Factors Influencing the Choice between IUD and Implant among Long-Acting Reversible Contraceptive (LARCs) Users in Burkina Faso

Background: Long-acting and reversible contraceptive methods hold great potential as solutions to address the unmet need for contraception and the significant discontinuation rates, especially in sub-Saharan Africa. Among these methods, the Implant has gained popularity in sub-Saharan Africa, whereas the utilization of Intrauterine Devices (IUDs) has remained comparatively low, particularly in Burkina Faso. This study aims to evaluate the shifts in IUD and Implant usage from 2010 to 2020 and to pinpoint the factors influencing the choice of IUDs among LARCs users in Burkina Faso. Data and Methods: We conducted an analysis using data from Burkina Faso, drawn from the 2010 Demographic and Health Survey (DHS) and the 2020 PMA Phase 1 data. The 2010 DHS garnered responses from 17,087 women aged 15 - 49, achieving a response rate of 98.4%. The 2020 PMA data collected responses from 6590 women aged 15 - 49, with a response rate of 95.8%. The final sample of Long-Acting Reversible Contraceptives (LARCs) users consisted of 1502 women, including 576 women from the 2010 survey and 926 women from the 2020 survey. Results: The study demonstrates an expansion of IUD usage to include socioeconomically disadvantaged segments among LARC users. However, higher levels of education, older age, and decisions influenced by healthcare providers are correlated with the preference for IUDs over Implants. The choice of IUDs is also connected to a comprehensive understanding of contraceptive methods, suggesting potential biases in the counseling process. Conclusion: Facilitating the broader adoption of IUDs among disadvantaged groups could be achieved by improving the accessibility of IUD products and services in rural areas. Nevertheless, there should be focused initiatives to enhance access to removal services, as this factor could dissuade specific users. Further efforts are required to train healthcare providers, aiming to mitigate biases in delivering Long-Acting Reversible Contraceptives (LARCs). Providers should provide impartial counseling, irrespective of the selected type of LARC.

An Investigation on the Utilization of Intra Uterine Contraceptive Device among Women in Kabwe, Central Province

Introduction: Intrauterine contraceptive device (IUCD) is an effective long acting reversible contraceptive but its use is low. This study examined factors contributing to the utilization of intrauterine contraceptive devices (IUCDs) among women in Kabwe Central Province. Methodology: This was an analytical cross sectional study. Primary data was collected from 150 respondents in using simple random sampling method. Data was analysed using the statistical package of social sciences (SPSS) version 22. Chi-square test was used to test associations among the dependent and independent variables. Logistic regression analysis was conducted. The confidence interval was set at 95% and significant level was at 0.05%. Findings: The study found that 44% of the respondents had high level of knowledge about IUCD. About 28% of the respondents, said that they used IUCD because it maintains menstrual bleeding, 26% said that they used because IUCD it does not cause infections, and 19% said that they used IUCD because it does not migrate to other body parts. Majority (81%) of the respondents agreed with a statement that age contributes to underutilization of IUCD. About 77% of the respondents agreed with a statement that marital status contributes to underutilization of IUCD and 75% agreed with a statement that, education level contributes to underutilization of IUCD and was significant. Furthermore, 91% of the respondents agreed with a statement that lack of knowledge about IUCD contributes to underutilization of IUCD and 74% agreed with a statement that religion contributes to underutilization of IUCD. Age (p = 0.003), marital status (p = 0.002), education level (p = 0.003), and employment status (p = 0.02), were found to have a significant relationship with the utilization of IUCD. About 36% of the respondents said that knowledge or education affects the utilization of IUCD at a large extent. The study showed a positive relationship between the utilization of IUCD and all explanatory variables such as age, education/knowledge, marital status, religion, family size and income and acceptability which had a positive correlation ranging from 0.543 to 0.815. Older women with higher education levels were more inclined to use IUCDs compared to younger individuals and those with only a primary education. Religious affiliation influenced IUCD use with Muslim women being less likely to opt for IUCDs. Moreover, being married was associated with lower IUCD utilization. Conclusion: Based on these findings, the study identified age, education/knowledge, marital status, religion, family size and income, and acceptability as the primary drivers of IUCD usage. The study recommends that, there should be a conduct of educational workshops, there should be community awareness programs and there should be comprehensive family Planning Services.

