Abstract
The moment of admission for delivery may be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections. This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans. Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections. Two thirds of the women who continued with IUD at 6 months had undergone 2 or more cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.
Highlights
IntroductionIntrauterine device placement is usually performed 6 weeks following delivery (interval insertion), due to evidence indicating a lower expulsion rate when compared with immediate postplacental insertion.[2] in real life setting, women experience difficulties to return for a postpartum visit, and it was reported that almost half of the women who had the intention of using IUD for postpartum contraception turned out not to have an IUD inserted.[3] In face of these limitations of interval IUD placement, there has been growing interest on immediate insertion
Intrauterine device (IUD) is an effective contraceptive method for postpartum period, with the advantages over hormonal methods of being independent of women’s compliance and not affecting the coagulation system or lactation.[1]Intrauterine device placement is usually performed 6 weeks following delivery, due to evidence indicating a lower expulsion rate when compared with immediate postplacental insertion.[2]
Two thirds of the women who continued with IUD at 6 months had undergone 2 or more cesarean sections
Summary
Intrauterine device placement is usually performed 6 weeks following delivery (interval insertion), due to evidence indicating a lower expulsion rate when compared with immediate postplacental insertion.[2] in real life setting, women experience difficulties to return for a postpartum visit, and it was reported that almost half of the women who had the intention of using IUD for postpartum contraception turned out not to have an IUD inserted.[3] In face of these limitations of interval IUD placement, there has been growing interest on immediate insertion. Brazil has an estimated population of over 200 million inhabitants and is among the countries with the highest cesarean delivery rate.[7] Despite most women having access to prenatal care in Brazil,[8] postpartum contraception is not discussed frequently,[9] and health care providers view the moment of delivery as an inadequate setting to provide information about IUD and for women to decide whether they want it to be inserted or not
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