DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180877

Two years follow up study of post placental insertion of IUCD during caesarean sections: safety, efficacy and complications

Dilpreet Kaur Pandher, Shikha Rani, Poonam Goel

Abstract


Background: The present study evaluates safety, efficacy, expulsion rate and complications of PPIUCD insertion in women undergoing caesarean section in a medical college for 2 years period.

Methods: This is a prospective cohort study done over a 2 year period. Total 185 patients undergoing caesarean section and fulfilling medical eligibility criteria for PPIUCD were enrolled in the study. The followup of these patients was done at 6 weeks, 6 months and 1-2 years.

Results: Thirteen patients (7%) lost to follow up so final outcome analysis was done in 172 patients. The problems encountered were spontaneous expulsion in 4 patients, removal due to heavy menstrual flow in 13 patients, non-visibility of threads in 4 patients, discharge per-vaginum in 1 patient and pain lower abdomen in 1 patient. Voluntary removal was done in 3 patients by 2 years who wished to conceive. The successful continuation rate came out to be 84.9% by 2 years. There was no failure reported in terms of intra-uterine or extra-uterine pregnancy and no increased risk of infection or perforation over the 2 years follow up.

Conclusions: Immediate post-placental IUCD insertion is safe and effective method of contraception with no need to wait for 6 weeks which thereby reduces unwanted pregnancy rates. Mild discomfort and the minor post procedure complaints are taken care of well in puerperium. Higher rate of expulsion can be taken care of by early follow-up with regular visits and offering other safe and effective method of contraception.


Keywords


Long acting reversible contraception, PPIUCD, Postpartum contraception, Postplacental CuT

Full Text:

PDF

References


TCu380A Intrauterine Contraceptive Device (IUD) WHO/UNFPA Technical Specification and Prequalification Guidance 2016. Available at https://www.unfpa.org/sites/default/files/resource-pdf/TCu380A_IUD_WHO-UNFPA_Tech._Spec_and_PQ_guidance_2016_final.pdf

Roberto Rivera, William Winfrey. UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). External evaluation 2003-2007; Long-term safety and effectiveness of copper-releasing intrauterine devices: a case-study. World Health Organization 2008

Medical eligibility criteria for contraceptive use – Intrauterine devices. 5th ed 2015. Available at http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf. Accessed on 23 Dec 2017.

Rodrigues da Cunha AC, Doren JG, Cantuaria AA. Intrauterine device and maternal copper metabolism during lactation. Contraception. 2001;63(1):37-9.

Jin RN, Niamh C, John S, Yogender PG, Leontine A. Levels and trends in contraceptive prevalence, unmet need, and demand for family planning for 29 states and union territories in India: a modelling study using the Family Planning Estimation Tool. Lancet. 2017;5(3):e350-e358.

United Nations Population Division (UNPD) and Department of Economic and Social Affairs. World Contraceptive Use 2015. Available at http://www.un.org/en/development/desa/population/publications/dataset/contraception/wcu2015.shtml. Accessed on Nov 22, 2017.

Rutstein S. Further evidence of the effects of preceding birth intervals on neonatal, infant, and under-five-years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. DHS Working Papers No. 41. Macro International;2008.

Somesh K, Reena S, Sudharsanam B, Elaine C, Kamlesh L, Richard S et al. Women’s experience with postpartum intrauterine contraceptive device use in India. Reprod Health. 2014;11:32

Mamta B, Jyoti L, Khushbu P. Study of efficacy and complication of postpartum IUCD insertion at Govt. medical college, Bastar. Int J Reprod Contracept Obstet Gynecol. 2016 Dec;5(12):4128-31.

Sujnanendra M. Evaluation of safety, efficacy, and expulsion of post-placental and intra-Cesarean Insertion of Intrauterine Contraceptive Devices (PPIUCD). J Obstet Gynaecol India. 2014 Oct; 64(5):337-43.

Mohamed SA, Kamel MA, Shaaban OM, Salem HT. Acceptability for the use of postpartum intrauterine contraceptive devices: Assiut experience. Med Princ Pract. 2003;12(3):170-5.

Thomas D, Maluccio J. Fertility, contraceptive choice, and public policy in Zimbabwe. World Bank Econ Rev. 1996;10(1):189-222.

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

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

Xu JX, Reusché C, Burdan A. Immediate postplacental insertion of the intrauterine device: a review of Chinese and the world’s experiences. Adv Contracept. 1994; 10 (1):71-82.

Manju S, Sabuhi Q, Chandrawati. Post-placental intrauterine device insertion: A five year experience at a tertiary care centre in north India. Indian J Med Res. 2012;136:432-5.

Marai W. Lower genital tract infections among pregnant women: a review. East Africa Med J. 2001;78:581-5.

Kurewa NE, Mapingure MP, Munjoma MW, Chirenje MZ, Rusakaniko S, Stray-Pederson B. The burden and risk factors of sexually transmitted infections and reproductive tract infections among pregnant women in Zimbabwe. BMC Infect Dis. 2010;10:127.

Letti Müller AL, Lopes Ramos JG, Martins-Costa SH, Palma 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.

Raffat S, Azra J, Anila A. Immediate Postpartum Insertion of Intrauterine Device: An Ideal Method. JSOGP. 2015;5(1):34-9.

Chi IC, Su-Wen Z, Balogh S, Ng K. Post-cesarean section insertion of intrauterine devices. Am J Pub Health. 1984;74(11):1281-2.

Muthal-Rathore A. Immediate postpartum insertion for intrauterine devices: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organisation; 2010.