الفهرس 
Birth Control and Family PlanningOnly 14 pages are availabe for public view
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Abstract
The intrauterine device (IUD) is the most widely used contraceptive method in the world also in Egypt. Oral contraceptive was the leading method used by Egyptian women. from a public health viewpoint. Prevalence rates range among countries increased from 2% to 80% of contraceptive users (Nullahnung, 2014).
Intrauterine device (IUD) is safe and cost effective reversible. Method of contraception. It is a flexible device that protects from unexpected pregnancy when inserted into a woman’s uterus through the vagina. An IUD is made of polyethylene and impregnated in barium sulfate to make it radio opaque. It has two plastic strings tied to the end of the IUD hangs down through the cervix into the vagina to indicate that IUD in place and to facilitate its removal (WHO, 2014).
In Egypt, prevalence of IUD use among married women increased from 4% in 1980 to 37% in 2014. Because it is a clinical method, most common, IUD use is a good proxy indicator to measure clinical contraceptive use in Egypt (Al Inany, 2015).
Reasons for IUD removal were some medical factors and some general factors. General factors include; misperceptions, woman’s occupational status, husband’s occupational status, husband’s educational status, experience of side-effects and follow-up practice were associated with early discontinuation of IUD and medical as bleeding, menstrual disorder, abnormal vaginal discharge, itching, PID, cervicitis. It is necessary for the nurse to investigate the components of contraceptive dynamics such as; contraceptive discontinuation, failure and switching to conduct proper counseling and assist in the prevention of unintended pregnancy (Mardi et al., 2014).
The aim of the study was to analyze the factors associated with IUD discontinuation at Zagazig, Awlad sakr general hospitals. The study was conducted in the Family planning out patient clinics and labor units.
A total simple random sample of 90 women attending the Family planning out patient clinics of the above setting were included in the study.
Structured interviewing sheet was designed, validated and utilized by the investigator to collect data about: demographic characteristics, obstetrical history, data related to the use of IUD and reasons for discontinuation both medical and non-medical reasons as well as women desire for selection of another method for contraception.
A pilot study was carried out on 9 women to assess the applicability of the data collection tools.
The Present study revealed that:
• Women requested the removal of their IUD had a mean age of (33.3±7.8) years, mostly from the urban areas, housewives and obtained higher level of education.
• Women who had their IUDs removed had a mean number of para and living children 2.38±1.08 and 2.38±1.09 respectively. Regarding parity, more than half of studied sample were para 2-3 while Parity 1 were (22.2%) and Para ≥ 4 (14.4%).
• Distribution of the studied women according to their socio-demographic characteristics, (80%) of the studied women >20-30 years old. In addition, (91.11%) of them were from rural area. Regarding education level, (51.11%) of them finished secondary stage, while (96.67%) of them were married while, (3.33%) were widowed.
• One quarter of subjects (25.6%) were aborted while, (74.4%) had no abortion.
• More than three quarters of studied women with regular menstruation constitutes the highest percentage (91.1%), (23.3%) of them have dysmenorrhea.
• statistically significant relation was found between womens’ age and severe cramps in the abdomen, fall of the coil, medical reasons and choosing another method for not getting pregnant also, relation between residence and severe pain in the back, fall of the coil and social causes.
• More than three fifth of women didn’t know the type of IUD they need to remove.
• Statistically significant relation was found between gravidity and severe pain in the back and if there was pain occurring under certain conditions (96.2%) and (4.2%) have no pain, Regarding social causes, (55.2%) of the studied women have desire for pregnancy, (22.2%) of them have medical reasons and (77.8%) choose another method for no pregnancy (77.8%).
• Also a significant relation between abortion and inflammation in the genital tract (4.7%), social causes (5.1%), irregular menstruation (1.7%) and medical reasons (12.5%). However, (0.58%) of the studied women chose another method if they do not want to get pregnant and (0.56%) of them used different types of instrument.
• The desire for conception was the most common reason for discontinuation of the IUD constitutes (56.5%). The second reason for IUD withdrawal was bleeding and spotting. Other medical and social problems constitute a sizable portion of reasons for the discontinuation of the IUD. Only one third of the sample who had the desire to use another method for contraception.
• A statistical significant relation was found between women’s age, education, number of living children, previous use of the IUD, the duration of the current IUD and the reasons for discontinuation of the IUD.
This study could be summarized as the desire for conception was the most common reason, with the highest percentage, followed by heavy bleeding and spotting, of those the majority (66.3%) had lost the follow up. More than three fifth of women did not know the type of IUD they need to remove. A statistical significant relation was found between women’s age, education, number of living children, previous use of the IUD, duration of current IUD and the reasons for IUD discontinuation.
This study recommended that proper selection of an IUD candidate together with meticulous assessment and careful insertion of the IUD to avoid immediate and remote problems that cause discontinuation. Proper counseling is essential during initial and return visits. Factors responsible for making the woman lost the follow up should be overcome.