DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20192417

Prospective study on outcome of post-partum intrauterine contraceptive device insertion at tertiary level rural health institute of Gujarat, India

Shilpa N. Ninama, Tejas A. Shah, Mayur R. Gandhi

Abstract


Background: This study was conducted to evaluate the acceptance, safety, efficacy, complications and expulsion rate of post-partum intrauterine contraceptive device (PPIUCD) insertion among post-partum pregnant women in a rural tertiary care center. Objective of this study was assessment of the efficacy and safety of post-partum IUCD insertion. Comparing the complications and client satisfaction in both groups (intra caesarean insertion versus vaginal route of insertion).

Methods: This is a prospective study conducted at one of the rural tertiary care teaching institution. A total of 150 patients with caesarean or vaginal deliveries had PPIUCD insertions and they were followed up for a period of one year. The outcome measures analyzed were menstrual irregularities, vaginal discharge, pelvic infection and perforation and efficacy measures - failure, expulsion and removal. Data are expressed in frequency and percentage. Chi square test was used for comparison and P value <0.05 was considered significant.

Results: The study shows that PPIUCD is an effective intervention in both caesarean and vaginal delivery with non-significant differences in safety and efficacy depending on the route of insertion. There was no case of perforation and no significant risk of infection in either caesareans or delivery. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the caesarean group compared to vaginal insertion.

Conclusions: PPIUCD is a safe, effective and long term reversible method of contraception and should be encouraged by public awareness and community acceptance.


Keywords


Intra caesarean, Post placental, Post-partum contraception, Post-partum intra uterine contraceptive device

Full Text:

PDF

References


Post-partum IUCD reference manual. New Delhi: Family planning division, Ministry of Health and Family Welfare, Government of India; 2010. Available at: http://www.nrhmtn.gov.in/modules/PPIUCD%20Reference%20Manual.pdf. (Last accessed 22 May 2019).

Garg N, Grover S, Kaur B. Post-partum IUCD: its acceptance and complications. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):2973-7.

Shukla M, Qureshi S, Chandrawati. Post placental intrauterine devices insertion: a five-year experience at a tertiary care center in North India. Ind J Med Res. 2012;136(3):432-5.

Grimes D, Schulz K, van Vliet H, Stanwood N. Immediate post-partum insertion of intrauterine devices: A Cochrane review. Hum Reprod. 2002;17:549-54.

Kumar S, Sethi R, Balasubramaniam. Women’s experience with post partum intrauterine contraceptive device use in India. Reprod Health. 2014;11:32.

Jani PS. Prospective study on outcomes of postpartum intrauterine contraceptive device including safety, efficacy and expulsion at GMERS Medical College, Dharpur-Patan, Gujarat, India. Int J Reprod Contracep Obstet Gynecol. 2018;7(8):3131-5.

Nayak A, Jain M. Experience on awareness, acceptability, safety, efficacy, complications and expulsion of post-partum intrauterine contraceptive device insertion. Int J Sci Study. 2017;5(1):207-12.

Tripathi U, Sahu D. Outcome of immediate postpartum insertion of IUCD: a prospective study. Indian J Obstet Gynecol Res. 2018;5(4):511-5.

Hooda R, Mann S, Nanda S, Gupta A, More H, Bhutani J. Immediate postpartum intrauterine contraceptive device insertion in caesarean and vaginal deliveries: a comparative study of follow up outcome. Int J Reprod Medicine. 2016;7695847.

Bhalerao, Purandare. Post puerperal cu T insertion. J Postgrad Med. 1989:70-3.

Thonneau PF, Almont T, Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol. 2008;198(3):248-53.

Singal S. Clinical outcome of postplacental copper T 380A insertion in women delivering by caesarean section. J Clin Diag Res. 2014;8(9):1-4.