Re: IUD and PID
From: MTRingstaf@aol.com
Sat May 29 19:43:53 1999
Stud Fam Plann 1976 Sep;7(9):261-3
Effectiveness of the Iranian auxiliary midwife in IUD insertion.
Zeighami E, Zeighami B, Eftekhari AE, KhoshNEVIS P
In Iran, a traditional rural midwife is allowed to perform pelvic exams and
insert IUD'S under conditions of almost total independence after she has
received one month of intensive training in the procedures. The present study
compared two groups containing 232 village women each, matched for age and
parity. One group had IUDs inserted by rural midwives and the other by
physicians or nurse-midwives at ubran clinics. The one-year and two-year
closure rates for the two groups were very similar, as were the net closure
rates for various categories of termination. No cases of severe complication
were known to have occurred in either series. This evidence indicates that a
rural midwife, following short, intensive training in the technique, can
insert IUDs as safely and effectively as physicians and nurse-midwives.
PMID: 968931, UI: 77016248
------------------------------------------------------------------------------
--
------------------------------------------------------------------------------
Int J Gynaecol Obstet 1977;15(1):84-7
------------------------------------------------------------------------------
IUD insertions by midwives: five years' experience in Santiago, Chile.
Pastene L, Rivera M, Zipper J, Medel M, Thomas M
This report includes data on insertions of Lippes Loop D, Copper-7, and
Copper-T intrauterine devices (IUDs) performed by certified nurse-midwives
and physicians with comparable levels of training and experience in inserting
IUDs. Net 1-year pregnancy, expulsion, and removal rates were used to compare
the experiences of the 2 groups. There were no significant differences
between the groups in most of the event rates or in the overall method
discontinuation rates. The authors conclude that, with adequate training and
experience, nurse-midwives can provide this family planning service with no
additional risk to patients.
PMID: 923900, UI: 78043901
------------------------------------------
Bull Pan Am Health Organ 1995 Sep;29(3):206-15
------------------------------------------
------------------------------------------
Comparative study of safety and efficacy of IUD insertions by physicians and
nursing personnel in Brazil.
Lassner KJ, Chen CH, Kropsch LA, Oberle MW, Lopes IM, Morris L
Department of Information, Evaluation, and Research, Center for Research on
Integrated Maternal and Child Care (Centro de Pesquisas de Assistencia
Integrada a Mulher e a Crianca-CPAIMC), Rio de Janeiro, Brazil.
To assess whether trained nursing personnel could provide IUD services as
safely and effectively as physicians in Brazil, an experimental study was
conducted at the main clinic of the Center for Research on Integrated
Maternal and Child Care in Rio de Janeiro. From November 1984 through April
1986, a total of 1,711 women who requested IUD insertion at the clinic were
randomly assigned to have a Copper-T 200 IUD inserted by one of the clinic's
11 physicians or 13 nurses. All of the physicians and nursing staff members
who provided these services had taken the Center's standard clinical family
planning training course. Of 860 insertions attempted by the physicians and
nurses, 1.3% and 3.3%, respectively, were unsuccessful. Statistically, this
difference was very significant (P < 0.01). Also, mainly because the cervix
was small and undilated, nulliparous women had a relatively high insertion
failure rate of 8.0%, as compared to 1.5% for primiparas and 1.0% for
multiparas. The overall rate of complications at insertion was 1.8%, these
complications including diaphoresis, vomiting, syncope, cervical laceration,
and one case of perforation of the uterus; no significant difference was
found between the complication rates for insertions performed by physicians
as compared to nurses. However, 9.0% of the study subjects reported severe
pain during IUD insertion, with significantly higher percentages reporting
pain if the IUD was inserted by a physician, or if the subject was
nulliparous, had preinsertion symptoms, or had a history of pelvic
inflammatory disease (PID) or sexually transmitted disease (STD). It was also
found that the nurses had a dramatically high insertion failure rate (11.6%)
with nulliparous subjects, while the physicians' failure rate with such
subjects was a significantly lower 3.4%. No significant difference was found
in the groups served by nurses and physicians with regard to postinsertion
complaints or termination of use within 12 months of insertion. These
findings suggest that future training, besides preparing nursing personnel in
IUD insertion, should emphasize preparation in taking the client's medical
history and diagnosing existing medical symptoms that could be associated
with IUD insertion complications. In addition, if a nulliparous woman
requests an insertion, it should be performed by a physician or more
experienced nursing staff member with close medical supervision. Because of
high rates of reported pain at insertion, such women, as well as those with
medical symptoms associated IUD insertion complications and those with a
history of PID or STD, should be considered candidates for extra care and
counseling.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 8520606, UI: 96052126
Stud Fam Plann 1977 Sep;8(9):237-43
Nurse-midwife insertion of the copper T in Thailand: performance, acceptance,
and programmatic effects.
Wright NH, Sujpluem C, Rosenfield AG, Varakamin S
While oral contraceptives have been widely available in rural Thailand since
their distribution by lower level paramedical health workers was authorized
in 1970, the IUD has been restricted to large, urban clinics staffed by
physicians. A study was conducted in 1972-73 to evaluate the performance of
nurse-midwives in IUD (Copper T) insertion and to assess the reaction of
acceptors and the likely effects on the National Family Planning Program. It
was found that nurse-midwives were competent to insert Copper Ts and handle
early complications. Acceptor continuation rates were very high and
nurse-midwife acceptors clearly preferred IUD insertion by a female health
worker. Programmatic evidence suggests that using nurse-midwives more
extensively for Copper T insertion would increase IUD acceptance at no cost
to the existing loop program.
Int J Gynaecol Obstet 1976;14(3):205-7
Evaluation of trained midwives in a copper-T IUD insertion Program in
Isfahan, Iran.
Loghmani M, Mitra M
>From four centers in Isfahan, data from 252 insertions of the Cu-T-200 made
by midwives and 646 insertions of the same device made by doctors are
compared. Although the net cumulative one-year continuation rate for women
who had a copper-T inserted by a midwife is significantly lower than for
women who had a copper-T inserted by a doctor there are no significant
differences between the one-year event rates for the two groups of patients.
These data suggest that an expanded role for midwives in IUD insertion
programs would be an efficient use of health personnel.
PMID: 13004, UI: 77091723
Respectfully submitted by,
Marilyn Ringstaff, CNM
Rome, GA
(Obviously not a lot of US data available, RCT anyone?)