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

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.

A 20-Year-Old Contraceptive Device Transformed into a Calcified Mass

Case: A 52-year-old female who was presented to accident and emergency felt unwell;she reported that she had an IUCD inserted over 20 years ago. On examination she had a large calcified mass occupying the vagina. CT scan confirmed a calcified IUCD. Conclusion: Serious complication secondary to IUCD is rare but well recorded, extensive calcification as in this case is very rare and has not been previously reported.

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.

Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.

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.

Role of IL-6 in the contraceptive mechanism of intrauterine device

目的 :探讨血清中白细胞介素 - 6(IL- 6)水平与宫内节育器 (IUD)存在的关系。方法 :采用酶联免疫吸附试验测定 64例置器妇女 (试验组 ,试验组又分为置器出血组和无出血组 ) ,以及60例健康妇女 (对照组 )血清中 IL- 6水平 ,同时测定两组血清中 C-反应蛋白 (CRP)水平。结果 :试验组 64例中有 31例血中 IL- 6水平升高 ,与对照组相比差异显著 (P<0 .0 1 )。但其中置器出血组与不出血组中 IL- 6水平无统计学差异 (P>0 .0 5)。试验组及对照组血清中 CRP检验结果均为阴性。结论 :宫内节育器引起子宫内膜无菌性炎症反应 ,导致部分妇女血清中 IL- 6水平升高。IL-

25岁以下未育女性人工流产后即时落实宫内节育器和短效口服避孕药的临床对照观察

目的:观察25岁以下未育女性人工流产后即时放置宫内节育器(IUD)和使用短效复方口服避孕药(COC)的可行性和使用情况。方法:将≤25岁未育早孕自愿要求人工流产的女性作为观察对象,根据其意愿术后放置IUD或使用COC避孕。IUD组148例,COC组204例,随访6个月观察两组的避孕情况。结果:两组均无妊娠发生。IUD组1例因完全脱落而终止使用,终止率为0.7%。COC组术后3月的累积停用率69.1%,6月达92.1%,停用的主要原因是嫌麻烦/不能坚持服药,占31.4%。术后1,3个月的不适主诉率IUD组高于COC组(P<0.010,P<0.001)。结论:≤25岁未育女性人工流产后即时放置IUD或使用COC避孕均可行高效。IUD组6个月续用率高;COC副作用轻,但需加强咨询,提高续用率。

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.

医用润滑剂组成结构的红外光谱研究

采用中红外(MIR)光谱开展了避孕套中医用润滑剂结构的研究。结果发现:医用润滑剂主要包括固态润滑剂和液态润滑剂,其中固态润滑剂的主要结构是高岭石族物质,而液态润滑剂的主要结构是水溶性硅油。研究为探索计生用品中的医用润滑剂结构建立了一种方法,具有一定的应用价值。

无痛人流术后放置曼月乐与活性γ-宫内节育器的避孕效果比较

目的 探讨无痛人流术后宫内放置曼月乐与活性γ-宫内节育器(γ-IUD)的临床效果比较。方法 选取2020年6月—2022年1月淄博市妇幼保健院收治的120例无痛人流手术后有避孕意愿的妇女作为研究对象。采用随机数字表法将其分为A、B组,每组60例。A组术后即刻宫内放置曼月乐避孕,B组术后即刻宫内放置活性γ-IUD避孕。对比两组妇女不同时间的宫内节育器续用情况、月经周期变化、性生活质量、并发症发生率差异。结果 术后6个月,A组与B组妇女的累积续用率分别为95.00%和98.33%,差异无统计学意义(χ^(2)=1.000,P=0.317)。术后12个月,A组与B组妇女的累积续用率为93.33%和96.67%,差异无统计学意义(χ^(2)=0.702,P=0.302)。A组与B组妇女术前、术后3个月的月经周期、行经时间、月经量及性欲、性唤起、性高潮、性心理、性行为、射精时间6个调查维度评分差值比较,差异均无统计学意义(P>0.05)。A组妇女术后总并发症发生率为23.33%,高于B组的8.33%(P <0.05)。结论 无痛人流术后宫内放置曼月乐与活性γ-IUD的宫内避孕效果、累积续用率、性生活情况差异不大,但是后者术后的并发症发生率更低,更推荐临床使用。

