Clinical Outcomes of Trans-caesarean and Vaginal Post-placental CuT380A IUCD Insertions: A Comparative Study

Abstract

Background: Immediate postpartum CuT380A intrauterine contraceptive device (PPIUCD) insertion provides a novel approach in reducing the unmet contraceptive needs of family planning. The insertion can be trans-caesarean or vaginal following delivery of the placenta. The clinical outcomes of the different routes of insertion have not been adequately studied.
 Aim: The study aimed at comparing the clinical outcomes following trans-caesarean and vaginal post-placental insertions of CuT380A IUCD.
 Methodology: The study was a prospective cohort study of 81 pregnant mothers managed at a tertiary health institution in southern Nigeria. They were recruited into two groups using a convenient sampling technique; 27 and 54 mothers in the caesarean and vaginal delivery groups respectively. The pregnant mothers were followed up till delivery and at the six weeks postnatal visit. Information on their socio-demographic characteristics, Obstetrics and Gynecology history were obtained with the aid of a proforma. The proforma was updated with the clinical outcomes of immediate PPIUCD insertions in the two groups, at the six weeks visit. Data obtained were analyzed using statistical package of social sciences version 21. Continuous variables were expressed as means and standard deviations. The Chi square test was used for dichotomous or categorical variables. A p-value of less than 0.05 was considered statistically significant.
 Results: The study showed that PPIUCD is a safe practice in both vaginal and caesarean deliveries with no significant differences in clinical outcomes. However, incidence of missing string was higher in the caesarean group compared to vaginal group (81.5% vs 51.9%; p value-0.01); and expulsion rate was also high in the vaginal group but not significant. (13.0% vs 7.4%; p value 0.45).
 Conclusion: Immediate postpartum CuT380A contraception, irrespective of route of insertion, is convenient, effective, and safe. Although there is a relatively higher incidence of missing strings, including expulsions after vaginal PPIUCD insertions, immediate post-partum contraception should be encouraged. This will help to reduce high unmet contraceptive needs in our environment and loss to follow up irrespective of route of delivery.
 Recommendation: Immediate PPIUCD, irrespective of the route, should be encouraged and integrated into the existing Maternal and Child Health Programme. Awareness should be created to promote acceptance in our environment.