title: Association of the Position of the Copper T 380A as Determined by the Ultrasonography Following its Insertion in the Immediate Postpartum Period with the Subsequent Complications: An Observational Study.
abstract: OBJECTIVE
  Incorrectly placed copper T 380A leads to increased contraception failure. This study aimed to find an association between the ultrasonographic position of the copper T 380A in the immediate postpartum period and the adverse effects observed during the period of 6 months after its insertion.
  
  
  METHODS
  This descriptive study was carried out in the Department of Obstetrics & Gynaecology of a tertiary-care-center of India from September 2011 to February 2013. The women eligible for immediate postpartum copper T 380A insertion with previous regular menstrual cycles for at least 6 months before the current pregnancy, and those who were willing for follow-up visits and had easy accessibility to the hospital, were recruited. A clinical evaluation and ultrasonographic assessment of Intra-Uterine-Contraceptive-Device (IUCD) after insertion was carried out after enrolment. The complications (expulsions, vaginal discharge, menstrual irregularity, and lower abdominal pain) were subsequently assessed during a 6-month follow-up period. The primary objective was the ultrasonographic assessment of the placement of IUCD immediately after insertion. The incidence of complications and their association with the presence of malposition was also studied.
  
  
  RESULTS
  Hundred patients were evaluated during the study period. Forty-four (44 %) women were found to have malpositioned IUCDs on ultrasonographic evaluation done following insertion. The complications among the IUCD users included menstrual irregularity (27.17 %), pain in lower abdomen (20.65 %), vaginal discharge (7.6 %), and expulsions (9.7 %). The IUCD expulsions, menstrual irregularities, and pain were significantly more in patients with malpositions (p < 0.05).
  
  
  CONCLUSIONS
  Malpositioning of IUCD is common immediately following insertion and is significantly associated with more complications during the follow-up.
authors.affiliation: Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
authors.forename: Shashiprateek
authors.initials: S
authors.lastname: Malik
authors.affiliation: Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
authors.forename: Renuka
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
authors.forename: Saritha
authors.initials: S
authors.lastname: Shyamsunder
authors.affiliation: Department of Radiodiagnosis, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.
authors.forename: M K
authors.initials: MK
authors.lastname: Mittal
keywords: Contraception; Expulsion; IUCD; Malposition; Menstrual irregularity