The Latest Scientific Knowledge and WHO Guidance about IUDs. Roy Jacobstein, M.D., M.P.H. Clinical Director, ACQUIRE EngenderHealth IUD Standardization Workshop Accra, Ghana June 2006. IUDs: Effectiveness and Safety. Highly effective, comparable to FS, V, Implants
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The Latest Scientific Knowledge and WHO Guidance about IUDs
Roy Jacobstein, M.D., M.P.H.
Clinical Director, ACQUIRE
IUD Standardization Workshop
New UnderstandingsNew Perceptions New “Truths”
Three main provider concerns:
Evidence is reassuring …
Concern: Does IUD Cause PID?
* Farley et al., Lancet 1992
PID Incidence Rate by Time Since Insertion
(per 1000 woman years)
Months (first year)
Time Since Insertion
Source: Farley et al, 1992, in FHI 2004
High Risk Setting of 10% Cervical Infection
Simple Screening Questions
Only 1 in 667 would get PID from IUD
Only 1 in 333 would get PID from IUD
* Shelton, Lancet 2001
*AbouZahr, Br Med Bull 2003 **Guttmacher Institute, 1999
* Westrom, Am J Obstet Gynecol 1975
infertile women: twice the % of antibodies
* Hubacher et al., N Engl J Med 2001
* Shelton, Lancet 2001
Three possible questions to consider:
& 95% CI
Sinei et al, Lancet, 1998Morrison et al., Br J Obstet Gynaecol 2001
* Richardson et al., AIDS 1999
Current WHO Guidance About IUDs in Response to thisNew Evidence
In the presence of a given condition or classification, e.g., STIs or HIV/AIDScan a particular FP method be used?
(And with what degree of caution or restriction, as reflected in 4 categories or gradations based on risks & benefits)?
“Data do not confirmthe utility
of prophylactic administration
of antibiotics …”*
* Cu-T 380A labeling
* Grimes et al., Contraception 1999
Question 10. Should prophylactic antibiotics be
provided for Copper-bearing IUD insertion?
* WHO, Selected Practice Recommendations (SPR), 2004
Study in Kenya found:
Checklist for ruling out pregnancy among FP clients in primary care” * Stanback et al., Lancet 1999
Typical ectopic pregnancy rate per 1000 woman years of method use
Adapted from: Sivin 1991, in FHI 2004
Progesterone-Releasing Intrauterine Systems (IUS)