Абстрактный

The rate of complications in the copper intrauterine device use among HIV positive women with postpartum inserting

Posokhova Svitlana Petrivna

 HIV/AIDS epidemic in Ukraine continues increasing. The problem of prevention of unintended pregnancies among women infected with HIV is important. The new data show, that intrauterine device (IUD) can be safely used by women living with HIV/AIDS, who are clinically healthy or receive antiretroviral therapy (ART).

Objectives: Our case-control study had the aim to determine whether IUD-related complications after postpartum insertion are more common among HIV positive than among HIV negative women.

Methods: We selected purposively 88 postpartum HIV positive women with median counts of CD4+ > 350 cells and 45 HIV negative women in the maternal wards. Our examination included: the general blood count, screening of STI. IUD inserted to women irrespective of number of delivery, which proceeded without complications. We inserted the Co-IUDs to all women in the first 48 hours after vaginal delivery. The rate of IUDs -related complications were evaluated at 1, 6 and 12 months of use after vaginal delivery.

Results: Among HIV-infected women median age was 25.2 years, history of IDU had 17%, smoking – 54.5%, alcohol use – 4.5%. HIV-infected women in 52.2 % cases had sexually transmitted infection which in 3.4 times more as compared to HIV-negative. STI were treated according to reports. One of the most often complications after postpartum inserting of IUD – is expulsion The rate of expulsion was similar in the both groups and increased after second or third delivery. At 6 months after the delivery 83 HIV-infected and 43 HIV-negative continued to be observed, as 4 (3 %) of them had expulsion of IUD and 3 (2.25 %) had left out follow-up. 16 (19.3%) HIV-positive women with IUD had complaints of heavy menstrual bleeding within last 2 months. The frequency of heavy menstrual bleeding was 1.7 times less (11.6 %) in HIVnegative women. Two HIV-positive women with heavy anemia have removed of IUD. The control examination through 9 months after delivery had made about 80 % of women with IUD, which continued to use this contraceptive. The first episode of pelvic infection appears in HIV infected women after 9 month using of IUD. After 12 month using of IUD the rate of pelvic infection was 5.68% in HIV positive women and 4.4 % in uninfected women.

Conclusion: Thus, the rates of complications in HIV positive women were not higher than in uninfected women. The postpartum inserting of IUD appears to be a safe and acceptable method of contraception for HIV positive women