Ultrasound guided detection of position of post partum intra uterine contraceptive device and its relation to complications

Dolly Chawla, Puja Bharti, Menka Verma, Rashmi Khatri


Background: Worldwide, Intrauterine Contraceptive Device (IUCD) is one of the most commonly used reversible methods of contraception among married women of reproductive age. It is the second most commonly used forms of contraception, ranking second only to female sterilization. Proper positioning of Copper containing IUCD is of utmost importance for efficacy and safety. The immediate postpartum period, after a birth but prior to discharge from the hospital is an important but under utilized time frame to initiate contraceptives, specially long acting contraceptives such as intrauterine contraceptive device (IUCD). To study the location of Copper IUCD by ultrasound, relationship between position and complaints, failure rate and expulsion rate in post-partum IUCD cases.

Methods: The study was prospective, analytical study conducted on 200 women for one year.  IUCD insertion was done in two groups; group A (normal delivery, postplacental) and group B (caesarean section, intracaesarean). On ultrasonography, position and distance of IUCD from fundus of uterus was measured. Outcome measures were expulsion, complication and failure rate upto six months. Informed consent was taken from each participant and ethical justification for the study was sought.

Results: Majority of the patients were in age group of 21-25 years. Multigravidae patients had more acceptability of IUCD than primigravidae. More than half of IUCD insertion was done by senior residents (56%). Malpositions were more common in vaginal delivery (62%) than caesarean section (28%). Most common malposition was mid cavity and least common was oblique. Most common complaint was pain abdomen and least common was expulsion.

Conclusions: Sonography can be used as an adjunct to clinical examination to examine the position of the IUCD. Ultrasonography done after PPIUCD insertion helps in determining, whether PPIUCDs are placed in normal position or malposition. Malpositioned PPIUCDs have more complications as compared to normally placed IUCDs


Intra uterine contraceptive device, Location, Malposition, Post Partum, Ultrasound

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Special bulletin on maternal mortality in India 2010-2012.Sample registration system by Registrar General, India. December 2013:1-4.

Chandhick N, Dhillon BS, Kambo I, Saxena NC. Contraceptive knowledge, practices and utilization of services in the rural area of India (an ICMR task force study). Indian J Medical Sciences. 2003;57:303.

Conde-agudelo A, Belzium JM. Maternal mortality and morbidity associated with interpregnancy interval: cross sectional study. Br Med J. 2000;321(7271):1255-94.

O'Hanley K, Huber DH. Postpartum IUDs: Keys for success. Contraception. 1992;45:351-361.

World Health Organisation. Mechanism of action, safety and efficacy of intrauterine devices: Report of a scientific group. Technical report series 753.WHO:Geneva;1987.

Department of Reproductive Health and Research, WHO. Medical Eligibility Criteria for contraceptive use. 4th ed. Geneva (CH): World Health Organization; 2010 (updated 2009; cited 2017 Apr 21).

United Nations, Department of Economics and Social Affairs, Population Division (2011). World Contraceptive Use 2010(POP/DB/CP/Rev2010).

Stover J, Ross J. How increased contraceptive use has reduced maternal mortality. J Maternal Child Health. 2010;14:687-695.

Xu J, Yang X. Comparison between two techniques used in immediate postplacental insertion of TCu 380A intrauterine device: 36-month follow-up. Contraception. 1999;10(3):156-62.

Celen S, Sucak A, Yildiz Y, Danisman N. Immediate post-placental insertion of an intrauterine contraceptive device during caesarean section. Contraception. 2011 Sep 30;84(3):240-3.

Grimes D, Schuluz K, van Vliet H. Immediate post-partum insertion of intrauterine devices. The Cochrane Library. 2005;3(7).

Gupta S. Association of the position of the Cu T 380a as determined by USG following its insertion in the immediate postpartum period with the subsequent complications. J Obstet Gynaecol India. 2014;64:349-353.