A one-year cohort study of complications, continuation, and failure rates of postpartum TCu380A in Tanzania

Abstract

Background Less than 1% of married women in Tanzania use an Intrauterine Contraceptive Device (IUD) for contraception. An initiative by the International Federation of Gynecology and Obstetrics (FIGO) has been in progress since 2015 resulting in escalated method uptake in implementing hospitals. This study investigates failure rate, complications, and risk factors for one-year continuation of TCu380A IUD when used for immediate postpartum contraception under the initiative in Tanzania Methodology A prospective cohort study of women who had TCu380A insertion within 48 hours of delivery in 6 hospitals in Tanzania between 1st December 2017 and 18th April 2018 was conducted. Face to face post insertion interviews were made with 1114 clients before discharge and later through phone calls up to the beginning of 13th month postpartum. Postpartum Intrauterine Device (PPIUD) continuation status, complications, duration of time they stayed with the IUD and the currently used method if PPIUD was discontinued were enquired. The outcome variable was PPIUD continuation at one year of IUD insertion. Data were analyzed using Statistical Product and Service Solutions software (SPSS) for Windows version 20 (IBM SPSS Statistics, Chicago, IL, USA). Results In total 511(45.8%)clients had consented and availed to complete the one-year follow-up. Out of these, 440 still had IUD, giving a one-year continuation rate of 86.1%. Most (63%) IUD discontinuations occurred in the period between 7th week and 6 months of insertion. One-year method expulsion rate was 2.1%. There was one reported pregnancy that gives a method failure rate of about 2 per 1000. The independent risk factors in favor of method continuation at one year were absence of medical or social problem, being a youth (16-24 years), and delivery by Cesarean section. Conclusions The continuation rate when CuT380A is used for immediate postpartum contraception is high, with low complication and failure rates. Some medical and social factors are important for method continuation, hence the need to consider in training, counselling and advocacy.

Applicator for cervical brachytherapy for MRI or CT guided therapy

“…This is likely to be more frequent in patients with cervical tumors due to distorted anatomy. Expulsion of IUDs used for contraception occurs in about 2% of the women at 1 year [17]. The brachytherapy applicator will likely be needed for about a month, and thus the expulsion rates are expected to be less than 2%.…”

A non‐inferiority analysis of hemoglobin levels in postpartum IUD users in Bangladesh

“…If counseling regarding contraceptive methods is done in the antenatal period, and women choose the method, PPIUD can be inserted immediately after the birth of the baby and the placenta 10–12 . The use of PPIUD has been shown to have few complications, to be highly effective at preventing a pregnancy, and is acceptable to women around the world 13–16 . The International Federation of Gynecology and Obstetrics (FIGO) PPIUD Initiative, 17 in collaboration with the Obstetrical and Gynecological Society of Bangladesh (OGSB), allowed for comprehensive, non‐coercive, balanced discussions through designated counselors, who provided information on contraceptive methods and insertion of PPIUD for those choosing the method.…”