Re: Question for those of you inserting IUDs**PP
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Jul 24 18:59:57 2007
My partner heard something, perhaps from the Mirena rep, to wait until 8
weeks PP for Mirena insertion, not 6.
Garry
At Tue, 24 Jul 2007, ainsron wrote:
>
>Per Family Health International:
>Perforation
>The enlarged postpartum uterus may contribute to the displacement of the
>IUD. This has caused concern over possibile increased risk of uterine
>perforation as uterine involution occurs. FHI has reported that the
>perforation risk at one month for immediate postpartum insertions was no
>greater than that associated with interval insertion, about 1 per 2000
>insertions.
>
>W. A. A. Van Os1 and D. A. Edelman2
>
>(1) Department of Obstetrics and Gynaecology, Elisabeth Gasthuis, PO Box
>417, 2000 AK Haarlem, The Netherlands
>(2) Medical Research Consultants, Inc., 68 Spyglass Circle, 06340 Groton,
>Connecticut, USA
>
>Received: 29 March 1989 Accepted: 18 April 1989
>
>Abstract The English language literature on IUDs was reviewed to evaluate
>the uterine perforation rate associated with use of the Multiload. No
>reports of cervical perforation were found, and the uterine perforation rate
>was 0.12/1000 insertions compared to a rate of 0.68/1000 insertions for
>other copper-bearing IUDs. This lower rate may reflect an under-reporting of
>uterine perforations in the medical literature, or may represent a truly
>lower perforation rate due to factors related to the Multiload design and/or
>its insertion technique.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
>Bulley, MD
>Sent: Tuesday, July 24, 2007 4:01 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Question for those of you inserting IUDs
>
>My personal perforation rate: one perf in 26 years.
>
>That was in someone who Insisted (against my better judgement) on
>getting an IUD at her 6 week visit - {BACKGORUND: she had been promised
>one by another resident ... she was going to get a TL within the
>following 6 months - she has had CS #5 or 6 but without a TL (because
>the hospital was Catholic and it was hard to get the dispensation from
>the priests to do the TL - so she was going to go the the Univ of Mich
>to get it later)}
>
>I counseled her against it and read her all the Bad Things That Can
>Happen - and the attending for the resident clinic said to go ahead an
>put it in ... so I did.
>
>She returned after I finished residency with no strings and then had a
>laparoscopy at the U of Mich with a retrieval and a TL.
>
>Now I know that you need to be more careful about 6 week PP insertions -
>and I make sure the uterus is good and firm - frustrating patients and
>making them come back every month until the uterus really reaches its
>non pregnant consistency.
>
>That does not give a "rate" but is my personal experience / anecdote!
>
>Joanne
>
>At Tue, 24 Jul 2007, GIN11153@aol.com wrote:
>>
>>Friend asked me about perforation rate. I don't have an answer but thought
>>that it is an accepted complication that is discussed in an informed
>consent.
>>Your thoughts, please!
>>
>>Gail Neuman RNC CPHW
>>student midwife and student nurse practitioner
>>certified high risk OB
>>Perinatal Nurse Associates
>>801 N. Tustin Ave., Suite 305
>>Santa Ana, CA 92705
>>(714) 314-7070
>>(714) 838-1479 fax
>>
>>************************************** Get a sneak peek of the all-new AOL
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>--
>Joanne Bulley, MD, FACOG
>Solo gyn
>Keene, NH USA
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
