Objective: To compare IUD-endometrium (ED) distance and the incident
of malposition postplacental CuT-380A IUD insertion in vaginal
delivery between ring forceps technique and push and push
technique.
Method: This study was a double-blind randomized control trial,
performed in September 2014 until March 2015 at Dr. Kariadi Hospital.
Ring forceps and push and push insertion technique groups
consisted of 25 subjects in each group. Follow-up was performed at
1-2 weeks, 6-8 weeks and >12 weeks after insertion.
Result: The mean of IUD-ED distance in push and push group was
shorter (but not statistically significant) than ring forceps group. The
IUD-ED distance was at 1-2-week follow-up 4.1 (2.2) vs. 4.9 (3.4)
mm; p=0.208, at 6-8-week follow-up: 2.6 (1.8) vs. 3.2 (3.7) mm;
p=0.452, and at > 12-week follow-up: 0.9 (0.8) vs. 1.0 (0.9) mm;
p=0.427, respectively. Malposition was found in 1-2-week follow-up,
but the IUD was changed to the normal position (sagital position in
uterine fundus) at 6-8-week and >12-week follow-up. Up to 3
months of follow-up, there was no occurrence of perforation, expulsion
or pregnancy in both groups. Most of subjects (56% in the
ring forceps, 68% in push and push groups) did not feel painful during
IUD insertion.
Conclusion: Push and push insertion technique clinically tends to
produce IUD-ED distance shorter than ring forceps technique. Both
techniques are comfortable, safe and effective.
[Indones J Obstet Gynecol 2016; 4-2: 78-87]
Keywords: immediate postplacental IUD insertion technique, IUDendometrium
distance, IUD malposition, push and push technique,
ring forceps technique