A Comparative Observational Study of Postpartum Intra-Uterine Contraceptive Device Insertions in a Sub Divisional Hospital and Medical College of Bihar (original) (raw)
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.
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A retrospective analysis on acceptability and complications of PPIUCD insertion
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Apart from this, it does not interfere with breastfeeding. 5 In addition, complaints associated by IUCD insertion are masked by postnatal lochia and afterpains. 6 The objective of the present study was to assess the Knowledge, attitude and practice of postpartum Intrauterine contraceptive ABSTRACT Background: PPIUCD has been introduced in the national family welfare program since March 2010 in several states. AN IUCD can be inserted in 48 hours postpartum, referred to here as postpartum intrauterine contraceptive device. This study was done to assess the Knowledge, attitude and practice of postpartum Intrauterine contraceptive device in antenatal patients at a tertiary care centre in Northern India. Methods: This is a questionnaire based cross sectional observational study including 350 antenatal women attending antenatal OPD over a period of 6 months. Results: Out of these 350 women, 126 women (36%) had knowledge of PPIUCD. only 30 % of women had previous knowledge about PPIUCD however only 10 % of women practiced it in the past. After appropriate counselling 18% of women agreed for insertion of PPIUCD after this delivery. Conclusions: The study concludes that the antenatal women had poor knowledge regarding PPIUCD. Practices were even worse. This might be attributed to low education , refusal by family especially male partner, and religious beliefs. But once appropriate knowledge and information is provided, attitude gradually changes.
GLOBAL JOURNAL FOR RESEARCH ANALYSIS, 2020
Background: Population explosion is one of the major problems in India. It is a result of prevailing high birth rates and unmet need of birth controlling methods. The Government of India under National Health Mission has taken an initiative to provide PPIUCD in immediate postpartum period. In spite of several training programmes & awareness activities across the country, the acceptance & utilization of PPIUCD is very low. Hence, this study was conducted to determine proportion of women accepting PPIUCD & describe the factors affecting acceptability & non-acceptance of PPIUCD in selected hospital of DNH. Method: It was an exploratory study conducted at Shri Vinoba Bhave Civil Hospital, Silvasssa from January to February 2020. The sample size of the study was 90. The data was collected under 1)Antenatal mothers with term pregnancies 2)Immediate postnatal mothers delivered normally 3)Immediate postnatal mothers delivered through CS. Thirty(30) samples were selected in each category usi...
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.
Higher maternal and child mortality and morbidity are interrelated with short intervals between births. Postpartum women need a range of effective contraceptive methods for prevention of an unplanned pregnancy, within a short interval. Significant counselling during the antenatal period and before delivery decides the use of PPIUCD as a method of contraception. Immediate postpartum insertion of IUCD is a safe and effective, in comparisons with other insertion times. Objective: The study was aimed to evaluate the acceptance of immediate postpartum intrauterine contraceptive device (PPIUCD) insertion during normal vaginal delivery and intraceasarean after 10 minutes of removal of placenta (post placental insertion) and immediate post partum (within 48 hours) of normal vaginal delivery. Materials and Method: It was conducted among 50 postpartum women attending Eastern Command Hospital, Kolkata with their consent and permission of Institutional Ethics Committee. The participants were counselled during antenatal period, early labour and postpartum period (within 48 hours of delivery). Results: The acceptance of PPIUCD insertion was higher during early labour (48%) followed by post partum period (34%) and antenatal period (18%). It was higher in multigravida (88%) than among primigravida (12%). The acceptance in multigravida with two or more children was higher (54%) than multigravida with one child (34%) and with primigravida (12%). It was higher in normal vaginal delivery (84%) than intraceasarean insertion (16%). Post placental insertion was higher (62%) than immediate post partum insertion (38%). Conclusion: The acceptance of PPIUCD was high. This study will develop possible references to motivate the pregnant women with an assurance for immediate PPIUCD insertion.
Where do we stand a Decade after Introduction of Ppiucd Program
Journal of clinical case studies reviews & reports, 2021
Introduction: At present one of the major challenges our country is facing is population explosion, unintended and unwanted pregnancies. This is in spite of being the first country in the world to launch a family planning program. Long-acting, reversible family planning methods, such as intrauterine contraceptive devices, have been reported to be very effective. This is usually inserted as an interval procedure but can be inserted post-delivery also which has many advantages. Study was undertaken to find out the present status of this programme ten years after its initiation by the government. Materials and Methods: This observational study was conducted for three months at three large medical institutes. The participants were all labour cases admitted for delivery. Only willing cases were included; they were interviewed to find out their awareness, acceptance and planning for future contraception. Results and Observations: 3453 were willing to be part of the study. The study showed that a large number of women (23.5%) relied upon breast feeding as a method of spacing. Almost half of them (47.5%) were undecided regarding methods to delay the next pregnancy. 81% had heard about the device. 5.9% had some information regarding insertion after delivery. Only 9.1% cases remembered being told something specifically about insertion after delivery. Insertion was done in 3.5% cases, mostly with cesarean section. Discussion: Contraception is an important part of population control and prevention of unwanted and unintended pregnancies. In India, as in many other countries, postpartum family planning is usually initiated after 6 weeks postpartum. The postpartum period is an optimal time for effective contraception as the new mother is more receptive to accept family planning and the couple is of proven fertility. Though insertion of contraceptive device immediately after delivery is a good method of contraception but its awareness, acceptance and insertion is extremely low hence there is a great need of making concerted efforts to improve its acceptance and insertion. Counseling during antenatal period is the ideal time.
