ContraceptionNCT02024672
Monitoring With Ultrasound Imaging of Intrauterine Device (IUD) Position Placed Immediately After Giving Birth
An observational study of Contraception and Postpartum, run by Icahn School of Medicine at Mount Sinai at 2 sites in United States.
Trial summary
Intrauterine devices (IUDs) are one of the most effective reversible forms of contraception, and are a good option in the postpartum period for women to avoid a rapid repeat pregnancy. IUDs can be placed immediately postpartum, after delivery of the placenta by either vaginal or cesarean birth. Read more about this study
- Who is it for?
- Ages 18 to 55 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Contraception, Postpartum
- What is being tested?
- Immediate postpartum placement of IUD
- How many people
- 96 participants
- Where
- 2 sitesUnited States
- Study dates
- Dec 2013to 15 Sep 2017
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 55 years
- Women only
- Healthy volunteers accepted
- Adult
Study population: Patients will be recruited from the group of women receiving prenatal care at Mount Sinai Hospital in New York City and Elmhurst Hospital in Queens. Patients who express an interest in an IUD for contraception after delivery will be given information about immediate postpartum IUDs and the study.
Who may be able to join
- Women >18 years of age
- English or Spanish speaking
- Desire postpartum IUD placement, either copper IUD or levonorgestrel IUD
Who cannot join
- Contraindications for IUD use (CDC MEDICAL Eligibility Criteria category 3 or 4 for specific IUD)
- Positive Chlamydia or gonorrhea cervical cultures in past 3 months
- Immediate postpartum hemorrhage
- Premature rupture of membranes (PROM) >12h or diagnosis of endometritis
Trial locations and contacts
2 sites in 1 country.
United States2 sites
Elmhurst Hospital Center
Elmhurst, New York, 11373
Icahn School of Medicine at Mount Sinai
New York, New York, 10029
About this study
Official title: Ultrasound Surveillance of IUDs Placed Immediately Postpartum
Intrauterine devices (IUDs) are one of the most effective reversible forms of contraception, and are a good option in the postpartum period for women to avoid a rapid repeat pregnancy. IUDs can be placed immediately postpartum, after delivery of the placenta by either vaginal or cesarean birth. This practice has been shown to be safe, and is recommended by the American College of Obstetricians \& Gynecologists, the World Health Organization and the U.S. Center for Disease Control. Immediate postpartum IUD placement has the advantage of providing contraception at a time that the woman is already accessing medical care, avoiding potential loss to follow up or risk of unintended pregnancy. Additionally, women who have anesthesia for delivery have reduced pain at the time of IUD placement compared to having the IUD placed at the postpartum follow up appointment. Immediate postpartum IUD placement is a relatively new practice in the US and little is known about the expected appearance of IUDs inside the uterus taken with an ultrasound when they have been placed at the time of delivery. It is less likely that IUD strings will be visible at the cervix after immediate postpartum IUD placement due to subsequent uterine involution, which makes it important to monitor correct positioning of the IUD via ultrasound. This study will document normal changes in the positioning of the IUD visualized via ultrasound, and determine if a correlation exists between IUD position and risk of expulsion. Ultrasound surveillance to document IUD position and distance from the fundus, will be performed at 6 weeks, 3 months and 12 months after placement. Symptoms of menstrual bleeding and pain will also be recorded in order to determine if they are correlated with IUD position.
Read the detailed description
The goal of this study is to document the expected ultrasound appearance of intrauterine devices (IUDs) placed immediately postpartum. This practice has been shown to be safe and effective, but little is known about long-term follow up for IUDs placed in this setting. Because IUD strings will not be visualized for many patients after immediate postpartum IUD placement, sonographic imaging will likely be required for the majority of patients to determine expulsion. However, the ultrasound appearance of these IUDs, placed immediately after birth and before uterine involution, may be different than those IUDs placed outside of the postpartum period. To our knowledge no other study has documented expected ultrasound appearance of IUDs placed in the immediate postpartum period.
The specific aims of this study are to: 1. document normal appearance of IUDs on ultrasound after immediate postpartum placement; 2. document if this appearance changes over time; and 3. determine if location on ultrasound is associated with side effects or expulsion.
