Consensus of best practice in intrauterine contraception in France

Abstract

Objective: Our aim was to provide a consensus of best practice in intrauterine contraception (IUC) for French practitioners.

Methods: A meeting of 38 gynaecologists was held to establish a consensus of best practice in IUC, using the validated nominal group (NG) method to reach consensus. Seventy questions were posed covering insertion, monitoring and removal of IUC devices. Two working groups were formed and all proposals were voted on, discussed and approved by the NG.

Results: Of the 70 questions asked, answers to only four failed to reach NG consensus. While, in general, the IUC practices of French gynaecologists are in line with international guidelines, some notable differences were identified: for example, when to use the levonorgestrel-releasing intrauterine system versus the copper intrauterine device; practice recommendations in the event of upper genital tract infections; and immediate postpartum insertion. Clinicians are encouraged to inform women about IUC, irrespective of their age or parity. In general, the wishes and characteristics of the woman must be the main criteria informing the choice of IUC, once all potential contraindications have been excluded and information about IUC shared.

Conclusions: This consensus paper is intended to update and standardise knowledge about IUC for health care professionals, to address any reticence about use of this contraceptive method.

摘要

目的：我们的目的是为法国医生提供宫内避孕 (IUC) 最佳实践的共识。

方法：有38位妇科专家召开会议, 建立 IUC 最佳实践共识, 会议使用经验证的名义群体(NG) 方法达成共识。会议中提出了70个问题, 包括 IUC 器械的置入、监测和取出。成立了两个工作组, 并对所有提案进行了表决、讨论和批准。

结果：在被问及的 70 个问题中, 只有 4 个问题的答案未能达到 NG 共识。总的来说法国妇科专家的 IUC 实践与国际指南一致, 但也发现了一些显著差异：例如, 何时使用左炔诺孕酮宫内缓释系统与铜型宫内节育器；上生殖道感染时的实践建议；以及产后立刻置入等。鼓励临床医生告知女性关于 IUC 的信息, 无论其年龄或胎次如何。一般而言, 一旦排除了所有潜在禁忌证并共享了关于 IUC 的信息, 女性的意愿和特征必须是选择 IUC 的主要标准。

结论：本共识文件旨在更新和规范医疗保健专业人员的 IUC 相关知识, 以解决对使用本避孕方法的信息宣传。

Keywords:

• Consensus
• copper
• intrauterine contraception
• levonorgestrel
• nulliparous

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We would like to thank the KPL team who helped organise and write this expert opinion paper.

NG expert panel: This consensus paper of good IUC practice was developed from a meeting of the following physicians: K. Ardaens, gynaecology, Lille; E. Aubeny, medical gynaecology, Paris; J.-M. Audren, obstetrics and gynaecology, Brignoles; H. Baffet, medical gynaecology, Lille; J.-P. Bénezech, gynaecology, Albi; R. Benichou, obstetrics and gynaecology, Bruges; C. Binelli, gynaecology, Nantes; C. Cantegrel, medical gynaecology, Albi; J.-D. Cost, gynaecology, Villeurbanne; P. De Reilhac, gynaecology, Nantes; P. de Saint Hilaire, obstetrics and gynaecology, Lyon; E. Deleuze Rochaix, medical gynaecology and obstetrics, Lyon; R. Drefus, gynaecology, Paris; P. Driguez, gynaecology, Paris; V. Echallier Laveix, obstetrics and gynaecology, Pierre-Bénite; C. Fohet, medical gynaecology, La Farlède; P. Fournet, obstetrics and gynaecology, Mont-Saint-Aignan; H. Guillaume, obstetrics and gynaecology, Manosque; T. Harvey, obstetrics and gynaecology, Paris; S. Heckel, gynaecology, Lyon; I. Heron, gynaecology, Rouen; D. Hery, obstetrics and gynaecology, Avignon; B. Letombe, medical gynaecology, Lille; P. Madelenat, gynaecology, Paris; O. Marpeau, obstetrics and gynaecology, Aix-en-Provence; J. Maruani, medical gynaecology, Marseille; P. Merviel, obstetrics and gynaecology, Brest; M.-H. Meynie-Plume, obstetrics and gynaecology, Toulouse; C. Pélissier, gynaecology, Paris; S. Pozzi-Gaudin, medical gynaecology, Clamart; P. Roblin, generalist, Marseille; M. Roman, obstetrics and gynaecology, Mougins; F. Scheffler, medical gynaecology, Amiens; M. Scheffler, obstetrics and gynaecology, Nancy; D. Serfaty, gynaecology, Paris; M. Thevenot, medical gynaecology, Agen; C. Wong, obstetrics and gynaecology, Saintes.

Disclosure statement

DS is or has been a scientific adviser or speaker for the following pharmaceutical companies: HRA, Bayer, Innothera, Althea, Gedeon Richter, Aspen and Pfizer. JPB is a member of the family planning and contraception commission of the National College of French Gynaecologists and Obstetricians and is or has been a scientific adviser or speaker for the following pharmaceutical companies: MSD, Bayer, Théramex, Pierre Fabre and Sanofi. SH is or has been a scientific adviser for Bayer HealthCare Pharmaceuticals. PDR declares no conflict of interest.

Additional information

Funding

The working group meetings received financial support from Bayer HealthCare Pharmaceuticals. The latter did not participate in the development of the consensus on good IUC practice. No company representative was present at the meetings.