Enhancing contraceptive usage by immediate postpartum intra uterine contraceptive device insertion with evaluation of safety, acceptability and expulsion

Lekhya Tirupati, Pradeep Shivaraju, Krishna Lingegowda, Sabitha Srinivasan


Background: India’s population which crossed one billion in 2000 is projected to reach 1.53 billion by 2050 making India the most populous country in world. In India 65% of women have unmet need for family planning in the first post-partum year. PPIUCD is highly effective, safe, long-acting, coitus independent and rapidly reversible method of contraception with very few side effects.  Since there is tenfold increase in institutional deliveries due to maternity benefit schemes, postpartum period is potentially an ideal time to begin contraception as women are more strongly motivated and these women would leave the hospital with contraceptive in place.

Methods: The present study was a prospective study to assess the acceptance rate of PPIUCD insertion and evaluation of safety of Cu T 380A when inserted within ten minutes of placental expulsion in 100 women delivering at PESIMSR, Kuppam. A specially designed proforma was used to collect the data of women attending hospital between period June 2016 to June 2017.

Results: Out of 486 patients who were counselled only 100 women (20.57%) accepted for PPIUCD insertion. The acceptance rate of PPIUCD is 20.57%. Of 100 women who had PPIUCD insertion, 91 were seen at follow up, 76 (78.12%) women were continuing with no complaints and only 15 (16.4%) women developed complications. PPIUCD was found to be safe as there was no reported case of perforation or failure during usage. The complications like expulsion was found to be 1.09%, infection 5.4%, pain abdomen 5.4%, bleeding 1.09% and missing strings 5.4%.

Conclusions: PPIUCD was demonstrably safe, having no reported case of uterine perforation. Expulsion rates are low implying more retention rates, thus more effective. Public awareness regarding the concept and advantages of PPIUCD insertion can be improved by mass media approach and creating strategies and training programmes under Government policies.


Postpartum intrauterine contraceptive device, Post placental IUCD

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Marston C. Report of a WHO Technical Consultation on Birth Spacing Geneva Switzerland 13-15 June 2005.

PPIUCD Reference Manual, Ministry Of Health and Family Welfare, Feb 2011,10,24. Available at

Safwat A, Mohamed Momen A, Kamel Omar M, Shaaban HT, Salem. Acceptability for the Use of Postpartum Intrauterine Contraceptive Devices: Assuit Experience, Medical Principles and Practice 2003; 12(3):170-5.

Mishra S. Evaluation of safety, efficacy, and expulsion of post-placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD). J Obstet Gynecol India. 2014;64(5):337-43.

Sharma A, Gupta V. A study of awareness and factors affecting acceptance of PPIUCD in South-East Rajasthan. Int J Community Med Public Health. 2017;4(8):2706-2710.

Thomas D and Maluccio J. Fertility, Contraceptive Choice, and Public Policy in Zimbabwe. World Bank Eco Review. 1996;10(1):189-222

World Contraceptive Use 2010, United Nations, Population Division, Department of Economics and Social Affairs.

Sanskriti P, Amita T, Pratima M, Rupali D, Jyotsna S, Kumar A. Exploring reasons behind Low acceptance for PPIUCD in postnatal women. New Indian J Surg. 2011;2(4):246.

Verma A, Chawla I. A follow up study of postpartum intrauterine device insertion in a tertiary health care centre. Int J Reproduct, Contracep, Obstet Gynecol. 2017;6(7):2800-5.

WHO Report. Mechanism of action, safety and efficacy of intrauterine devices. World Health Organ Tech Rep Ser 1987;753:1.

Chi IC, Wilkens L, Rogers S. Expulsions in immediate postpartum insertions of Lippes Loop D and Copper T IUDs and their counterpart Delta devices—an epidemiological analysis. Contraception. 1985;32(2):119-34.

Sofat R. Postpartum CuT insertion - a trial. 4. Indian J Maternal Child Health. 1990;1(1): 23-42.

O'Hanley K, Huber DH. Postpartum IUDS: keys for success. Contracep. 1992;45(4):351-61.

Maluchuru S, Aruna V, Prabhavathi N. Post-partum–intrauterine device insertion–2yr experience at a tertiary care center in Guntur medical college/govt. general hospital, Guntur. IOSR J Dent Med Sci. 2015;14(7):2279-861.

Nathalie Kappa et al Intrauterine device insertion during the postpartum period:a systematic review Contraception.2009;80(4);327-36

Lopez, Grimes, Szpir (Family health international/CRTU 7. programme). Immediate postpartum insertion of an IUD is safe and effective. Global health technical briefs. 2007. USA: USAID (United States Agency for International Development and Family Health International); 2007.

Cole LP, Edelman DA, Potts DM, Wheler RG, Laufe LE, Postpartum insertion of modified intrauterine devices, J Reproduct Med. 1984;29(9):677–82.

Phatak L, Chandorkar KA. An experience with immediate postpartum and postabortalIUD insertions. B. Disappearance of IUD threads. In: Zatuchni GI, ed. Postpartum Family Planning. New York: McGraw Hill, 1970,299-306.

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 Sep;136(3):432.