Immediate Postpartum Intrauterine Contraceptive Device Insertions in Caesarean and Vaginal Deliveries: A Comparative Study of Follow-Up Outcomes

Reetu Hooda, Sonika Mann, Smiti Nanda, Anjali Gupta, Hemant More, Jaikrit Bhutani, Reetu Hooda, Sonika Mann, Smiti Nanda, Anjali Gupta, Hemant More, Jaikrit Bhutani

Abstract

Background. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is a lucrative postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Our aim was to study the clinical outcomes of IPPIUCD insertions and compare them as a factor of route of insertion (vaginal versus caesarean). Methods. This is a retrospective analytical study done in a tertiary care teaching institute. A Cohort of 593 vaginal and caesarean deliveries with IPPIUCD insertions, over a two-year period, was studied and compared for follow-up results. Outcome measures were safety (perforation, irregular bleeding, unusual vaginal discharge, and infection), efficacy (pregnancy, expulsions, and discontinuations), and incidence of undescended IUCD strings. Descriptives were calculated for various outcomes and chi square tests were used for comparison in between categorical variables. Results. Overall complication rates were low. No case of perforation or pregnancy was reported. Spontaneous expulsions were present in 5.3% cases and were significantly higher in vaginal insertions (p = 0.042). The incidence of undescended strings was high (38%), with highly significant difference between both groups (p = 0.000). Conclusion. IPPIUCD is a strong weapon in the family planning armoury and should be encouraged in both vaginal and caesarean deliveries. Early follow-up should be encouraged to detect expulsions and tackle common problems.

References

    1. Huang Y.-M., Merkatz R., Kang J.-Z., et al. Postpartum unintended pregnancy and contraception practice among rural-to-urban migrant women in Shanghai. Contraception. 2012;86(6):731–738. doi: 10.1016/j.contraception.2012.05.007.
    1. Postpartum IUCD Reference Manual. New Delhi, India: Family Planning Division. Ministry of Health and Family Welfare, Government of India; 2010.
    1. Grimes D. A., Lopez L. M., Schulz K. F., Van Vliet H. A., Stanwood N. L. Immediate post-partum insertion of intrauterine devices. Cochrane Database of Systematic Reviews. 2010;(5)CD003036
    1. Grimes D., Schulz K., Van Vliet H., Stanwood N. Immediate post-partum insertion of intrauterine devices. Cochrane Database of Systematic Reviews. 2003;(1)CD003036
    1. Shukla M., Qureshi S., Chandrawati Post-placental intrauterine device insertion—a five year experience at a tertiary care centre in North India. Indian Journal of Medical Research. 2012;136(3):432–435.
    1. Çelen Ş., Möröy P., Sucak A., Aktulay A., Danişman N. Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices. Contraception. 2004;69(4):279–282. doi: 10.1016/j.contraception.2003.12.004.
    1. Tatum H. J., Beltran R. S., Ramos R., Van Kets H., Sivin I., Schmidt F. H. Immediate postplacental insertion of GYNE-T 380 and GYNE-T 380 postpartum intrauterine contraceptive devices: randomized study. American Journal of Obstetrics and Gynecology. 1996;175(5):1231–1235. doi: 10.1016/s0002-9378(96)70033-9.
    1. Xu J.-X., Rivera R., Dunson T. R., et al. A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the copper T-380A IUD in Shanghai, People's Republic of China. Contraception. 1996;54(1):33–38. doi: 10.1016/0010-7824(96)00117-5.
    1. Sood B., Asif R., Charurat E., et al. Revitalization of postpartum IUCD (PPIUCD) services: experience from India. Contraception. 2012;86(2):184–185. doi: 10.1016/j.contraception.2012.04.059.
    1. Kittur S., Kabadi Y. M. Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy and expulsion. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2012;1:26–32.
    1. Speroff L., Darney P. A Clinical Guide for Contraception. 5th. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2010. Intrauterine contraception; pp. 239–280.
    1. Welkovic S., Costa L. O. B. F., Faúndes A., De Alencar Ximenes R., Costa C. F. F. Post-partum bleeding and infection after post-placental IUD insertion. Contraception. 2001;63(3):155–158. doi: 10.1016/s0010-7824(01)00180-9.
    1. Çelen Ş., Sucak A., Yildiz Y., Danişman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Contraception. 2011;84(3):240–243. doi: 10.1016/j.contraception.2011.01.006.
    1. Gupta A., Verma A., Chauhan J. Evaluation of PPIUCD versus interval IUCD (380A) insertion in a teaching hospital of Western U. P. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2013;2:204–208. doi: 10.5455/2320-1770.ijrcog20130619.
    1. United Nations Population Information Network (POPIN) UN Population division. Department of Economic and Social Affairs with support from UN Population Fund. Network Intrauterine devices. Family Health International. 1996;16(2)
    1. Kapp N., Curtis K. M. Intrauterine device insertion during the postpartum period: a systematic review. Contraception. 2009;80(4):327–336. doi: 10.1016/j.contraception.2009.03.024.
    1. Letti Müller A. L., Lopes Ramos J. G., Martins-Costa S. H., et al. Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: A Pilot Study. Contraception. 2005;72(3):192–195. doi: 10.1016/j.contraception.2005.03.014.

Source: PubMed

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