Status of Postpartum Intra Uterine Contraceptive Device in a Tertiary Care Hospital in Dhaka (original) (raw)
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Bangladesh Medical Journal, 2019
Worldwide intra uterine contraceptive device (IUCD) is a reversible method of contraception. Postpartum IUCD insertion is labeled when IUCD is inserted within 10 minutes to 48 hours of expulsion of placenta. The objective of the study was to analyze the acceptability and feasibility of immediate postpartum intrauterine contraceptive device (PPIUCD) in a tertiary care hospital of Bangladesh. A cross sectional study was conducted among eligible postpartum women at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Bangladesh. Counseling was done about the procedure of PPIUCD in details. After having the consent, Cu-T 380A was inserted in 343 women. The women were followed up at six weeks after delivery. A total number of 18190 women were counseled during antenatal period and at labor ward. A total number of 6441 were admitted for delivery. Among the admitted patients, 343 accepted this method. Forty nine percent of the acceptors belonged to the age group of 25 – 30 years. Majo...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: IUCD (intrauterine contraceptive device) to prevent pregnancy are among the oldest method of contraception. The modern IUCD are highly effective, safe private, long acting and rapidly reversible contraceptive method. Aims and objective of this study was to study the acceptability and safety of postpartum intrauterine contraceptive device (PPIUCD) in postpartum period and to assess the feasibility, safety, efficacy and expulsion rate of IUCD.Methods: A prospective observational study was conducted at tertiary care teaching hospital in Maharashtra from January 2018 to October 2018 and patients were followed up to a period of one-year post IUCD insertion.Results: Majority of patients in this study were in age group 21 to 26 years of age (58.7%) and the least number were in the age group more than 30 years (3.3%). This study showed that majority of patients were primigravida (44%) and the lowest number belonged to gravida 6 (0.3%). Regarding timing of IUCD insertion 73% were...
2022
Postpartum IUCD is a very effective method of contraception that can be offered to the patient immediately after delivery to meet the unmet needs of contraception in postpartum period. The aim of our study was to evaluate the acceptance rates of PPICDReasons for acceptance and denials and the clinical outcomes/course which included complications, rates of expulsion and continuation rates at 6& 10 weeks, in those women who got it inserted. Method: A Prospective observational study was conducted at Kashmir’s largest maternity hospital, Lalla Ded hospital. This study was conducted on those women who had received counselling for PPIUCD insertion. In this study, the acceptance rates of PPIUCD insertion, reasons for denial in those who refused, and clinical outcomes in those who accepted PPIUCD were observed at 6 weeks and 10 weeks. Results: Out of 4000 women counselled for contraception only 560 accepted PPIUCD with acceptance rate of 14%. The commonest reason for refusal were fear of si...
Women's experience with postpartum intrauterine contraceptive device use in India
Reproductive Health, 2014
Background: Postpartum intrauterine contraceptive devices (PPIUCD) are increasingly included in many national postpartum family planning (PPFP) programs, but satisfaction of women who have adopted PPIUCD and complication rates need further characterization. Our specific aims were to describe women who accepted PPIUCD, their experience and satisfaction with their choice, and complication of expulsion or infection. Methods: We studied 2,733 married women, aged 15-49 years, who received PPIUCD in sixteen health facilities, located in eight states and the national capital territory of India, at the time of IUCD insertion and six weeks later. The satisfaction of women who received IUCD during the postpartum period and problems and complications following insertion were assessed using standardized questionnaires. Results: Mean (SD) age of women accepting PPIUCD was 24 (4) years. Over half of women had parity of one, and nearly one-quarter had no formal schooling. Nearly all women (99.6%) reported that they were satisfied with IUCD at the time of insertion and 92% reported satisfaction at the six-week follow-up visit. The rate of expulsion of IUCD was 3.6% by six weeks of follow-up. There were large variations in rates of problems and complications that were largely attributable to the individual hospitals implementing the study. Conclusions: Women who receive PPIUCD show a high level of satisfaction with this choice of contraception, and the rates of expulsion were low enough such that the benefits of contraceptive protection outweigh the potential inconvenience of needing to return for care for that subset of women.