Author(s): Ihab I. Samaha, Ibrahim A. Abdelazim* and Tamer E. El-Ghazaly
Background: Pain during intrauterine contraceptive device (IUCD) insertion may be a barrier to choose the IUCD as contraceptive method. The trans-abdominal sonographic (TAS) guided IUCD insertion may decrease the IUCD insertion pain and may increase the proper positing of IUCD.
Objectives: To detect whether the use of TAS during IUCD insertion in outpatients setting is useful or not.
Methods: Three hundred (300) women eligible for IUCD insertion were included in this study and randomized into two groups (150 women in each group). TAS-guided IUCD insertion (TAS-IUCD insertion) group and non-TAS-IUCD insertion group (no ultrasound used during IUCD insertion). In the TAS-IUCD insertion group, the IUCD was applied with moderately full bladder under TAS guide without uterine sounding. While, in non-TAS-IUCD insertion group, the IUCD was applied without ultrasound guide using the routine IUCD insertion technique and uterine sounding. Participants were interviewed immediately after IUCDs insertion to report the pain intensity during IUCD insertion using visual analogue scale (VAS) and examined 4-6 weeks after IUCDs insertion by trans-vaginal sonography (TVS) to detect the intrauterine position of the inserted IUCDs. Collected data were statistically analysed to detect whether the use of TAS during IUCD insertion in outpatients setting is useful or not.
Results: There was no significant difference between TAS-IUCD insertion group and non-TAS insertion group regarding the rate of IUCD expulsion (0.7% (1/150) versus 1.3% (2/150), respectively, P=0.6), and rate of IUCD embedment (0.7% (1/150) versus 2% (3/150), respectively, P=0.3). The rate of displaced IUCDs was significantly lower in TAS-IUCD insertion group compared to non-TAS insertion group (0% (0/150) versus 2% (3/150), P=0.03). The mean pain score was significantly lower in TAS-IUCD insertion group compared to non-TAS insertion group (1.3 ± 1.02 versus 1.6 ± 0.76, P=0.0001).
Conclusion: The pain score and the rate of displaced IUCDs were significantly lower in TAS-IUCD insertion group compared to non-TAS insertion group. The use of TAS during IUCDs insertion in outpatients setting is clinically useful, it decreases the pain score during IUCDs insertion, and it decreases the rate of displaced IUCDs.