Postpartum Insertion Research Articles

POSTPARTUM INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICE: A SAFE AND EFFECTIVE CONTRACEPTION

The incidence of maternal mortality and morbidity related to the termination of unwanted pregnancy in Pakistan is rising at an alarming rate. Instant Postpartum insertion of intrauterine contraceptive device (PPIUCD) is an effective contraceptive measure to reduce unexpected pregnancy and its associated complications in developing countries like Pakistan. The current study was conducted in a public sector hospital in Karachi with a total of 7314 pregnant women counselled for insertion of PPIUCD antenatally. Out of which 5682 women agreed to the insertion and 1632 refused the procedure, mostly due to unfamiliarity with PPIUCD insertion. PPIUCD was inserted within 48 hours of delivery in 1441 patients and they were followed for 6 months onwards. Total postpartum insertions were 1441 which was found to be an effective measure with the continuation rate of 91% among 785 followed up cases. Postpartum IUCD insertion was found as an effective, satisfactory and convenient practice for the women of developing countries like Pakistan, to get an on-time appropriate contraceptive measure. : PPIUCD was found to have high retention and low expulsion rate and its efficacy can be improved further by proper training and skills of healthcare professionals. In this regard, appropriate strategies should be formulated and implemented at the statutory level by increasing social awareness and practice of using PPIUCD by health care providers to reduce undesired pregnancies.

Complications of Post-Partum Intrauterine Contraceptive Device Insertion

Objective: To determine the complications of post-partum intrauterine contraceptive device insertions in terms of frequency of bleeding and expulsion. Patients and Methods: A total number of 180 females aged 18–40 years with gestational age 36–40 weeks and having Hb ≥8 g/dl at time of delivery. All antenatal patients admitted for delivery to our hospital were counseled for PPIUCD. The PPIUCD was inserted within 10 minutes after placental delivery. Patients were called for follow-up after 6 weeks, 3 months and 4 months. Complications of PPIUCD were measured in terms of bleeding and expulsion rate within 4 months of follow-up. Results: Mean age of patients was 28.86±4.83 years. Mean parity of females was 2.13±0.90. There were 126 (70.0%) patients who underwent normal vaginal delivery while remaining 54 (30.0%) patients underwent C-section. At the end of follow-up period, bleeding was found in 26 (14.4%) patients after IUCD insertion and expulsion was found in only 11 (6.11%) patients. Conclusion: Post-partum insertion of intra-uterine contraceptive device (IUCD) is associated with acceptable rates of complications. In present study bleeding occurred in 15.27% patients and expulsion occurred in 6.89% patients after post-partum insertion of IUCD. Keywords: Post-partum intra-uterine contraception device (PPIUCD), Bleeding, Expulsion.

Safety profile of immediate post-partum intrauterine device insertion during caesarean delivery – a clinical trial with three years of follow up

Background: Many countries recommend the use of long-acting reversible contraceptive intrauterine device immediately after cesarean delivery. The cesarean delivery rate in Iraqi public hospitals is 32.2% and may reach 85.8% in private hospitals. Immediate post-partum intrauterine device insertion at cesarean is rarely done in Iraq. Objectives: To assess the safety and practicality of immediate post-partum intrauterine device insertion during cesarean delivery for family planning and pregnancy spacing in Iraqi women. Subjects and Methods: A single arm clinical trial included 150 eligible women who attended Al-‎Elwiyah Maternity Teaching Hospital or Al Hayat Rahibat Hospital for term delivery. A copper intrauterine device was placed in the uterine cavity immediately after delivery of the placenta during cesarean delivery. The intrauterine device was fixed in place at the fundus using an absorbable suture. Patients were followed up at six weeks, then annually for three years. Results: Expulsion of the intrauterine device was not reported by any of the participants. The most-reported complaints in the first twelve months of intrauterine device placement were abdominal pain, abnormal vaginal discharge, and ‎heavy menstrual blood loss, however, none were statically significant (P= 0.256). After the first year, there was a significant reduction in the ‎frequency of complaints (P= 0.002). Only 7.33% (95% CI: 6.92–7.75%) of the patient requested intrauterine device removal within the three years. The main reason was to plan a new pregnancy followed by recurrent infection associated with uncontrolled diabetes ‎mellitus. Diabetes was ‎a significant predictor for immediate post-partum intrauterine device removal, P= 0.049. Conclusion: The intrauterine device placement during cesarean delivery with suture fixation is a safe procedure with a zero-expulsion rate and is an effective reversible long-term contraceptive method.

Acceptability of Intrauterine Contraceptive Device Insertion in immediate Postpartum Period

Background: Mostly, females seek birth space after a delivery. But usually are unaware about contraceptive method and their usage, especially during postpartum period. Controversial results have been noticed from literature regarding the acceptability of PPIUCD among females of reproductive age groups. So we conducted this study to find the acceptability in local population. Aim: To determine the frequency of acceptability of immediate post-partum intra-uterine contraceptive device insertion in females presenting for delivery. