Safety and Success of immediate post-placental intrauterine device insertion at the time of Cesarean Section

Abstract

Background: Evidence is building up in favour of insertion of an intrauterine device (IUD) in the immediate postpartum period i.e.: post-placental IUD (PPIUD) insertion with regard to its safety and effectiveness as a method of contraception. PPIUD insertion at the time of Cesarean section (CS) is also a safe and acceptable method. However there is not much research evidence to encourage service providers to adopt this practice. We carried out this study to determine safety and success rates of immediate post caesarean IUD insertion. Materials And Methods: A cross sectional study was conducted on women who underwent PPIUD insertion following childbirth at the Teaching Hospital, Kandy from January 2013 to March 2013. Data were collected by an intervieweradministered questionnaire at postnatal wards as an exit interview. Repeat interviews were carried out at 6 weeks and 6 months since the date of PPIUD insertion. All women were assessed clinically and ultrasonically. Patient perceived morbidities following insertion of PPIUD and expulsion rates were assessed as outcome measures. Result: At the end of 3 months, 121 mothers had undergone PPIUD following CS and 362 following vaginal Delivery (VD). Eight women (6.7%) complained of abdominal pain following PPIUD insertion in the CS group while the same for the VD group was 3(0.8%). Abnormal vaginal bleeding was the second commonest complaint with 5(6%) and 8(2.2%) in CS group and VD group respectively. At the end of the observational period of 6 months, Six (5%) IUDs had been expelled in the CS group, where one (4.5%) was in elective CS and five (5.5%) were in emergency CS. This difference was not significant (p=0.5). The expulsion rate in women in VD group was found to be 17.7% (16), which was significantly higher than the same reported from the CS group (p Conclusions: Post caesarean IUD insertion appears to be a safe and effective option at this short term analysis. This could be an effective method of family planning for women wishing for long acting reversible contraception. Considering the poor compliance to other family planning methods and the rate of CS at hospitals, application of this intervention seems feasible. Further studies need to be carried out to evaluate the outcomes at long term.