Comparison of expulsion and complications of intrauterine device insertion in immediate post placental period with interval period: a prospective study
Keywords:PPIUCD, IUCD, Expulsion, Contraception
Background: In India unmet need for contraception is estimated to be 15.8% as estimated by DHS survey. Immediate insertion of IUCD after delivery of placenta provides important opportunity to address the need for contraception. This study was carried out to evaluate complications and expulsion rates of immediate post placental insertion of IUCD in comparison to interval insertion.
Methods: This was a prospective clinical study conducted at ESIC medical college and district hospital, Kalaburgi, Karnataka, India with sample size of 150 women (50 each in vaginal, cesarean delivery and interval insertion) from June 2015 to Jan 2016.
Results: Majority of women were multipara with mean age of 27.5 years. There was no statistically significant difference in the overall rates of complication in each group in follow up period (p= 0.7, 0.9, 0.5 for bleeding, pain and infection respectively).While comparing expulsion rates among the three groups, vaginal delivery (group A) had higher expulsion 6%, trans cesarean insertion (group B) had one expulsion 2% and there were no expulsion in interval insertion (group C). The difference was found to be statistically significant among group A and C.
Conclusions: From above study postpartum insertion of IUCD is safe, effective and feasible reversible method of contraception. The rate of expulsion is higher in postpartum insertion compared to trans cesarean and interval insertion, can be minimized if it is inserted by trained provider and placed at fundus. The continuation rates were comparable in three groups i.e., 94%, 96% and 100% respectively.
Klijzing E. Are there unmet family planning needs in Europe? Fam Plann Perspect. 2000;32:74-81.
National Rural Health Mission Ministry of Health and Family Welfare Government of India. JSY. Available at http://www.mohfw.nic.in/layout_09-06.pdf. Accessed 19 September 2012.
Mülller ALL, Ramos JGL, Martins-Costa SH, Palma Dias RS, Valério EG, Hammes LS, et al. Trans vaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception. 2005;72:192-5.
Lara RR, Tobias GM, Pérez CR, Ramirez NV. Random comparative study between intrauterine device Multiload Cu375 and TCu 380a inserted in the postpartum period. Ginecol Obstet Mex. 2006;74(6):306‐11.
Shukla M, Qureshi S, Chandrawati. Post-placental intrauterine device insertion - a five year experience at a tertiary care centre in north India. Indian J Med. 2012;136(3):432-5.
Celen S, Möröy P, Sucak A, Aktulay A, Danişman N. Clinical outcomes of early post placental insertion of intrauterine contraceptive devices. Contraception. 2004;69:279‐82.
Gupta A, Varma A, Chauhan J. Evaluation of PPIUCD versus interval IUCD (380A) insertion in a teaching hospital of Western UP. Int J Reprod Contracept Obstet Gynecol. 2013;2(2):204-8.
El Beltagy NS, Darwish EA, Kasem MS, Hefila NM. Comparison between cupper T380 iud and multiload 375 iud in early post‐partum insertion. Middle East Fertility Society J. 2010;16:143‐8.
Eroglu K, Akkuzu G, Vural G, Dilbaz B, Akin A, Taskin L, et al. Comparison of efficacy and complications of IUD insertion in immediate post placental/early postpartum period with interval period: 1 year follow-up. Contraception. 2006;74:376-81.