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: The current outburst of Indian population (1.21 billion as per census 2011) is because of the lack of awareness and acceptance of contraception in the immediate postpartum period. Postpartum intrauterine contraceptive device (PPIUCD) insertion can do wonders and curb this unmet need of family planning if good counselling and proper insertion techniques are followed. Methods: The present study was carried among 526 women in the department of obstetrics and gynaecology of Nehru Hospital in BRD medical college Gorakhpur, India. Intrauterine contraceptive device (IUCD) was inserted in 424 women in PPIUCD group and in 102 women in interval IUCD group after taking proper consent and following the WHO medical eligibility criteria for contraceptive use (MEC). Follow-up was done at 6 weeks and 6 months. Results: The acceptance rate of PPIUCD was 30.34% as compared to 18% in interval IUCD group (p-value <0.05). The chief reason for declining the use of IUCD was fear of excessive pain and bleeding (26.3%). Long term reversible method (32%) was the main reason given for accepting IUCD. There was no perforation or any other major complication at the time of insertion in both the groups. Rate of expulsion was 5.7% in PPIUCD and 2.22% in interval IUCD group p-value (>0.05). Conclusions: PPIUCD is a safe, effective, feasible and reversible method of contraception. It should be made a part of family health care programmes in India.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND In order to increase the usage of birth-spacing contraceptive methods, GOI has introduced the task-sharing strategy whereby in addition to doctors, staff nurses and ANMs are also trained and entrusted with the responsibility of postpartum intrauterine contraceptive device insertion after vaginal delivery. Aims and Objectives-This study aims to compare the outcome of this strategy at a sub-divisional hospital and medical college in Bihar and to frame recommendations to increase the success of task-sharing for PPIUCD insertions by all cadres of skilled birthattendants in health-care facilities. Setting and Design-The study is conducted in two time-spans when the author was working in a sub-divisional hospital at Sherghaty and later at Sri Krishna Medical College, Muzaffarpur. It is a retrospective comparative observational analysis of data collected from the two levels of healthcare facilities. MATERIALS AND METHODS Data was collected from the PPIUCD insertion and follow-up registers maintained in both hospitals. The percentage of PPIUCD insertions after vaginal delivery and caesarean delivery, the service-provider for PPIUCD insertion, user satisfaction with the method, complications and removals were analysed. RESULTS Percentage of PPIUCD insertions was significantly higher at the SDH compared to the medical college. 50% of insertions were done by nurses and ANMs in the immediate post-placental period. User satisfaction rate was high with very low complication and low removal rates. There were no PPIUCD insertions at the medical college following vaginal delivery. No systematic follow-up records were being maintained there. CONCLUSION In order to increase the effectiveness of the PPIUCD, the task-sharing strategy of GOI can be very effective as shown by the enthusiasm and efficiency of nurses and ANMs at the SDH. Key factors to increase the usage of this PPFP method is motivation, sensitive counseling skills and adequate training and confidence in its insertion technique.
Journal of Medical and Scientific Research, 2022
introduction: Immediate postpartum period is when women are receptive to family planning counselling. Pregnancy within a year of the last delivery increases maternal and perinatal morbidity and mortality. Postpartum intrauterine contraceptive device (PPIUCD) is one method which is safe and effective method for spacing and also for limiting pregnancy. This study was done to evaluate PPIUCD insertion for its awareness, acceptance, and expulsion. Materials and methods: All pregnant women were counselled regarding PPIUCD, and those willing were included in the study. Intrauterine contraceptive device used in this study was CuT 380A. It was inserted after delivery of the placenta after vaginal delivery and after caesarean section using sponge-holding forceps. They were asked to follow up after 6 weeks and 6 months of insertion. Data collected was subjected to statistical analysis using SPSS V22 software, and results were drawn. Results: From 1602 deliveries, 456 (28.46%) women accepted PPIUCD, and 36.32% (n=582) were aware of this method. 60.08% (n=274) had PPIUCD insertion after vaginal delivery and 39.91% (n=182) after caesarean section. The main reason for refusal was fear of bleeding (n=280) (26.81%). The most common complication seen was lower abdominal pain (11.62%). No case was reported with uterine perforation. conclusion: This method has shown to be a very safe, effective and economical method for contraception. In India, where there is very little access to contraception during interval period and women do not return to the hospital for a postnatal checkup and contraceptive advice, this PPIUCD method is most beneficial.