Study design This is a prospective, observational study. All patients who have an IUD (either copper or levonorgestrel) placed immediately postpartum (within 10 minutes of delivery of placenta) after either Cesarean or vaginal delivery at Mount Sinai Medical Center and at Elmhurst Hospital Center will be eligible to participate in the study.
Study visits will include a speculum exam for IUD string check at 6 weeks, and ultrasounds to evaluate IUD position at the following time points: 6-10 weeks following placement, 3 months following placement (with inclusion up to 6 months), and 12 months following placement (with inclusion up to 15 months).
The ultrasound will document the following: size and position of uterus, IUD-Myometrium distance, IUD-endometrium distance, IUD-fundus distance and position of IUD. When participants present for the scheduled ultrasound visits, they will be asked to return with the completed symptom diary as well, to assess bleeding and pain.
Study Endpoints IUD expulsion, removal, or completion of the 12-15 month follow up visit will be the study endpoints. The participant will be withdrawn from the study if IUD expulsion occurs, or if she requests IUD removal for any reason. Participants will also be able to withdraw from the study at any time if they no longer wish to participate, but they may keep their IUD in place if desired.
Study procedures At the routine 6 week postpartum visit for all patients, pelvic and speculum exam will be performed as per normal clinical routine, and visualization of IUD strings at the cervical os will be documented. If IUD strings are not visualized, an ultrasound will be performed by the clinical provider to confirm presence or absence of IUD within the uterus.
A formal ultrasound to evaluate IUD position will be scheduled in the FPA gynecologic ultrasound unit or in the Gynecology clinic at EHC at the following time points: 6-10 weeks following placement, 3 months following placement (with inclusion up to 6 months), and 12 months following placement (with inclusion up to 15 months). The formal ultrasound will document the following: size and position of uterus, endometrial stripe (EMS) thickness, IUD-Myometrium distance, IUD-endometrium distance, IUD-fundus distance and position of IUD.
Immediate postpartum placement of IUDs is a relatively new clinical practice in the United States; as such there is no recommended or "standard" follow up protocol in this situation. For IUDs placed outside of the postpartum period, the standard follow up is a string check (speculum exam to confirm presence of strings at cervical os) 2-6 weeks after IUD placement. If strings are not visible, or if the patient experiences symptoms concerning for expulsion, a transvaginal ultrasound will be performed. Once correct placement is confirmed by ultrasound, patients without visible strings generally have ultrasounds yearly to confirm placement. Based on this standard practice, patients with visible strings will have the ultrasound only for research purposes. Additionally, the three month ultrasound will be only for research purposes, even in those without visible strings.
When participants present for the scheduled ultrasound visits, they will be asked to return with the completed symptom diary as well.
- Conditions
- Contraception, Postpartum
- Being tested
- Immediate postpartum placement of IUD
- Keywords
- Intrauterine devices, IUDs, postpartum, contraception
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Immediate postpartum placement of IUDOther
pelvic exam, transvaginal ultrasound (3 during the course of the study), bleeding and symptom diary
| Study group | Role | What they receive |
|---|---|---|
| Immediate postpartum placement of IUD | Women who plan to have an IUD placed at the time of cesarean section or vaginal delivery, or women who have had an IUD placed at the time of cesarean section or vaginal delivery. Receives: Other: Immediate postpartum placement of IUD |
What is being measured
The primary outcome is the main question the study is designed to answer.
IUD-endometrial distance association with expulsion risk
Measured: at 6 weeks after IUD placement
IUD-endometrial distance association with expulsion risk
Measured: at 3 months after IUD placement
IUD-endometrial distance association with expulsion risk
Measured: at 1 year after IUD placement
Secondary outcomes (5)
Expected normal appearance of IUD on ultrasound and change in appearance over time
Measured: 6 weeks after IUD placement
Expected normal appearance of IUD on ultrasound and change in appearance over time
Measured: 3 months after IUD placement
Expected normal appearance of IUD on ultrasound and change in appearance over time
Measured: 1 year after IUD placement
IUD endometrial distance association with side effects
Measured: 6 weeks after IUD placement
IUD endometrial distance association with side effects
Measured: 1 year after IUD placement
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Dec 2013 (estimated)
- Study startDec 2013
- Primary completion15 Sep 2017
- Study completion15 Sep 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for ContraceptionStudies of the same condition, open and under way.
