Study on the use practices and knowledges of French practitioners about the use of intra-uterine devices in early post-partum contraception in France.

OBJECTIVES: Intra-Uterine Device (IUD) insertion is possible in early postpartum. Although this contraception method is recognized and used in lots of country, it seems infrequent and poorly known in France. Our study aims to assess the barriers to the application of this method in France. METHODS: A questionnaire was sent to obstetricians-gynaecologist professionals and midwives in France, through the affiliation to CNGOF (French National College of Obstetricians and Gynecologists) and to CNSF (French National College of Midwives). Questions were focused on the practices and knowledge about the insertion of IUD in early postpartum. RESULTS: four hundred eight practitioners responded. Amongst them, 63% knew about the possibility to use IUDs after a vaginal delivery and 31% knew it could be inserted during cesarean section. Ten percent of them used this method. Most of these practitioners (80% of them) would like to discuss the insertion of an IUD in early postpartum with their patients and 71% would like to perform the insertion themselves after training. Besides, this study shows that contraception is rarely addressed by physicians during the follow-up of pregnancies. Less than 15% of respondents report discussing the topic systematically with the patient during the pregnancy follow during pregnancy follow. CONCLUSION: insertion of IUDs in early postpartum is uncommon in France. The main limitation seems to be a lack of knowledge, but practitioners seem to be interested in this practice. Training courses could be created in order to rase up the adoption of this practice.

[Management of labor and delivery in low risk nulliparous women: comparison between level 1 and level 3 maternities]. / Prise en charge du travail et de l'accouchement chez la nullipare à bas risque: comparaison d'une maternité de type 1 et d'une maternité de type 3.

OBJECTIVES: To compare obstetrical practices between level 1 ( community hospital) and level 3 (university hospital) maternities in a low risk nulliparous population. MATERIALS AND METHODS: 1532 low risk nulliparas were included in a retrospective study conducted in the setting of two maternities in the Ile-de-France area. Cesarean delivery and forceps rates, management of labor, analgesia, maternal and neonatal outcomes were compared. RESULTS: Cesarean delivery rates were not significantly different (11.5% in level 3 vs 10.2% in level 1). Level 1 maternity performed induction of labor more often (14.7% vs 8.7%, p<0.01). Peridural analgesia rates were higher in the level 3 maternity (95.1% vs 75.5%. p<0.01) but general anesthesia was two-fold more frequent in level 1 maternity. Level 3 maternity performed more instrumental deliveries (27.5% vs 17.4%, p<0.01) and more episiotomies (72.7% vs 39.3%). But we noted more first and second degree perineal tears in the level 1 maternity (29.9% vs 17.4%, p<0.01). Neonatal hospitalizations were more frequently in level 3 maternity. CONCLUSION: Some "interventionist" practices, but not all, were less frequent amongst physicians managing mainly low-risk women than amongst physicians managing mainly high-risk women but without difference for the cesarean delivery rates. The main differences were observed for epidural, instrumental delivery, and episiotomy rates but perineal tears and induction of labor were more frequent in the level I maternity. These differences could be explained by obstetrical politics in the two maternities rather than the type of level.