Journal of Reproductive Health and Medicine, 2016
Introduction: Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. Contraception plays a major role in women's health. Increased number of institutional deliveries allows us to offer family planning methods to couples. Postpartum intrauterine devices (PPIUCD) are the reversible long acting method. It does not interfere with breast feeding and can be provided before the woman leaves the hospital. This study of acceptance of postpartum intrauterine device was conducted in tertiary care hospital in India. Aim and objectives: To find out the (1) acceptance of PPIUCD CU T 380 A, (2) retention rate of PPIUCD and (3) spontaneous expulsion rate at end of 6 months of delivery. Material and methods: PPIUCD was inserted in 680 women either after vaginal delivery or during caesarian section. Data analysis was done at the end of 6 months. Results: (1) Insertion of PPIUCD amongst Para 2 was highest 375 (55.14%). (2) Retention rate was 86.33%. (3) Spontaneous expulsion was found in 55 (8.54%) women. (4) Bleeding was the main symptom perceived by 249 (88.71%) women followed by long thread 73 (26.02%) and pain in lower abdomen 45 (15.90%). (5) Total 361 (61.29%) women were satisfied and were continuing the method. Conclusion: Retention rate of PPIUCD was high. Spontaneous expulsion in intra-caesarian IUCD was less as fundal placement was assured at the time of insertion. Bleeding problems were the major complaint and the main reason for removal of PPIUCD.
Our aim was to study acceptability of PPIUCD in our target population, based on their demographic variables including parity and mode of delivery. Method : The study was conducted at V.S.General Hospital, Ahmedabad from 1stJune,2016 to 31December,2016.CuT 380A was inserted in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications for PPIUCD. They were followed up for a period of one year, and studied the various complaints and complications associated with PPIUCD insertion. Conclusion: Both the acceptance and actual insertion of IUCD were low probably because the use of IUCD is a new concept in the community. Inserting CuT 380 A at 10 minutes after placental delivery is safe leading to the expanding of the usage of IUCD meeting the unmet needs. The expulsion rates would be minimal if it was inserted by a trained provider and placed at the fundus. Even though expulsion rate high with IUCD, acceptance was high when it is inserted in postpartum period. Results: 2% of the women who delivered vaginally at VSGH, Ahmedabad chose PPIUCD and 7% of those who undergone C-Section chose PPIUCD.100 of those who received a PPIUCD (256) returned for a follow up visit which is 39%.48.04% of those who inserted IUCD were 2nd para and 37.5% primi para , 11% 3rd para and only 3.47% of 4th para opted for IUCD.6% of all patients demand removal and 3 % demand re-insertion.PPIUCD continuation rate in my study is 83.9%.Only 1 patient had misplaced IUCD in follow up, apart that no patient encountered any serious complication.
Contraception, 2016
Objective: As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertionsexpulsion and infectionfor physicians and nurses/midwives to generate evidence for task sharing. Study design: We analyzed secondary data from the PPIUCD program in seven states using a case-control study design. We included facilities where both doctors and nurses/midwives performed PPIUCD insertions and where five or more cases of expulsion and/or infection were reported during the study period (January-December 2013). For each case of expulsion and infection, we identified a time-matched control who received a PPIUCD at the same facility and had no complaints. We performed a multiple logistic regression analysis focusing on provider cadre while controlling for potential confounding factors. Results: In 137 facilities, 792 expulsion and 382 infection cases were matched with 1041 controls. Provider type was not significantly associated with either expulsion [odds ratio (OR) 1.84; 95% confidence interval (CI): 0.82-4.12] or infection (OR 0.73; 95% CI: 0.39-1.37). Compared with centralized training, odds of expulsion were higher for onsite (OR 2.32, 95% CI: 1.86-2.89) and on-the-job training (OR 1.23, 95% CI: 1.11-1.36), but odds of infection were lower for onsite (OR 0.45, 95% CI: 0.27-0.75) and on-the-job training (OR 0.31, 95% CI: 0.25-0.37). Conclusion: Trained nurses and midwives who conduct deliveries at public health facilities can perform PPIUCD insertions as safely as physicians. Implications: Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services.