Intrauterine Device in the Immediate Postpartum: Study Comparing Insertion after Cesarean Section and Vaginal Delivery

Abstract

Objective To compare the safety, side effects and failure rates of contraception copper intrauterine device (IUDs) in the immediate postpartum period after a vaginal delivery and during a cesarean section. Patients and methods This was a descriptive and analytical study, conducted in Gynecology and Obstetrics departments hospital Pikine and Abass Ndao hospitals. It compared two groups of women with IUDs in the immediate postpartum period after a vaginal delivery and during cesarean section. Our sample consisted of 215 patients. We had divided them into two groups: group 1 consisted of 115 patients who delivered by cesarean section; Group 2 consisted of 100 patients who delivered vaginally and whom the insertion was made in post placental or within 48 hours after birth. The variables studied were the sociodemographic characteristics, characteristics of pregnancy and childbirth, insertion procedures, follow up with the assessment of side effects and complications. Results and comments The socio-demographic characteristics were superimposed in both groups. Nine patients were lost to follow up, 4 in group 1 and 5 in group 2. The complaints such as pain (3.7% for Group 1 against 2.6% for group 2), vaginal bleeding (2.1% for group 2, and 1.8% for group 1) were rarely reported and stackable in both groups. After 6 months of follow up, the menses was observed in 42.8% of group 2 against 43.1% of group 1. The abnormal menstrual flow, evaluated by the Higham score, was noted in 29.6% of group 2 and 25% of group 1, and was dominated by excessive bleeding. They motivated IUD removal in two patients. A significant difference was found in the perception of IUD strings, it was effective in 95.4% of patients in group 2 against 50.5% for group 1. The evictions were 9 at 3-month follow-up 7 related group 2 and 2 for Group 1. It was partial (isthmic IUD) and total expulsion. At 6 months follow-up, 3 cases of partial expulsion were noted and concerned only group 2. This made a total expulsion rate of 5.3%, with 9.5% for group 2, and 1.8% for group 1. no cases of pregnancy or uterine perforation had been reported during this study. A vaginal sampling was performed in all our patients and the results were generally comparable in both groups and normal in most cases. However, we noted 17.6% of infection in group 2, and 16.2% in group 1. Conclusion From the results of our study, we can say that IUD insertion in the period of immediate postpartum remains safe and effective regardless of the way of delivery. The risk of expulsion is minimal so acceptable.