Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation

Abstract

This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Abstract Introduction: Expanding access to postpartum intrauterine contraception (PPIUC) can reduce unintended pregnancies and short inter-pregnancy intervals; however, provision across Europe is limited. Our aim was to determine the feasibility, clinical outcomes and patient satisfaction of providing immediate PPIUC after vaginal birth using a health services research model. Material and methods: Phased introduction of PPIUC across two Lothian maternity hospitals; all women intending vaginal birth during the study period without a contraindication to use of the method were eligible to receive PPIUC. Midwives and obstetric doctors were trained in vaginal PPIUC insertion using Kelly forceps. Women received information antenatally and had PPIUC insertion of either a levonorgestrel intrauterine system or a copper intrauterine device within 48 hours of vaginal birth.Follow-up was conducted in-person at 6 weeks postpartum and by telephone at 3, 6 and 12 months. Primary outcomes were: uptake, complications (infection, uterine perforation), expulsion and patient satisfaction at 6 weeks; and method of continuation up to 12 months. Secondary outcomes included hazard ratio for expulsion adjusted for demographic and insertion-related variables.Results: Uptake of PPIUC was 4.6% of all vaginal births; 465/447 (96.1%) of those requesting PPIUC successfully received it and most chose a levonorgestrel intrauterine system (73%). At 6 weeks postpartum, the infection rate was 0.8%, there were no perforations and 98.3% of women said they would recommend the service. The complete expulsion rate was 29.8% (n = 113) and most had symptoms (n = 79). Of the additional 121 devices removed, 118 were because of partial expulsion. The rate of complete/partial expulsion was higher for insertions by midwives compared with those by doctors. The re-insertion rate after expulsion/removal was 87.6% and method continuation at 12 months was 79.6%. | 599COOPER Et al.

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

“…Method continuation in the current study was found to be high (86%) at one year of follow-up which is comparable or better than the 55-82% commonly reported by many other published studies [3,20,[27][28][29][30][31]. Moreover, the most vulnerable period for PPIUD discontinuation was that period after the puerperium to six months of delivery (i.e., 43-180 days) contrary to the period of up to 6 weeks post-delivery that is reported to be critical for IUD related complications and removal in some earlier studies [32,33].…”

Twelve-month complications, continuation and failure rate of CuT380A when used for immediate postpartum contraception in Tanzania: A cohort study

“…Method continuation in the current study was found to be high (86%) at 12 months of follow-up which is comparable or better than the 55-82% commonly reported by many other published studies [3,20,[27][28][29][30][31]. Moreover, the most vulnerable period for PPIUD discontinuation was that period after the puerperium to six months of delivery (i.e., 43-180 days) contrary to the period of up to 6 weeks postdelivery that is reported to be critical for IUD related complications and removal in some earlier studies [32,33].…”

Immediate postpartum intrauterine contraceptive device utilization and influencing factors in Addis Ababa public hospitals: a cross-sectional study

“…However, unmet need for family planning is high in the postpartum period, ranging from 32 to 62% in low and middle- income countries [ 3 , 7 , 8 ]. Because of unmet need, unintended pregnancy is common in postpartum period [ 9 , 10 ]. Beside this closely spaced pregnancies are expected to have adverse maternal, perinatal and infant outcomes [ 11 , 12 ].…”