Evaluation of long-term clinical outcomes among PPIUCD users at six medical college hospitals

A. G. Radhika; Rashmi Gupta; Amita Suneja; Gowri Dorairajan; Pratima Aggarwal; Venkatesh Ashok; Vanita Suri; Rimpi Singla; Smiti Nanda; Meenakshi Chauhan; Vandana Rani; Nalini Arora; Rachna Chaudhary; Abhilasha Gupta; Rajeev Kumar Malhotra; Shalini Singh

doi:10.18203/2320-1770.ijrcog20243187

Authors

A. G. Radhika Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
Rashmi Gupta Department of Family Planning, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
Amita Suneja Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
Gowri Dorairajan Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
Pratima Aggarwal Department of Family Planning, JIPMER, Puducherry, India
Venkatesh Ashok Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
Vanita Suri Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
Rimpi Singla Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
Smiti Nanda Department of Obstetrics and Gynecology, PGIMS Rohtak, Haryana, India
Meenakshi Chauhan Department of Obstetrics and Gynecology, PGIMS Rohtak, Haryana, India
Vandana Rani Department of Obstetrics and Gynecology, PGIMS Rohtak, Haryana, India
Nalini Arora Department of Obstetrics and Gynecology, ESI-PGIMSR, Kolkata, West Bengal, India
Rachna Chaudhary Department of Obstetrics and Gynaecology, Lala Lajpat Rai Medical College, Meerut, India
Abhilasha Gupta Department of Obstetrics and Gynaecology, Lala Lajpat Rai Medical College, Meerut, India
Rajeev Kumar Malhotra Department of Statistics, All India Institute of Medical Sciences, New Delhi, India
Shalini Singh Department of Maternal and Child Health, Indian Council of Medical Research, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20243187

Keywords:

Continuation rate, Lower segment cesarean section, Normal vaginal delivery, Postpartum intrauterine contraceptive device, Satisfaction rate, Short and long-term outcomes

Abstract

Background: Postpartum IUCDs are becoming increasingly popular in low-income countries, but there are few studies addressing long-term outcomes.

Methods: A prospective observational study conducted in six tertiary care hospitals across India to investigate satisfaction rates, expulsions, adverse events and complications of PPIUCD for up to 24 months.

Results: PPIUCD was accepted by 16262 out of 56619 eligible women. Of these, 59.6% had NVDs, and the rest had LSCSs. PPIUCD continuation proportion was 90.3% at 6 weeks and 72.5% at 6 months. It decreased to 50.6% after 24 months. Women reported 73.91% satisfaction at 6 months, but only 48% at 24 months. PPIUCD removal and expulsion rates were 8.39% and 3.76% at 6 months and 13.4% and 2.95% at 24 months. Removal rates were significantly different between NVD and LSCS women (25.37% versus 18.8%; p<0.001). Thread discomfort was the most common reason for removal and was more common in LSCS group. Expulsions were higher at six months in the NVD, 9.85% versus 7.10% (p<0.001). Reported side effects were abdominal pain, abnormal bleeding and white discharge in both groups.

Conclusions: There was a progressive reduction in continuation and satisfaction with PPIUCD use over 24 months. Thread discomfort, abdominal pain, and abnormal bleeding were major reasons for dissatisfaction. Most of the women chose private practitioners for IUCD. Additionally, the reported side effects highlight the need for further research. Both quality of life and contraceptive efficacy play a major role in the success of contraception.

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