基于人工流产术后即时放置宫内节育器的避孕效果分析

目的分析人工流产术后即时放置宫内节育器的避孕效果。方法选取2019年1月至2021年12月九江市妇幼保健院收治的98例人工流产术后患者作为研究对象,根据宫内节育器放置时间不同分为研究组与对照组,每组49例。研究组行人工流产术后立即放置宫内节育器,对照组行人工流产术后第1次月经后3~7d放置宫内节育器,比较两组基本临床指标、避孕成功率、性生活质量、性功能情况、身体健康状况、治疗满意度及不良反应发生情况。结果两组一次放置成功率、阴道出血量比较差异无统计学意义;研究组禁止性生活时间短于对照组,差异有统计学意义(P<0.05)。两组避孕成功率比较差异无统计学意义。放置后,两组性反应评分均低于放置前,对照组性疼痛与情绪、性交流与调适评分均低于放置前,研究组性疼痛与情绪、性交流与调适及性反应评分均高于对照组,差异有统计学意义(P<0.05),其他评分组内、组间两两比较差异无统计学意义。放置前后,两组性欲、性高潮、性交痛、性唤起、阴道润滑度、性满意度评分比较差异无统计学意义。放置后,对照组生理职能、躯体疼痛评分均低于放置前,且研究组生理机能、生理职能、生命活力评分均高于对照组,差异有统计学意义(P<0.05),其他评分组内、组间两两比较差异无统计学意义。研究组治疗总满意率为97.96%,高于对照组的81.63%,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论人工流产术后即时放置宫内节育器避孕效果显著,可减轻对患者术后性功能的影响,对患者性生活质量及身体健康的影响较小,患者满意度较高,临床应用价值较高。

人工流产术后放置宫内节育器1年停用影响因素分析

目的:调查非意愿妊娠人工流产者术后放置宫内节育器(IUD)停用情况及影响因素。方法:收集2022年1-12月本院收治的人工流产者1035例,均流产术后应用IUD避孕措施,随访1年,观察IUD使用情况并分为停用组(189例)、续用组(846例)。调查IUD停用原因,通过单因素分析及多因素logistic回归分析法分析人工流产者术后落实避孕措施1年内停用危险因素。结果:随访1年,人工流产术后IUD停用189例(18.4%),原因包括不良反应83例、社会心理因素100例、其他原因6例。多因素logistic分析显示,年龄低、无生育史、无重复流产、受教育程度高中及以下为人工流产者术后放置IUD停用的危险因素(OR=1.657、1.669、2.442、1.790,P<0.05)。结论:非意愿妊娠人工流产者术后放置IUD仍存在一定比例的停用情况,影响因素较多,临床需加强术前咨询、术后管理,针对性采取干预对策以提高流产后长效避孕措施的落实使用率。

User Perspective of Misplaced PPIUCD and Factors Resulting in PPIUCD Removal: Qualitative Pilot Study