- More trials run by Icahn School of Medicine at Mount SinaiThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 96 participants (actual)
Sponsor and investigators
- Lead sponsor
- Icahn School of Medicine at Mount Sinai
- Sponsor type
- University, hospital or other
- Collaborators
- Teva Pharmaceuticals USA
- Responsible party
- Sponsor
- Investigators
- Britt Lunde, MD, MPH, Principal investigator, Icahn School of Medicine at Mount Sinai
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02024672
- Sponsor's protocol ID
- GCO 13-1557
- Status last verified
- Oct 2017
- First submitted
- 27 Dec 2013
- Last updated
- 11 Oct 2017
- Results posted
- No
- Data monitoring committee
- No
Publications
ACOG Practice Bulletin No. 121: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2011 Jul;118(1):184-196. doi: 10.1097/AOG.0b013e318227f05e. No abstract available.
PubMed 21691183Medical Eligibility Criteria for Contraceptive Use: A WHO Family Planning Cornerstone. 4th edition. Geneva: World Health Organization; 2010. Available from http://www.ncbi.nlm.nih.gov/books/NBK138639/
PubMed 23741782Centers for Disease Control and Prevention (CDC). Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of hormonal contraception among women at high risk for HIV infection or infected with HIV. MMWR Morb Mortal Wkly Rep. 2012 Jun 22;61(24):449-52.
PubMed 22717514Levi E, Cantillo E, Ades V, Banks E, Murthy A. Immediate postplacental IUD insertion at cesarean delivery: a prospective cohort study. Contraception. 2012 Aug;86(2):102-5. doi: 10.1016/j.contraception.2011.11.019. Epub 2012 Jan 20.
PubMed 22264666Faundes D, Bahamondes L, Faundes A, Petta C, Diaz J, Marchi N. No relationship between the IUD position evaluated by ultrasound and complaints of bleeding and pain. Contraception. 1997 Jul;56(1):43-7. doi: 10.1016/s0010-7824(97)00072-3.
PubMed 9306030Faundes D, Perdigao A, Faundes A, Bahamondes L, Petta CA. T-shaped IUDs accommodate in their position during the first 3 months after insertion. Contraception. 2000 Oct;62(4):165-8. doi: 10.1016/s0010-7824(00)00167-0.
PubMed 11137069Shimoni N, Davis A, Westhoff C. Can ultrasound predict copper IUD expulsion after medical abortion? Poster presentation at NAF 2012 conference, Columbia University Medical Center.
Study at a glance
From the registry record, last updated by the sponsor on 11 Oct 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Ultrasound Surveillance of IUDs Placed Immediately Postpartum
- ClinicalTrials.gov ID
- NCT02024672
- Acronym / sponsor ID
- GCO 13-1557
- Conditions
- Contraception, Postpartum
- Keywords
- Intrauterine devices, IUDs, postpartum, contraception
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 96 participants (actual)
- Lead sponsor
- Icahn School of Medicine at Mount SinaiUniversity, hospital or other
- Collaborators
- Teva Pharmaceuticals USA
- Study start
- Dec 2013
- Primary completion
- 15 Sep 2017 (actual)
- Study completion
- 15 Sep 2017 (actual)
- First posted
- 31 Dec 2013 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Intrauterine devices (IUDs) are one of the most effective reversible forms of contraception, and are a good option in the postpartum period for women to avoid a rapid repeat pregnancy. IUDs can be placed immediately postpartum, after delivery of the placenta by either vaginal or cesarean birth. This practice has been shown to be safe, and is recommended by the American College of Obstetricians \& Gynecologists, the World Health Organization and the U.S. Center for Disease Control. Immediate postpartum IUD placement has the advantage of providing contraception at a time that the woman is already accessing medical care, avoiding potential loss to follow up or risk of unintended pregnancy. Additionally, women who have anesthesia for delivery have reduced pain at the time of IUD placement compared to having the IUD placed at the postpartum follow up appointment. Immediate postpartum IUD placement is a relatively new practice in the US and little is known about the expected appearance of IUDs inside the uterus taken with an ultrasound when they have been placed at the time of delivery. It is less likely that IUD strings will be visible at the cervix after immediate postpartum IUD placement due to subsequent uterine involution, which makes it important to monitor correct positioning of the IUD via ultrasound. This study will document normal changes in the positioning of the IUD visualized via ultrasound, and determine if a correlation exists between IUD position and risk of expulsion. Ultrasound surveillance to document IUD position and distance from the fundus, will be performed at 6 weeks, 3 months and 12 months after placement. Symptoms of menstrual bleeding and pain will also be recorded in order to determine if they are correlated with IUD position.
