ABSTRACT
Objective: To evaluate the rate of expulsion of intrauterine device (IUD) inserted during the immediate and mediate puerperium. To evaluate whether the type of delivery is a predictor of expulsion of the IUD when inserted in the puerperium period. Material and Methods: This was a prospective observational study. Patients whose IUD (TCU-380 copper) was placed during the puerperal period were divided in two groups according to the time of placement: immediate and mediate puerperium. The decision regarding the time of IUD insertion was made in a non-randomized manner. Analysis was performed using chi-square, Mann-Whitney U, and Spearman's correlation tests and logistic regression analysis. Results: The total rate of IUD expulsions was 28.8% (49/170). There was no significant association between the occurrence of expulsion and the timing of IUD insertion (immediate vs mediate puerperium; 26.6% vs 34.78%, p=0.296). Among patients experiencing expulsion, 79.6% (39/49) underwent insertion after vaginal delivery and 20.4% (10/49) during cesarean section (CS). The type of delivery was a significant predictor for IUD expulsion (p<0.0001). Vaginal delivery was fourfold more likely to be associated with IUD expulsion inserted in the puerperal period than CS (odds ratio: 4.23, 95% confidence interval: 1.94-9.25). There was no significant correlation between the period between IUD insertion and the diagnosis of expulsion in regard to number of pregnancies (r=-0.160, p=0.271) or gestational age at delivery (r=-0.058, p=0.939). Conclusion: Vaginal delivery was the most prevalent type of delivery in patients who underwent IUD insertion during the immediate and mediate puerperium. The risk of IUD expulsion after vaginal delivery was greater than CS.
ABSTRACT
OBJECTIVE: To assess the impact of gestational diabetes and hypothyroidism on the third-trimester ultrasound parameters and in adverse perinatal outcomes. METHODS: We performed a retrospective cohort study with 817 singleton pregnant women between 26w0d and 37w6d of gestation which were divided in four groups: 56 gestational diabetes mellitus (GDM), 63 hypothyroidism, 14 GDM + hypothyroidism, and 684 controls. The following ultrasound parameters were assessed: mean uterine artery pulsatility index (PI), umbilical artery PI, middle cerebral artery PI, single deepest pocket (SDP) and cerebroplacental ratio (CPR). Adverse perinatal outcomes were the following: low birth weight, macrosomia, and Agar score at 1st min <7. These four groups were compared using the Kruskall-Wallis and χ(2) tests. RESULTS: Pregnant women from GDM showed higher weight (p < 0.001), BMI (p < 0.001), SDP (p < 0.001) and newborns with higher birth weight (p = 0.008) and macrosomia (p = 0.02) than other groups. Comparing with control, hypothyroidism showed higher SDP (p < 0.05). CONCLUSION: Pregnant women with GDM showed higher risk of macrosomic newborns than other three groups. Both pregnant women with GDM and hypothyroidism showed higher SDP than normal pregnancies.
