Prospective study on outcome of post-partum intrauterine contraceptive device insertion at tertiary level rural health institute of Gujarat, India

Abstract

INTRODUCTIONFamily planning is the only way to combat the issue of population explosion. Various methods are available for women to choose in order to avoid unwanted pregnancies. In India, 65% of women have unmet need of family planning in first year of post-partum period. 1 Post partum period is the best opportunity for women as far as insertion of intra uterine contraceptive devices (IUCDs) are concerned. The use of IUCD is most convenient and safe as it is long acting and reversible and safer method of contraception. 2 It has been provided by the government health facilities at free of cost. In the era of increasing institutional deliveries, the only thing requires is to motivate the women for post partum insertion of IUCD. Women should be counselled during antenatal period, at the time of admission, during early labour and for those having planned caesarean section regarding acceptance of ABSTRACT Background: This study was conducted to evaluate the acceptance, safety, efficacy, complications and expulsion rate of post-partum intrauterine contraceptive device (PPIUCD) insertion among post-partum pregnant women in a rural tertiary care center. Objective of this study was assessment of the efficacy and safety of post-partum IUCD insertion. Comparing the complications and client satisfaction in both groups (intra caesarean insertion versus vaginal route of insertion). Methods: This is a prospective study conducted at one of the rural tertiary care teaching institution. A total of 150 patients with caesarean or vaginal deliveries had PPIUCD insertions and they were followed up for a period of one year. The outcome measures analyzed were menstrual irregularities, vaginal discharge, pelvic infection and perforation and efficacy measures -failure, expulsion and removal. Data are expressed in frequency and percentage. Chi square test was used for comparison and P value <0.05 was considered significant. Results: The study shows that PPIUCD is an effective intervention in both caesarean and vaginal delivery with nonsignificant differences in safety and efficacy depending on the route of insertion. There was no case of perforation and no significant risk of infection in either caesareans or delivery. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the caesarean group compared to vaginal insertion. Conclusions: PPIUCD is a safe, effective and long term reversible method of contraception and should be encouraged by public awareness and community acceptance.