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

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.

Review of PPIUCD at tertiary care centre in Southern Rajasthan

“…In this study 50.83% insertions were made in post-placental period followed by 41.45% during LSCS which is similar to another study conducted by Ranjana et al, 9 which had 52.94% post-placental 42.64% intra caesarean and 4.41% post-partum insertion. While in study by Vilvapriya and Veeraragavan 10 78.3% of insertions were intra Caesarean 14% post-placental and 7.7% were postpartum.…”

“…11 This study revealed that 3.24% and 2.47% of clients had missing thread on examination on follow up which is similar to the study conducted by Pandher et al, 15 while other studies had more missing threads present study. 6,7,11 About 6% of clients requested IUCD removal on follow up which was less than study done by Gnanasekar 7 , Ranjana et al, 9 and Rani et al 17 Major causes of requesting for removal were irregular bleeding and pain abdomen on follow up which were similar to studies done by Madhuri and Sreelakshmi 6 , Gnanasekar 7 and Ranjana et al 9 Study found continuation rate of 91.91% and 85.30% on follow-up which is comparable to findings revealed in studies done by Madhuri and Sreelakshmi 6…”

Demographics and follow up of post partum intra-uterine copper device in tertiary hospital in Delhi, India

“…234 patients (79.3%) did not have any complaints, which is higher than study conducted by Ranjana et al where 58.47% had no complaints and similar to study conducted by Rajni et al where 62% of patients were satisfied with PPIUCD. 2,4 Other studies using CuT-380 A have reported IUCD removal due to bleeding/pain as 6% to 8%.9,10Difference in types of IUCD could possibly explain the different rates of bleeding problem, where as we observed approximately 1% removal for the same reasons.…”

“…6 In this study, 33% (110 patients) were primipara and 67% (225 patients) were multipara, which differs from study conducted by Ranjana et al where 41% of patients were primipara and 58.82% were multiparous. 2 Both the studies were conducted in the same hospital at different time periods. This statistics highlights the possible decreasing usage of copper T as spacing contraceptive among primipara.…”

“…Copper IUCDs are the most commonly used type of IUCD and the Cu T 380A has been found to be most effective IUCD. 2 Insertion of IUCD in postpartum period has advantages of safety due to blunt insertion technique, and certainty of non-pregnancy of woman apart from simplicity, minimal motivation, and reversibility, free of cost availability, virtually no systemic side effects and high continuation rate. 3 Our study aims to determine the prevalence of PPIUCD in a tertiary care facility and also study the awareness about the same and follow up care.…”