Copper T (380 A) and risk of uterine perforation in lactating women: rural scenario
Keywords:Copper T 380A, Lactating women, Uterine perforation
Background: Copper T 380 A is commonly used as PPIUCD as well as Interval contraception in rural areas of Chhattisgarh. Studies have reported that interval insertion of intrauterine device in women during their lactation period is associated with high risk of uterine perforation as compared to postpartum insertion similar as our study.
Methods: 50 consecutive women were included, who came in family planning OPD of Chhattisgarh Institute of Medical Sciences (CIMS), a Government Medical College, with history of copper T insertion, during their lactation period, within one year of child birth. The copper T insertion was done by health workers at peripheral health centers with complains of pain lower abdomen, menstrual irregularities, missing thread, vaginal discharge, uterine perforation following Copper T 380 A insertion. Apart from patient’s characteristics such as age and parity etc. the method of detection of the perforation and details of management were analyzed.
Results: There was one case of partial uterine perforation, one case of copper T lying in peritoneal cavity, two cases of expulsion and three cases had embedded copper T in the myometrium.
Conclusions: The risk of perforation due to copper T 380A insertion in lactating women is slightly high, thus timing of insertion, proper counseling and providers training, which are vital factors for intrauterine device use during lactation period, should be considered seriously so as to minimize the complications.
National Family Health Survey. (NFHS-3), 2005-2006: India. Mumbai, India: International Institute for Population Sciences (IIPS) and Macro International. 2007;1 Available at: http://rchiips.org.
State Fact Sheet Chhattisgarh: National Family Health Survey - 4, 2015 -16 Ministry of Health and Family Welfare, Government of India, International Institute for Population Sciences (Deemed University) Mumbai. Available at http://rchiips.org/NFHS/factsheet.
Bhalerao AR, Purandare MC. Post-puerperal Cu-T insertion: a prospective study. J Postgrad Med. 1989;35(2):70-3.
Farr G, Rivera R. Interactions between intrauterine contraceptive device and breastfeeding status at time of intrauterine contraceptive device insertion: analysis of copper T 380A acceptors in developing countries. Am J Obstet Gynecol. 1992;167(1):144-51.
Shah RS, Hazari KT, Chitlange SM, Shah R, Vaidya PR, Purandare MC. Does lactation affect intrauterine device performance? J Famil Welfar. 1998;44(4):62-5.
Annual Health Survey 2011-2012 fact Sheet, Chhattisgarh, Vital statistics division, Office of the Registrar General and Census Commissioner, India, New Delhi. Available at: www.censusindia.gov.in.
Ghike S, Joshi S. Awareness and contraception practices among women- An Indian rural experience, South Asian Federat Obstet Gynecol. 2010;2(1):19-21.
Upadhye JJ, Upadhye JV. Contraceptive awareness and practices in women of urban India. Int J Reprod Contracept Obstet Gynecol. 2017;6(4):1279-82.
Kaislasuo J, Suhonen S, Gissler M, Lahteenmaki P, Heikinheimo O. Intruterine Contraception: incidence and factors associated with uterine perforation-a popular- based study. Hum Repord. 2012;27:2658-63.
Esposito JM, Zarou DM, Zarou GS. A Dalkon shield imbedded in a myoma: case report of an unusual displacement of an intrauterine device. Am J Obstet Gynecol. 1973;117:578-81.
Rowlands S, Oloto E, Horwell HD: Intrauterine devices and risk of uterine perforation: current perspectives; Open Acess J Contracept. 2016:7 19-32.
Norman D Goldstuck, Petrus S Steyn. Intrauterine contraception after cesarean section and during lactation: a systematic review: Internat J Women’s health. 2013;5:811-8.
Goldstuck N. Assessment of uterine of uterine size and shape:a systemic review addressing relevance to intrauterine procedures and events. Afr J Reprod Health. 2012;16;129-138.
Goldstuck ND, Wildemeersch D. Role of uterine forces in intrauterine device embedment, perforation, and expulsion. Int J Women’s Health. 2014:6 735-44.
Heinemann K, Reed S, Moehner S, Minh TD. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contracept. 2015;91:274-9.
Harrison- Woolrych M, Ashton J, Coulter D. Uterine perforation on intrauterine device insertion: is the incidence higher than previously reported? Contracept. 2003;67:53-6.
Caliskan E, Ozturk N, Dilbaz BO, Dilbaz S. Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care. 2003;8(3):150-5.
Berry-Bibee EN, Tepper NK, Jatlaoui TC, Whiteman MK, Jamieson DJ, Curtis KM. The safety of intrauterine devices in breastfeeding women: a systematic review. Contracept. 2016;94(6):725-38.
Sinha M, Gupta R, Tiwari A. Minimally invasive surgical approach to retrieve migrated intrauterine contraceptive device. Int J Reproduct Contracept Obstet Gynecol. 2013;2:147-151.
Galhotra A, Padhy GK, Pal A, Giri AK, Nagarkar NM. Mapping the health indicators of Chhattisgarh: A public health perspective. Population. 2014;65(62.2):82-7.
Rao KD, Sundararaman T, Bhatnagar A, Gupta G, Kokho P, Jain K. Which doctor for primary health care? Quality of care and non-physician clinicians in India. Soc Sci Med. 2013;84:30-4.
Boortz HE, Margolis DJA, Ragavendra N, Patel MK, Kadel BM, Migration of intrauterine devices: radiologic findings and implications for patients care. Radiographics. 2012;32:335-52.
Mittal S, Kumar S, Roy K K. Role of endoscopy in retriieval of misplaced intrauterine device. Aust NZJ Obstet Gynecol. 1996;36(1):49-51.
Gill R, Mok D, Hudson M, Shi X, Birch D, Karmal S. Laparosopic removal of an intra-abdominal uterine device: case and systemic review. Contracept. 2012;85:15-8