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.
IOSR Journals , 2019
INTRODUCTION: PPIUCD is a promising approach in the field of family planning.Both vaginal insertion and intracesarean insertion of PPIUCD are safe in terms of complications and effective for spacing and limiting births. OBJECTIVE: Evaluation of safety and efficacy of vaginal and intra-cesarean insertion of PPIUCD.. IUCD used was CuT-380A.Study subjects were enrolled according to exclusion criteria and informed consent was taken. Patients were followed up at 4 weeks,3 months and 6 months. RESULTS: This study shows that PPIUCD is a promising method of contraception. It was highly acceptable,easily available method of contraception with only a few complications. The most common complication was found to be missing thread in both the groups (8% in vaginal group Vs 10% in caesarean group); which was followed by pain abdomen (6% in vaginal group Vs 5%in caesarean group). There was no complication of perforation or pregnancy in both the groups. CONCLUSION: Patient satisfaction was good in both methods of PPIUCD insertion. Use of IUCD in postpartum period can provide long term ,safe, reversible, coital independent and effective contraception.
AIMS Medical Science, 2020
Introduction: Closely spaced pregnancies are associated with adverse outcomes both for mother and foetus. The recommendations based on the results of technical consultants for healthy timing & spacing of pregnancies (HTSP) are that after a live birth, a woman should wait at least 24 months but not more than 5 years before attempting the next pregnancy to reduce the health risks and better outcome for the mother & baby. Here, our study was to see the effects of IUCD (CuT-380A) insertion immediately after vaginal delivery for spacing. Methods: This study was done at Agartala Government Medical College (AGMC) and GBP Hospital for one & half years (Jan'16-June'17). Antenatal mother of term pregnancy were counselled. They were recruited from Gynae OPD & emergency and evaluated for different outcomes at 6 th , 12 th & 18 th months in terms of different complications. Results: Total of 200 women of term period of gestation (POG) where counselled and 55 women participated in this study. Common complications were expulsion of IUCD 5 (9.1%) at 6 th month & bleeding per vagina 3 (5.5%) at one year. Expulsion of IUCD at one & half year was 5 (9.1%) and infection 1 (1.8%). 23 (42.6%) subjects continued with IUCD. Conclusion: Major complications are low here, but still outcomes in terms of different parameters are not encouraging. Health workers at different levels can overcome this gap to improve the outcome. All our efforts should be made to enhance the field activities in making people aware about PPIUCD.
Background: Short Interval between births is linked to higher maternal and child mortality, In India 15.60 million abortion are performed with abortion rate of 47.0/1000women aged 15-49 years (Jan2018). In spite of widely available contraceptives in free of cost, unplanned and unwanted pregnancies complicate maternal health especially in rural areas. Preventing unplanned pregnancy and abortion, contraceptives in immediate use of delivery may be a remedy and IUCD CUT is one of the answers. In this context of our study was to evaluate the safety and efficacy of insertion of immediate post placental IUCD (PPIUCD) using CUT 380A in women delivering vaginally in a rural hospital and to compare it with interval insertion of IUCD CUT 380A in same setting. Materials and methods: This prospective observational study was carried out in rural based community hospital in West Bengal between January 2019 and December2019. After counseling 122 willing parturient mothers in labour room and antenatal ward were consented for postpartum IUCD insertion within10 minutes of delivery of placenta, and 68 willing mothers were selected from family planning clinic any time after 6 weeks of delivery for interval IUCD insertion. After taking written consent both groups of women were inserted CUT 380 A and they were advised to attend FP clinic after 6 weeks and 6 months of insertion for follow-up study. Results: Among 520 women admitted for delivery 122 (23.46%) consented for PPIUCD insertion and 110 women were available for follow-up study after six month and among 410 women, 68 women (16.58%) were consented for interval IUCD insertion. Of that 62 women were available for follow-up after 6 months. On side effects study abnormal vaginal bleeding (7.27% VS 6.45%) dysmenorrhoea (3.63%Vs 3.22%), PID (2.7% VS 1.61%) and mixed side effects (6.36% VS 6.45%) were comparable of both PPIUCD and interval insertion group. But abnormal vaginal discharge was significantly more in interval insertion group (14.51% VS 4.54%) (P<0.05). Rate of discontinuation was more (20.99% VS 16.52%) in interval insertion group of women and are due to more side effects. PPIUCD inserted women continues more in percentage (85.48% VS 79.01%) than interval IUCD users. Conclusion: IUCD CUT 380 A is a safe, efficacious and long durable (10 years longevity) contraceptive and birth spacing method and PPIUCD is a better option than interval IUCD. Moreover women can take the advantages of family planning services on the same day of delivery through PPIUCD insertion option.
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