Acceptability and Complications of Postpartum Intrauterine Device Insertion in Tertiary Care Hospital in Eastern Nepal

D Yadav,M Yadav,Shanti Sunuwar Subedi

doi:10.3126/nmcj.v22i4.34179

Abstract

The modern intrauterine contraceptive device (PPIUCD) is a safe, effective and long term reversible, coitus independent method of contraception with fewer side effects. The immediate postpartum insertion is considered to be an ideal time as patients need not have to return to the facility for the same. The aim of the study was to see the acceptance of PPIUCD and study its related complications. This is a hospital based prospective observational study done in a tertiary hospital at Eastern Nepal over a period of Six months from August 2019 to January 2020. All the women who delivered during the study period were counseled for family planning methods and those who opted for PPIUCD were enrolled. Data was validated and analyzed using SPSS version 17. Acceptance of PPIUCD in the study was only 6.3% despite the method being very effective, safe, long acting and reversible with fewer side effects. The main reason for declining the method being misbelief about the method and husband’s refusal. Forty percent of the acceptors were in the age group of 21-25 years and 33.6% of them were multigravida. Insertion was high in post placental vaginal delivery (61%) as compared to trans cesarean (28%). The main reason for removal was psychosocial aspects followed by pelvic pain and abnormal uterine bleeding. Few complications like UTI (4.4%), fever (4%) were noted during hospital stay and at three month follow up pelvic pain was the most common problem reported. Though the overall acceptance of PPIUCD is in rising trend but in this study it is very low. Awareness of the method, improving health education, active participation of the partner in the counseling process will definitely change the recent scenario. It should be incorporated in the government schemes like Safe Motherhood to cover the high unmet need of contraception in Nepal.

Highlights

Postpartum family planning (PPFP) can be defined as the use of family planning methods in the immediate postpartum period through the 12 months following childbirth
Nepal Society of Obstetricians and Gynecologists (NESOG) jointly with the Nepalese government and with the support from International Federation of Obstetrics and Gynecology (FIGO) introduced the initiative of institutionalization of immediate services in selected major referral facilities of Nepal in 2015.10-12 This study aims to assess the acceptance of women for postpartum intrauterine device (PPIUD) and to illustrate their socio-demographic and obstetric profile determining the acceptance for the same and associated complications with the procedure
Acceptance of post placental IUCD insertion (PPIUCD) was highest among hindu women, women from rural areas and those belonging to joint families

Summary

Introduction

Postpartum family planning (PPFP) can be defined as the use of family planning methods in the immediate postpartum period through the 12 months following childbirth. The intention to choose PPFP methods such as postpartum intrauterine device (PPIUD) remains low in countries such as Nepal.[2] It has been estimated that three in five women worldwide face an unmet need of PPFP methods and this unmet need in Nepal is as high as 24%.3. Copper intrauterine devices (IUD) are preferred due to its long duration of effect, high impact in contraception, low failure rate, reversibility and low cost.[5,6] It is used by over 130 million women around the world. In developing countries 14.5% and in developed countries 7.6% of women use this method in reproductive age.[7]

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