Postpartum IUCD: its acceptance and complications

Abstract

Background: Intra Uterine Contraceptive Device is the most commonly used reversible method of contraception worldwide. Immediate PPIUCD insertion is labelled when intra uterine device is inserted within 10 minutes to 48 hours of expulsion of placenta. The objective of the study was to determine the proportion of women accepting PPIUCD, factors influencing its acceptance, to look for side effects like bleeding disturbances, expulsion, lost strings, pain abdomen and pelvic infection etc. and the drop-out rates for follow up after PPIUCD.Methods: This was an open prospective, and longitudinal study to assess the safety and acceptance of the Multi-load when inserted within 10 minutes to 48 hours of placental expulsion.Results: During the period of January 2015 to November 2015 there were total 1624 deliveries in the said period in the department of Obstetrics and gynaecology of GGS Medical College and Hospital Faridkot. Out of these 714 delivered by LSCS and 910 delivered Vaginally. After excluding 470 patients were counselled, only 97 (20.64%) accepted PPIUCD. Out of these 67 (69%) patients had post placental insertion. 15.4% underwent immediate postpartum insertion. 15.4% got PPIUCD with cesarean section. (25.77%) patients had missing threads/strings, 12 (12.37%) patients had mild pain and 9 women (9.27%) had excessive discharge.Conclusions: PPIUCD is cost effective and a very safe means of contraception. Postpartum period is the period when patient is highly motivated for contraception and can be easily counselled. PPIUCD has a huge potentiality and abundant scope in India and if widely used it will have a strong impact on population control and will prevent unplanned pregnancy and its sequelae.

Determinants and perception of postpartum intrauterine contraceptive device services in Maharashtra, India

“…Health care workers explained the common reasons for removal: lower abdominal pain, irregular/excessive bleeding, feeling of needle prick sensation, resistance from family members, and vaginal discharge. Lower abdominal pain is a common complaint and ranges from 0.8 to 15% [12], [15], [16], [18]- [21], [27], [28]. The present study observed a higher rate.…”

A novel approach to meet the unmet need for family planning

“…The incidence of loss to follow-up in our study (1.37%) was very much lower than that reported by the study conducted by Garg N et al (22.68%). 10 Study by Nayak et al and Verma A et al, reported much higher rates of loss of follow-up (58% and 40% respectively) Kittur et al, also reported similar higher rates of loss of follow-up. 15,16 The reason of low loss of follow-up rate in our study is because of the fact that it was done by a more accessible tertiary care hospital situated in a wellcommunicated location.…”

“…9 However, in another study by Garg N et al, showed that incidence of missing thread was more in case of Multiload 375 (25.77%) than Cu-T 380A (10-36%). 10 They also showed that bleeding (less than 11.3%) was less than incidence of missing thread in case of multiload 375. The possible explanation of this can be the initial length of string in both designs are different.…”

“…The rate of expulsion in our study was much lower than that shown by other similar studies. [8][9][10][11][12] This may be because of the timing of insertion, ideally which is within 10 minutes. If a technique directed approach was taken during the study, the question of disparity could be answered.…”

Misplaced intra uterine devices: a rare case of vaginal entrapment

“…The incidence of missing threads varies between 5% and 25% in various studies. [4][5][6][7] Postpartum insertions are commonly associated with curling up of the thread in the enlarged uterine cavity. These patients should be evaluated with pelvic ultrasound and if need be on hysteroscopy.…”