Hang-up IUD, New Technique for Suturing CuT-380A IUD to Uterine Fundus in Immediate Postplacental Insertion during Cesarean Delivery: Twelve Months Follow up

Hang-up IUD, Teknik Baru Penjahitan IUD CuT-380A pada Fundus Uteri pada Insersi IUD Pascaplasenta Persalinan Bedah Sesar: Pemantauan Dua Belas Bulan

Abstract

Objective: The aim of this study was to evaluate the effectiveness,
side effects and acceptability of postplacental CuT-380A IUD insertion
using new technique for suturing to uterine fundus during cesarean
section (hang up technique).

Method: Prospective cohort study of postplacental IUD CuT-380A
insertion during cesarean delivery. Hang-up technique consists of
performing a puncture in the center of the fundus wall using straight
needle into the uterine cavity and subsequently using chromic catgut
no. 1 to tie the IUD using anchor knot and hanging the IUD to the
fundus. Our subjects were women who underwent caesarean delivery
at dr. Kariadi Hospital between 1st June 2009 to 31st April 2011
and followed up at <6 weeks, 6 weeks, 3 , 6, 9 and 12 months.

Result: From 116 women, 8 women (7.4%) were lost to follow-up.
The 108 women were observed by scheduled home visits or by mail
or telephone. The youngest patient was 15 years old and the oldest
was 40 years old. The proportion of primiparous and multiparous
women was comparable (49.1% and 50.9%), gestational age was
28-44 weeks, birth weight ranged 2,950-4,500 grams. Six weeks
post cesarean section, out of the 108 women, two women complained
of foul-smelling lochia, two had puerperal fever, and three
complained of pelvic pain. At 6-months follow-up, 3 women underwent
IUD removal because two found the string very disturbing and
the other wanted to get pregnant because their child died. At 9-
months post-cesarean one woman was reported to be pregnant with
IUD in situ. At >12 months follow-up, one woman underwent IUD removal
because of severe dysmenorrhea. No perforation or expulsion
was reported.

Conclusion: Immediate postplacental insertion of IUD CuT-380A using
hang-up technique is safe and effective. Typical use effectiveness
is high (Pearl Index 0.93) and there were no reported incidents of
expulsion or perforation. Acceptance and continuation rate were
high, 98.15% and 95.37% respectively.

Keywords: anchor knots, cesarean section, hang-up IUD, postplacental
IUD insertion