trichomoniasis (5.0%) were found in present study, but none of them in both groups was significant. Menorrhagia was more frequent among women with IUD than that among women without IUD (P < 0.05). A trend of erosion cervix and dysmenorrhea being more frequent among women with IUD was also found (P < 0.05). Conclusions: IUD is the safety in general;however, an increase occurred in the frequency of vaginitis.

A comparative, randomized study of levonorgestrel Intrauterine System (LNG-IUS) vs Copper T 380 A intrauterine device applied during cesarean section

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.

Intrauterine contraceptive device appendicitis: A case report

Uterine perforation is one of the serious complications associated with use of the intrauterine contraceptive device （IUD）. Uterine perforaUon by IUD can involve several neighboring organs. A case of acute appendicitis was caused by a Multiload Cu 375 TUD inserted previously. This is a rare complication and only fourteen previous cases were recorded in the literature.

Com parison betw een Two Techniques Used in Im m ediatePostplacentalInsertion of TCu 380AIntrauterine Device:36-Month follow-up

Three hundred and eighty four women in Shanghai who delivered vaginally and chose IUD for contraception received the copper T 380A IUD inserted vaginally within 10 min after delivery of the placenta(i.e.,immediate postplacental insertion, IPPI). Among them, 98.70% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD insreted by ring forceps. Using Life Table Method and χ 2 test, expulsion and other discontinuation rates were compared at 6, 12, 24, and 36 months post insertion between these two different groups. No uterine perforation, infection or prolonged period of lochia occurred in the 384 cases. Expulsions were the main reason for discontinuation. From 6 months to 36 months, the gross cumulative rates of all discontinuation events (expulsion, pregnancy, removal for bleeding/pain, etc.) were not statistically significantly different (P>0.05). The results suggest that these two different insertion techniques do not significantly affect discontinuation rate in vaginal IPPI using the TCu 380 A, which appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breast feeding and IUD position in uterine cavity, are also analyzed and discussed in this paper.

Can We Predict Menorrhagia with Intrauterine Contraceptive Device (IUCD) Insertion?

Objective: Studying sub endometrial vascularity and blood flow in cases using intrauterine contraceptive devices for contraception with and without menorrhagia compared to cases not using intrauterine contraceptive devices. Methods: Three hundred and fifteen women attending gynecology and family planning outpatient clinics in the maternity hospital, Ain Shams University were included in the study. They were classified into three groups, 105 women using IUCD with menorrhagia (group I), 105 women using IUCD without menorrhagia (group II), and 105 normal controls not using IUCD (group III). After excluding local causes for bleeding, blood disease or any medical disorders, transvaginal ultrasound including three dimensional power Doppler (3DPD) ultrasound was done for all women. Right and left uterine artery pulsatility index (PI) and resistance index (RI) were calculated, subednometrial blood flow RI and PI were obtained then 3DPD Vascular indices (VI, FI and VFI) of subendometrial blood flow were obtained for all cases. Statistical analysis was done to compare between the three groups. Results: A significant statistical difference was found as regards subendometrial vascularity indices, while there was no difference as regards bilateral uterine arteries Doppler indices in the three groups. Conclusion: Subendometrial vascularity in cases of menorrhagia with IUCD was markedly higher than in cases without menorrhagia and cases with no IUCD. 3DPD may be used for selection of cases prior to insertion of IUCD.

Postpartum intrauterine device contraception: A review

AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period （within 10 min）, early post placenta period （10 min to 72 h）, and de-layed/interval period （greater than 6 wk）. Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS： IUD insertion in the immediate postpartum （within 10 min of placental delivery）, early postpartum （10 min up to 72 h） and Interval/Delayed （6 wk onward） were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal （copper） IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION： IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.