Postpartum intrauterine device

She was with what can be called an NGO. The NGO was affiliated to Johns Hopkins in US. She said they were working with our central government on a program for insertion of intrauterine-devices immediately after delivery of the baby and placenta, vaginally or after a cesarean section. She wanted us to do it in our patients too. "It will be possible only if you can convince heads of all other clinical units in my development" I said. " I will need references too." After all Johns Hopkins published Population Reports, and there had been no issue published recently on this technique. We had been using modified devices for early puerperal insertions. We used to put No. 2 chromic catgut sutures on the transverse bars of the devices so that they would stick in the decidua of the uterine fundus. By the time the catgut got absorbed, the uterus would be involuted and the device would not get expelled. Now they wanted us to use regular devices without any modifications. She sent me a CD with a number of published articles, mostly abstracts. She also arranged a meeting in which all questions we would ask would be answered. I read the references. They could not make it in time for the meetings and I had to leave for a planned teaching session. But the following points emerged in the discussion before I had to leave. I. The expulsion rates were far higher than after interval insertion. 2. The threads of the devices could remain above the cervix in 4 to 5 per cent cases. Ultrasonagraphy would be required in these patients every time the continued existence of the device in the uterine cavity had to be ascertained. 3. All the studies had been performed in developing counties and none in the developed countries.