Prospective study on outcomes of postpartum intrauterine contraceptive device including safety, efficacy and expulsion at GMERS Medical College, Dharpur-Patan, Gujarat, India

Abstract

INTRODUCTIONPostpartum period is a very vulnerable period both for women and infant. Initiation of contraception during this period is important to prevent unintended pregnancy and short birth intervals. It can avert more than 30% of maternal deaths and 10% of child mortality. Pregnancy occurring within six months of the last delivery holds a 7.5-fold increased risk for induced abortion and a 1.6-fold increased risk of stillbirth.In a recent study of postpartum unintended pregnancies 86% resulted from non-use of contraception and 88% ended in induced abortions.1 continuation of these pregnancies is also associated with greater maternal complications and adverse perinatal outcomes. In India 65% women in the first year postpartum have an unmet need for family planning. Contraception method by definition mean to prevent unwanted pregnancy. According to WHO, Medical Eligibility Criteria, an IUD can be inserted in 48 hours postpartum referred to here as PPIUCD.2 A 2010 cochrane review concluded that PPIUCD are a safer and effective contraceptive method.3 Healthy timing and spacing of pregnancies have a positive effect on maternal health and newborn outcome. 4 IUCD are used by only two percent of current users of contraception in India.5 A subsequent study suggested that 65% of women in the 1 st ABSTRACT Background: Evaluation of PPIUCD in terms of incidence of failure, expulsion, bleeding p\v and other complication. Present study is aimed at determining the safety, efficacy, expulsion of post placental and intra cesarean insertion of intrauterine device. Methods: Prospective analysis was carried out to collect information regarding IUCD insertion and outcome at tertiary care center for the period of three years using the hospital record that a total number of 600 mothers had postpartum intrauterine contraceptive device. Results: Total women opted for PPIUCD 600, Followed up 560 after 1 week, 580 after 6 weeks and 400 after 6 months. Complications after 6 months 228. (pain 66, bleeding 37, expulsion 17, strings problem 7, discharge p/v 101). Conclusions:The insertion of PPIUCD is safe and effective method of contraception in the means of complication though it is a new concept for the population it is well accepted by the community though expulsion rate is somewhat high compare to conventional IUCD. it can be reduced with practice.

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

“…In study carried out by Jani PS, abdominal pain was the major complication of PPIUCD followed by bleeding problem. 6 Shukla et al, reveal that no women complained of pain in lower abdomen or signs of pelvic infection at 6 week follow up. 3 Kumar S et al, mentioned that 8.9% had abdominal pain and 5.5% at menstrual problem after insertion of IUD at 6 week.…”

Follow-up of copper intrauterine device insertion by nurses: a prospective longitudinal study

“…In a study conducted at a hospital in India, 600 women who inserted the copper IUD in the immediate postpartum period were followed for six months; 45 (7.5%) presented some complication after six months being pain (1%), bleeding (0.7%), fall out (0.83%), string loss (1.2%), disorders (3.83%), and 555 (92.5%) had no complications (23) . In this context, the results in the studies cited are in line with the findings in this research.…”

“…Concerning IUD removal during the follow-up of 600 women for six months in India, it was found that, among the 37 cases (6.2%), the reasons for removal were pain (1.7%), infection (1, 3%), bleeding (1.5%), fall out (1.3%), and tubal ligation (0.3%); thus, the IUD continuation rate after six months was 93.8% (23) .…”

A preliminary feasibility study to evaluate the safety, acceptability and efficacy of PPIUCD prior to implementation of PPIUCD service

“…13 In other studies the average age was noted to be <30years. 14,15 Understandably the acceptance rate for PPIUCD is higher among primiparous women who would like to avoid another pregnancy soon. In our study 58.3% of the women were para 1.…”