Abstract
BackgroundPostpartum intrauterine device (PPIUD) use refers to intrauterine device (IUD) insertion after delivery but within 48 h of birth. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception. An important limiting factor to increased uptake of immediate postpartum IUD insertion may be its expulsion rates which vary widely. There is minimal documentation PPIUD expulsion rates and factors associated with PPIUD expulsion during puerperium in Uganda.ObjectiveWe aimed to determine the proportion of TCu380A (copper) intrauterine devices expelled by 6 weeks postpartum, and identify risk factors for expulsion among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a prospective cohort study from September 1, 2014 to January 31, 2015 at MRRH. We administered a structured questionnaire to all participants, to capture data on their baseline demographic, clinical and obstetric characteristics. We followed up women who accepted the PPIUD insertions at 6 weeks post insertion for any IUD expulsion. We fit multivariable log binomial regression models to identify risk factors for IUD expulsion.ResultsWe enrolled 167 women who had PPIUDs inserted. Of the144 women who returned at 6 weeks for follow up, 13 (9%; 95%CI:4.9–15%) of them had the IUDs expelled. In the multivariable model, the significant risk factors for PPIUD expulsion were: IUD insertion more than 10 min post-delivery (aRR 8.1, 95%CI 1.26–51.98, p = 0.027) and bloody lochia flow of ≥15 days (aRR 8.5, 95%CI 1.47–48.47, p = 0.017).ConclusionThe cumulative expulsion rate of postpartum IUDs among women delivering at MRRH was low and comparable to expulsion rates in interval insertions. Longer duration from delivery to IUD insertions and longer duration of bloody lochia flow were key risk factors for postpartum IUD expulsion. More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates.
Highlights
Approximately 220 million women in need of modern family planning methods are unable to access them for various reasons [1, 2]
The significant risk factors for Postpartum intra uterine device (PPIUD) expulsion were: intrauterine device (IUD) insertion more than 10 min post-delivery and bloody lochia flow of ≥15 days
More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates
Summary
Approximately 220 million women in need of modern family planning methods are unable to access them for various reasons [1, 2]. The unmet need for family planning in sub-Saharan Africa, including Uganda is still very high (25 and 34% respectively) [3,4,5]. The intrauterine device (IUD) is a highly effective, safe, reversible and longacting type of contraception [7]. Postpartum intra uterine device (PPIUD) insertion bridges the limitations to the unmet family planning need by promoting IUD use. Insertion of an IUD immediately after delivery has been recommended by WHO, as one of the safest and most effective method of reversible contraception for postpartum women who wish to either space or limit births, whether they are breastfeeding or not [8]. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception.
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