Detailed description
The goal of this study is to document the expected ultrasound appearance of intrauterine devices (IUDs) placed immediately postpartum. This practice has been shown to be safe and effective, but little is known about long-term follow up for IUDs placed in this setting. Because IUD strings will not be visualized for many patients after immediate postpartum IUD placement, sonographic imaging will likely be required for the majority of patients to determine expulsion. However, the ultrasound appearance of these IUDs, placed immediately after birth and before uterine involution, may be different than those IUDs placed outside of the postpartum period. To our knowledge no other study has documented expected ultrasound appearance of IUDs placed in the immediate postpartum period.
The specific aims of this study are to: 1. document normal appearance of IUDs on ultrasound after immediate postpartum placement; 2. document if this appearance changes over time; and 3. determine if location on ultrasound is associated with side effects or expulsion.
Study design This is a prospective, observational study. All patients who have an IUD (either copper or levonorgestrel) placed immediately postpartum (within 10 minutes of delivery of placenta) after either Cesarean or vaginal delivery at Mount Sinai Medical Center and at Elmhurst Hospital Center will be eligible to participate in the study.
Study visits will include a speculum exam for IUD string check at 6 weeks, and ultrasounds to evaluate IUD position at the following time points: 6-10 weeks following placement, 3 months following placement (with inclusion up to 6 months), and 12 months following placement (with inclusion up to 15 months).
The ultrasound will document the following: size and position of uterus, IUD-Myometrium distance, IUD-endometrium distance, IUD-fundus distance and position of IUD. When participants present for the scheduled ultrasound visits, they will be asked to return with the completed symptom diary as well, to assess bleeding and pain.
Study Endpoints IUD expulsion, removal, or completion of the 12-15 month follow up visit will be the study endpoints. The participant will be withdrawn from the study if IUD expulsion occurs, or if she requests IUD removal for any reason. Participants will also be able to withdraw from the study at any time if they no longer wish to participate, but they may keep their IUD in place if desired.
Study procedures At the routine 6 week postpartum visit for all patients, pelvic and speculum exam will be performed as per normal clinical routine, and visualization of IUD strings at the cervical os will be documented. If IUD strings are not visualized, an ultrasound will be performed by the clinical provider to confirm presence or absence of IUD within the uterus.
A formal ultrasound to evaluate IUD position will be scheduled in the FPA gynecologic ultrasound unit or in the Gynecology clinic at EHC at the following time points: 6-10 weeks following placement, 3 months following placement (with inclusion up to 6 months), and 12 months following placement (with inclusion up to 15 months). The formal ultrasound will document the following: size and position of uterus, endometrial stripe (EMS) thickness, IUD-Myometrium distance, IUD-endometrium distance, IUD-fundus distance and position of IUD.
Immediate postpartum placement of IUDs is a relatively new clinical practice in the United States; as such there is no recommended or "standard" follow up protocol in this situation. For IUDs placed outside of the postpartum period, the standard follow up is a string check (speculum exam to confirm presence of strings at cervical os) 2-6 weeks after IUD placement. If strings are not visible, or if the patient experiences symptoms concerning for expulsion, a transvaginal ultrasound will be performed. Once correct placement is confirmed by ultrasound, patients without visible strings generally have ultrasounds yearly to confirm placement. Based on this standard practice, patients with visible strings will have the ultrasound only for research purposes. Additionally, the three month ultrasound will be only for research purposes, even in those without visible strings.
