A prospective study of safety, efficacy and acceptability of postpartum insertion of intrauterine contraceptive device in a tertiary care hospital in Maharashtra, India (original) (raw)
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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.
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...
Santosh University Journal of Health Sciences, 2020
Introduction: Postpartum IUD insertion provides long term and effective contraception but there are concerns regarding increase in the risk of expulsion or perforation among researchers and clinicians. This study compares PPIUCD versus interval IUCD. Materials and Methods: In study 125 postpartum (post placental and intra-caesarean) and 140 interval IUCD insertions (total 265 IUCD) were done. 245 cases completed the study 21 were lost to follow-up. Cu T 375 was used in the study. Exclusion criteria were-women with active PID, uterine anomaly, current carcinoma, chorioamnionitis or puerperal sepsis, prolonged rupture of membranes >18hrs, genital trauma, PPH history of ectopic pregnancy, any hemorrhagic disorder, genital infection, diabetes mellitus, heart disease, pelvic tuberculosis and woman or husband having multiple sexual partners. All were followed up for 6 months. Various socio-demographic factors and complications like expulsion, bleeding, pain, infection and medical removal were compared among groups. Results: Most women came for follow up in both the groups (PPIUCD-75.8% and Interval-71.2%). The expulsion rate in PPIUCD group (9.2%) was significantly higher than interval group (2.4%) (p<0.02). 11.6% cases of PPIUCD group and 3.2%cases of Interval group reported with missing strings. The results were statistically significant (p<0.01). No case of perforation was reported in either group. Satisfaction with IUCD was 75% in PPIUCD group and 80% in Interval. Removal rate of IUCD was almost similar in both the groups (p=0.39). Conclusion: There is an increased risk of expulsion in PPIUCD insertion but its benefits outweigh the risks. So this method should be popularised across the country as a very effective method of interval contraception.
IP Innovative Publication Pvt.Ltd, 2017
Introduction: Significantly increased institutional deliveries in India provide an opportune time for offering postpartum family planning services to the women. Although the available contraceptive methods are many, need of a single efficacious, feasible and cost effective method is desirable especially in a low resource country like India. This study was done to evaluate the acceptance, efficacy and safety of intrauterine contraceptive device as an immediate family planning method following delivery, and the complications associated with it. Materials and Method: A total of 115 women who underwent PPIUCD insertion were followed up at 1, 3 & 6 weeks and at 3 & 6 months post-partum. Outcome in terms of side effects, removal and expulsion was noted and compared in vaginal delivery and caesarean section insertions. Results: Out of 280 women who were counselled, only 115 women (41.07%) accepted the PPIUCD insertion. Insertion in literate women was high and extremely statistically significant (P<0.0001) as compared to illiterate women. Expulsion rate was 17.85%. There was no expulsion in intracaesarean PPIUCD insertion which is statistically significant (P < 0.01) as compared to postplacental insertion. Excessive discharge (26.09%), missing strings (5.22%) and menorrhagia (4.35%) were minor complications.3 women (2.61%) had failure of PPIUCD at 6 months follow up. Conclusion: PPIUCD is a safe and efficacious family planning method after vaginal as well as caesarean delivery.
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.
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...
Status of Postpartum Intra Uterine Contraceptive Device in a Tertiary Care Hospital in Dhaka
Journal of National Institute of Neurosciences Bangladesh, 2022
Background: Timing of insertion, counseling, provider training and institutional support are critical factors for intrauterine contraceptive devices (IUCD) use during the postpartum period. Objective: The objective of the study was to determine the rate of acceptation, discontinuation, expulsion, infection and displacement of PPIUCD after vaginal delivery and cesarean section along with other complications among the study population. Methodology: This was a prospective observational study done in Shaheed Suhrawardy Medical College and Hospital from July 2015 to June 2016 among the pregnant women who delivered healthy baby by normal vaginal delivery and cesarean section. Data was collected by a structured questionnaire. Women who gave informed consent and who gave birth of healthy baby without complications were included. Women who had premature ruptured membrane with chorioamnionitis, pelvic inflammatory disease intrauterine fetal death or who did not give consent were excluded. Res...
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.
Journal of obstetrics and gynaecology of India, 2014
This study examines to describe the factors associated with acceptability of immediate PPIUCD insertion in women according to their socio-demographic and obstetrics characteristics, and future pregnancy desires and to determine the rates of uterine perforation, expulsion, pelvic infection, lost strings and displacement following PPIUCD insertion among the acceptors by 6 to 18 months. An intrauterine device (IUD) is an effective form of Long Acting Reversible Contraception. Present study is aimed at determining the safety, efficacy, and expulsion of Post-placental and intra-cesarean insertion of Intrauterine contraceptive device (PPIUCD). The study was conducted at District Head Quarters Hospital, Bolangir, Odisha, India. From 1st. January 2012 to 31st. December 2012. Women admitted and delivered at D.H.H. Bolangir, were counseled. CuT 380A was inserted within 10 minutes of delivery of placenta in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications f...