DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172529

A follow up study of postpartum intrauterine device insertion in a tertiary health care centre

. Ranjana, Anita Verma, Indu Chawla

Abstract


Background: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective and long-term contraception such as intrauterine device (IUCD) in post-partum women. This study was done to determine the efficacy and safety of Post-Partum Intrauterine Device (PPIUCD) and to compare the outcomes of PPIUCD insertion after vaginal delivery and caesarean section.

Methods: This follow up study was carried out in the department of Obstetrics and Gynecology, Dr. R.M.L Hospital, PGIMER, New Delhi over a period of 7 month from January 2016 to July 2016. PPIUCD (cu T- 380 A) insertions were done in 136 women who fulfilled the inclusion criteria. Women having haemoglobin less than 8 gm%, rupture of membranes more than 18 hours, obstructed labour, Uterine anomalies, distorted uterine cavity by fibroid, significant postpartum haemorrhage, coagulation disorders, fever or clinical symptoms of infection during labour were excluded from the study. Post insertion counselling was done, and these women were advised to follow up at 6 weeks and then after 6 months postpartum in the family planning O.P.D. At the follow-up visit, the women were asked for any symptoms of unusual vaginal discharge, irregular or heavy bleeding per vagina, and any expulsions if noticed.

Results: Total number of cases that reported for follow up in family planning OPD was 118. Therefore, 18 patients were lost in the follow up. In 58.47% women, there was no complaint. Heavy menstrual bleeding was found in 17.79% women and pelvic pain in 16.10% women. The expulsion rate was 5.08% and IUCD removal was done in 12.71% women. Though, the incidence of expulsion and removal rate was more in vaginal insertions than in caesarean insertions but this difference was not statistically significant, while the incidence of missing threads were found more in intra caesarean insertion (28% vs. 11.76% with p value <0.05). Continuation rate at 6 month was 82.20%.

Conclusions: PPIUCD insertion is a safe, convenient and effective method of contraception. Although the expulsion rate and removal rate was more in vaginal PPIUCD insertions, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in our country where most of the women do not come for contraceptive advice after delivery.


Keywords


Caesarean section, Contraception, Expulsion rate, Intrauterine device, Postpartum

Full Text:

PDF

References


Majhi AK. Importance of PPIUCD in perspective of present Indian Population Scenerio. Indian J Perinatol Reprod Biol. 2012;2(2):5-7.

IUCD Reference Manual for Medical Officers, Family Planning Division, Ministry of Health and Family Welfare, Govt. of India. 2007:1-20.

Sivin I, Stern J, Diaz S, Pavéz M, Alvarez F, Brache V, Mishell DR et al. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper T Cu 380Ag intrauterine contraceptive devices. Am J Obstet Gynaecol. 1992;166(4):1208-13.

Skjeldestad FE. The impact of intrauterine devices on subsequent fertility. Curr Opin Obstet Gynecol 2008;20(3):275-80.

Kulier R, O’Brien PA, Helmerhorst FM, Usher-Patel M, D’Areangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev. 2007;(4):CD005347.

Suri V. Post placental insertion of intrauterine contraceptive device. Indian J Med Res. 2012;136:370-1.

Grimes DA, Lopez LM, Schulz KF, Van Vliet HA, Stanwood NL. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev. 2010;5:CD003036,

Grimes D, Schulz K, Van Vliet HH, Stanwood N, Lopez LM. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev. 2003;1:CD003036.

Shukla M, Sabuhi Qureshi C. Post-placental intrauterine device insertion-A five year experience at a tertiary care centre in north India. Indian J Med Res. 2012;136(3):432.

Çelen Ş, Möröy P, Sucak A, Aktulay A, Danışman N. Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices. Contraception. 2004;69(4):279-82.

Tatum HJ, Beltran RS, Ramos R, Van Kets H, Sivin I, Schmidt FH, Ortho-McNeil I. Immediate postplacental insertion of GYNE-T 380 and GYNE-T 380 postpartum intrauterine contraceptive devices: randomized study. Am J Obstet Gynecol. 1996;175(5):1231-5.

Xu JX, Rivera R, Dunson TR, Zhuang LQ, Yang XL, Ma GT et al. A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the Copper T-380A IUD in Shanghai, People's Republic of China. Contraception. 1996;54(1):33-8.

Sharma A, Gupta V, Bansal N, Sharma U, Tandon A. A prospective study of immediate postpartum intra uterine device insertion in a tertiary level hospital. Int J Res Med Sci. 2015;3:183-7.

Xu JX, Reusche C, Burdan A. Immediate post placental insertion of intrauterine device: A review of Chinese and world experiences. Adv Contracept. 1994;10:71-82.

Gupta A, Verma A, Chauhan J. Evaluation of PPIUCD versus interval IUCD (380A) insertion in a teaching hospital of Western UP. IJRCOG. 2016;2(2):204-8.

Kittur S, Kabadi YM. Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy, and expulsion. IJRCOG. 2016;1(1):26-32.

Çelen Ş, Sucak A, Yıldız Y, Danışman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Contraception. 2011;84(3):240-3.

Thiery M, Van Kets H, Van der Pas H, Van Os W, Dombrowiez N. The ML Cu 250; clinical experience in Belgium and Netherlands. Br J Obstet Gynecol. 1982;89:51-3.

Müller AL, Ramos JG, Martins-Costa SH, Dias RS, Valério EG, Hammes LS, et al. Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception. 2005;72(3):192-5.

Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: a systematic review. Contraception. 2009;80:327-36.

Speroff L, Darney P. Intrauterine contraception, in A Clinical Guide for contraception. Lippincott Williams and Wilkins, Philadelphia, Pa, USA, 5th edition; 2010:239-80,

Sood B, Asif R, Charurat E, Das S, Kumar S, McKaig C et al. Revitalization of postpartum IUCD (PPIUCD) services: experience from India. Contraception. 2012;86(2):184-5.

Welkovic S, Costa LO, Faúndes A, de Alencar Ximenes R, Costa CF. Post-partum bleeding and infection after post-placental IUD insertion. Contraception. 2001;63(3):155-8.

Ricalde RL, Tobias GM, Perez CR, Ramirez NV. Random comparative study between intrauterine device multi load Cu375 and T Cu 380A inserted in the postpartum period. Gynecol Obstet Mex. 2006;74:306-11.

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(5):376-81.