When participants present for the scheduled ultrasound visits, they will be asked to return with the completed symptom diary as well.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Immediate postpartum placement of IUD | – | Other: Immediate postpartum placement of IUDWomen who plan to have an IUD placed at the time of cesarean section or vaginal delivery, or women who have had an IUD placed at the time of cesarean section or vaginal delivery. |
Who may qualify
- Ages
- 18 to 55 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult
- Study population
- Patients will be recruited from the group of women receiving prenatal care at Mount Sinai Hospital in New York City and Elmhurst Hospital in Queens. Patients who express an interest in an IUD for contraception after delivery will be given information about immediate postpartum IUDs and the study.
Key inclusion criteria (3 listed)
- Women >18 years of age
- English or Spanish speaking
- Desire postpartum IUD placement, either copper IUD or levonorgestrel IUD
Key exclusion criteria (4 listed)
- Contraindications for IUD use (CDC MEDICAL Eligibility Criteria category 3 or 4 for specific IUD)
- Positive Chlamydia or gonorrhea cervical cultures in past 3 months
- Immediate postpartum hemorrhage
- Premature rupture of membranes (PROM) >12h or diagnosis of endometritis
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Immediate postpartum placement of IUDpelvic exam, transvaginal ultrasound (3 during the course of the study), bleeding and symptom diary | Other | Immediate postpartum placement of IUD |
Primary outcome
IUD-endometrial distance association with expulsion risk
Time frame: at 6 weeks after IUD placement
IUD-endometrial distance association with expulsion risk
Time frame: at 3 months after IUD placement
IUD-endometrial distance association with expulsion risk
Time frame: at 1 year after IUD placement
5 secondary outcomes
Expected normal appearance of IUD on ultrasound and change in appearance over time
Time frame: 6 weeks after IUD placement
Expected normal appearance of IUD on ultrasound and change in appearance over time
Time frame: 3 months after IUD placement
Expected normal appearance of IUD on ultrasound and change in appearance over time
Time frame: 1 year after IUD placement
IUD endometrial distance association with side effects
Time frame: 6 weeks after IUD placement
IUD endometrial distance association with side effects
Time frame: 1 year after IUD placement
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Oct 2017.
- Background: PubMed 21691183ACOG Practice Bulletin No. 121: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol. 2011 Jul;118(1):184-196. doi: 10.1097/AOG.0b013e318227f05e. No abstract available.
- Background: PubMed 23741782Medical Eligibility Criteria for Contraceptive Use: A WHO Family Planning Cornerstone. 4th edition. Geneva: World Health Organization; 2010. Available from http://www.ncbi.nlm.nih.gov/books/NBK138639/
- Background: PubMed 22717514Centers for Disease Control and Prevention (CDC). Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of hormonal contraception among women at high risk for HIV infection or infected with HIV. MMWR Morb Mortal Wkly Rep. 2012 Jun 22;61(24):449-52.
- Background: PubMed 22264666Levi E, Cantillo E, Ades V, Banks E, Murthy A. Immediate postplacental IUD insertion at cesarean delivery: a prospective cohort study. Contraception. 2012 Aug;86(2):102-5. doi: 10.1016/j.contraception.2011.11.019. Epub 2012 Jan 20.
- Background: PubMed 9306030Faundes D, Bahamondes L, Faundes A, Petta C, Diaz J, Marchi N. No relationship between the IUD position evaluated by ultrasound and complaints of bleeding and pain. Contraception. 1997 Jul;56(1):43-7. doi: 10.1016/s0010-7824(97)00072-3.
- Background: PubMed 11137069Faundes D, Perdigao A, Faundes A, Bahamondes L, Petta CA. T-shaped IUDs accommodate in their position during the first 3 months after insertion. Contraception. 2000 Oct;62(4):165-8. doi: 10.1016/s0010-7824(00)00167-0.
- BackgroundShimoni N, Davis A, Westhoff C. Can ultrasound predict copper IUD expulsion after medical abortion? Poster presentation at NAF 2012 conference, Columbia University Medical Center.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Britt Lunde, MD, MPH principal investigator
Icahn School of Medicine at Mount Sinai
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Contraception and Postpartum, run by Icahn School of Medicine at Mount Sinai at 2 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Oct 2017. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
IUD-endometrial distance association with expulsion risk (time frame: at 6 weeks after IUD placement). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02024672, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Oct 2017.