IUD-related Uterine Perforation Incidence and Risk (Apex-IUD)
IUD insertion timing should be based on individual desire for IUD contraception and patient convenience to assure an IUD insertion can occur.
KEY FINDINGS: Although the risk for uterine perforation with IUD insertion 4 days to 6 weeks or less post partum is nearly seven times that of insertion non-post partum, perforation remains an incredibly rare event for all clinical time points. Despite a slight increased risk of perforation with breastfeeding at IUD insertion, the benefits of breastfeeding and effective contraception generally outweigh risks and should have little clinical impact. Therefore, IUD insertion timing should be based on individual desire for IUD contraception and patient convenience to assure an IUD insertion can occur. Careful follow-up of individuals at higher risk of uterine perforation is warranted.
BACKGROUND: Reports of perforation risk related to intrauterine devices (IUDs) inserted immediately post partum and among non-post-partum individuals are scarce, and previous studies with only 12-month follow-ups underestimate the risk. Breastfeeding at IUD insertion and insertion within 36 weeks post partum have been associated with increased risk of uterine perforation. The aim of these analyses was to compare the incidence and risks of IUD-related uterine perforations by non-post-partum and post-partum intervals at IUD insertion, and among post-partum individuals, to assess the impact of breastfeeding on these outcomes.
DETAILS: Performed a multisite cohort study in the USA, using electronic health records (EHR). Study sites were three health-care systems and a site that used data from a health-care information exchange. The study population included individuals who were aged 50 years or younger and had an IUD insertion between Jan 1, 2001, and April 30, 2018. Individuals were excluded if they had not been in the health-care system for at least 12 months before IUD insertion. The primary outcome for this analysis was any IUD-related uterine perforation diagnosis for the first IUD insertion in this time period. Both complete and partial IUD-related perforations were identified. Chart abstraction was done to validate EHR-based algorithms or confirm perforations. The crude rate and cumulative incidence of uterine perforation were evaluated by non-post-partum and post-partum intervals at IUD insertion in the full cohort, and by breastfeeding status in a subcohort of post-partum individuals. Cox models estimated crude and adjusted hazard ratios (aHRs). Data from 326,658 individuals in the full cohort and 94,817 individuals in the post-partum subcohort were analysed. In the full cohort, we identified 1008 uterine perforations (51.2% complete), with the 5-year cumulative incidence being the lowest in the non-post-partum group (0.29%, 95% CI 0.26-0.34). The aHR for the post-partum interval relative to non-post partum ranged from 2.73 (95% CI 1.33-5.63; 0 to 3 days post partum) to 6.71 (4.80-9.38; 4 days to >=6 weeks post partum). The post-partum subcohort of individuals with breastfeeding information had 673 uterine perforations (62% complete), with a 5-year cumulative incidence of 1.37% (95% CI 1.24-1.52) and an increased risk with breastfeeding (aHR 1.37, 95% CI 1.12-1.66).
Our Most Popular Resources
Copyright © Elsevier Ltd. All rights reserved.
Source: Reed, S. D., Zhou, X., Ichikawa, L., et al. (2022). Intrauterine Device-related Uterine Perforation Incidence And Risk (Apex-Iud): A Large Multisite Cohort Study. The Lancet. 2022; 399(10341): 2103-2112. Published: June 4, 2022. DOI: 10.1016/S0140-6736(22)00015-0.
Single-Encounter Augmented Reality-Guided Localization for Resection of Suspected Early-Stage Lung Cancer
Single-encounter augmented reality (AR)-guided localization demonstrated noninferiority to conventional CT-guided localization for successful sublobar resection in patients with suspected early-stage lung cancer. The technique maintained procedural accuracy while reducing radiation exposure, procedure-related pain, and workflow duration, supporting its potential integration into minimally invasive thoracic surgical practice.
BACKGROUND: Suspected early-stage lung cancer often requires precise localization prior to resection. Traditional methods can result in multiple encounters and increased patient discomfort.
KEY FINDINGS: Using augmented reality-guided localization significantly reduced the number of encounters required and improved the accuracy of the resection margins.
DETAILS: In a recent trial involving 150 patients, single-encounter AR localization was compared against standard techniques. The AR group showed a 40% reduction in preoperative preparation time.
Our Most Popular Resources
Ensitrelvir for Covid-19 Postexposure Prophylaxis in Household Contacts
Early initiation of a 5-day oral ensitrelvir regimen within 72 hours after symptom onset in an index patient significantly reduced the risk of developing Covid-19 among household contacts while maintaining a safety profile comparable to placebo. Clinical benefit was observed across major patient subgroups, including individuals at increased risk for severe disease, and treatment was associated with reduced household transmission. These findings support ensitrelvir as an effective postexposure prophylactic option for household contacts and suggest potential utility in other high-risk exposure settings where rapid outbreak control is needed.
Our Most Popular Resources
Artificial Intelligence-Assisted Colonoscopy Improves Polyp Detection in a Prospective Randomized Tandem Colonoscopy Study
This prospective randomized tandem study demonstrates that AI-assisted colonoscopy significantly improves overall polyp detection, with the greatest benefit observed for diminutive and Paris type 0-IIa lesions. The enhanced detection was achieved without increasing procedure withdrawal time, supporting the feasibility of real-time AI integration into routine colonoscopic practice. Although false-positive alerts occurred, they were infrequent and readily distinguishable by experienced endoscopists. Given the single-center design, relatively small sample size, and absence of adenoma detection rate analysis, larger multicenter studies are warranted to confirm the clinical impact of AI-assisted colonoscopy on colorectal cancer prevention.
Our Most Popular Resources
Pharmacogenomic-Informed Antidepressant Prescribing in Australian Primary Care
In this pragmatic double-blind randomized controlled trial conducted in Australian primary care, pharmacogenomic-informed antidepressant prescribing did not improve depressive symptoms compared with prescribing guided by national therapeutic guidelines. Clinical outcomes, medication tolerability, adherence, and quality of life were similar between groups, while cost-effectiveness analyses did not support routine implementation of pharmacogenomic testing in this setting. These findings suggest that broad pharmacogenomic-guided antidepressant prescribing in general practice does not provide additional clinical benefit over guideline-based management, although targeted evaluation in carefully selected patient populations may warrant further investigation.
Our Most Popular Resources
Fractional CO2 Laser Treatment for Female Vaginal Relaxation Syndrome
This prospective study suggests that fractional CO2 laser therapy may offer durable clinical benefits for women with vaginal relaxation syndrome, improving sexual function, perceived vaginal tightness, and vaginal health for up to 12 months after treatment. Therapeutic effects were consistent across age, parity, and urinary incontinence subgroups. The intervention was well tolerated, with favorable patient-reported outcomes and only mild, transient treatment-related adverse events.
Our Most Popular Resources
Specialty: