Immediate Postpartum Intrauterine Device in HIV-Infected Women: Experience from a Tertiary Care Center in Côte d'Ivoire

Abstract

Background Immediate postpartum intrauterine device (PPIUD) is a good solution for reducing low contraceptive coverage in developing countries. However, its use in HIV-infected women is poorly documented. The objective of this study was to assess whether the risk of PPIUD complications was higher in HIV-infected women. Methods A retrospective cohort study compared 64 HIV-infected women to 128 HIV-negative women who had had a PPIUD at the University Hospital of Treichville between January 2016 and March 2017, with a match at the insertion time of the PPIUD. The complications considered were pelvic pain, metrorrhagia and genital infections. Chi-squared test and relative risk were used to investigate the association between HIV infection and PPIUD complications. Results HIV-infected patients had an average age of 33.1 years, and 85.9% of them were on antiretroviral therapy. PPIUD was inserted during cesarean section in 66.1% of cases. There was no significant association between HIV infection and PPIUD complications (RR = 0.7, 95% CI [0.4-1.3], p = 0.3). The risk of genital infections was not increased in HIV-infected women (RR = 0.6 [0.1-2.7], p = 0.7). Conclusion HIV infection does not increase the risk of PPIUD complications. This effective contraceptive strategy can be offered to HIV-infected women. It is therefore necessary to strengthen the training of maternity staff in the installation of PPIUD.

Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review

“…Within 3 months post-insertion, across 21 studies, the proportion of women with infections ranged from 0% (eight studies) to 7.5% 41. By 6 months follow-up, the proportion of PPIUD-related infections was very similar to earlier follow-up, from 0% in five studies to 5.4% 46. The latter was reported in a retrospective study that included all postpartum genital infections in 128 women in Ivory Coast 46.…”

“…follow-up, from 0% in five studies to 5.4%. 46 The latter was reported in a retrospective study that included all postpartum genital infections in 128 women in Ivory Coast. 46 In the few studies (n=5) in which infection occurrence at 12 months was reported, the proportion of women with infections was ≤3.3%.…”