Postpartum and postabortal insertion of intrauterine contraceptive devices

Abstract

One hundred forty-four patients are studied over an 18 month period. Postpartum and postabortal insertions of intrauterine contraceptive devices using the Lippes Loop and the Dalkon Shield are compared. The age, parity, previous methods of contraception, and marital status of the study group indicated a poorly motivated patient population. Although accidental pregnancy rates and expulsion rates are higher, the technique is considered worth-while in the population studied. Future research should be directed toward improved devices in order to decrease side effects and to increase appeal of the technique to those who will benefit most.

PIP: An 18-month clinical trial carried out at the Methodist Hospital of Brooklyn, New York, compared postpartum and postabortion insertions of the Lippes Loop and the Dalkon Shield IUDs. The study group included all patients having an IUD inserted immediately after delivery or abortion in the hospital from July 1971-January 1973. Devices used in postpartum insertions included 46 Dalkon Shields, 26 Lippes Loops, and 1 Majzlin Spring, while 71 abortion patients had 53 Lippes Loops and 18 Dalkon Shields inserted. 63 of these patients were lost to follow-up. There were 8 removals for medical reasons, 13 accidental pregnancies, and 24 expulsions of IUDs. The accidental pregnancy rate was 9% for the total sample, 10% for the Lippes Loop group, and 8% for the Dalkon Shield group. The overall expulsion rate was 16.5%, with a rate of 19% for the Lippes Loop group, and 14% for the Dalkon Shield group. The parameters studied in this group of patients indicate a general tendency toward acceptance of the technique, especially among younger ( 25) women of relatively high parity and low family planning motivation. If the fact that 82% of the study group claimed their last pregnancy was accidental is a true reflection of patient motivation and understanding of contraception and family planning, then immediate IUD insertions should be considered as practical. Reported side effects indicate significant problems which, although not critical, can influence the patients' tolerance of the device. Considering all of the factors, it is concluded that immediate postpartum or postabortion insertion of IUDs in a high-risk population is worthwhile. However, as the object is to lower the accidental pregnancy and expulsion rates, an improved type of device is needed.