Objective: The aim of the current study was to assess the impact of operative interventions for misplaced device among women who opted for PPIIUCD and the evaluation of reasons for PPIUCD removal within the follow up period of two years. Design: A descriptive exploratory study was conducted over three months among fourteen PPIUCD acceptors at a tertiary care health facility in Delhi, India. Face-to-face & telephonic in-depth interviews were conducted with a selected sample of PPIUCD acceptors who had later opted for its removal. Results: Participants (n = 14) aged 24 – 40 exhibited generally positive attitudes towards PPIUCDs indicating an indicate an understanding of the importance of PPIUCD in preventing unintended pregnancies. Menstrual disturbance and misplaced IUCD were major reasons for removal. despite their own experience necessitating the removal of IUCD, positive experience by other family members (mothers in law) in this study helped to keep the confidence on the contraceptive. Themes included (a) general experience of PPIUCD use (b) Health Facility accessed for removal of IUCD (c) Would she recommend it to others? (d) preferred contraceptive after removal of IUCD. Conclusion: Misplaced IUCD, missing thread, menstrual irregularities, and pain are all associated with PPIUCD and are important reasons for dissatisfaction. Appropriate, timely and supportive individualized care that address knowledge gaps, societal perceptions, and healthcare system challenges would certainly help in reducing dissatisfaction due to PPIUCD and thereby the removal rates.

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。

宫腔镜取环术用于宫内节育环嵌顿的临床效果观察

目的探讨对宫内节育环嵌顿采用宫腔镜取环术治疗的临床效果。方法60例宫内节育环嵌顿患者,随机分为对照组和观察组,每组30例。对照组采用常规取环术治疗,观察组采用宫腔镜取环术治疗。比较两组手术指标以及取环情况、并发症发生率。结果观察组手术时间(18.61±4.57)min、取环时间(8.12±1.53)min均短于对照组的(31.44±7.25)、(10.33±2.10)min,阴道出血量(9.76±2.10)ml少于对照组的(16.25±2.43)ml(P<0.05)。观察组取环成功率96.67%高于对照组的70.00%(P<0.05)。观察组并发症发生率6.67%低于对照组的36.67%(P<0.05)。结论对宫内节育环嵌顿患者采用宫腔镜取环术治疗较常规取环术操作简单、效率高,对患者损伤小,能够提高取环成功率,可降低术后并发症发生风险,值得推广。

人工流产后即刻放置不同避孕环对预防再次怀孕及人工流产的影响

目的分析人工流产后即刻放置不同避孕环对预防再次怀孕及人工流产的影响。方法选取在本院门诊接受人工流产手术的100例患者为研究对象。按照随机数字表法将其分为两组,各50例。两组均开展人工流产,在完成手术后即刻放置避孕环。对照组应用圆形含铜含吲哚美辛宫内节育器,观察组应用γ型含铜含吲哚美辛宫内节育器,比较两组手术效果及预后情况。结果两组患者上环时间、术后2 h出血量、术后出血时间、再次怀孕率及重复人工流产率比较差异均无统计学意义(P>0.05)。观察组患者带环不良反应率为6.00%,低于对照组的24.00%,差异有统计学意义(P<0.05)。结论在人工流产后即刻放置两种避孕环均能够有效预防再次怀孕及人工流产,但γ型节育器带环期间安全性更高,具有一定优势。

Uterine Cavity-shaped Device Used in China

Objective To assess the effectiveness, side effects, and acceptability of copper uterine cavity - shaped intrauterine devices （UCD） with and without indomethacin. Methods We used electronic search and hand search to identify relevant literatures. Included papers were systematically reviewed according to previous established guidelines. Results A total of 39 related papers were identified. Of them, 9papers were included in this review： 4 associated with medicated or non-medicated UCD200 （containing copper 200 mm^2） and 5 associated with medicated or non-medicated UCD300 （containing copper 300 mm^2）. The contraceptive effectiveness, cumulative one-year and two-year continuation rates＇ were similar between medicated UCD200, non-medicated UCD200 and TCu220C. The effectiveness of non-medicated UCD300 was similar to that of TCu220C and TCu200. The effectiveness of medicated UCD300 was similar to that of MLCu375 and TCu220C but lower than that of TCu38OA. The cumulative one-year, three-year and five-year continuation rates were similar between medicated, non-medicated UCD300 and TCu380A or MLCu375. The problem of bleeding was less common among medicated UCD users than among non-medicated devices. Conclusions Uterine cavity-shaped devices should continue to be used in the National Family Planning Proramme. However, priority should be given to the 300 mm^2 copper containing device. A large multicenter randomized comparative trial of UCD300 and TCu380A is needed.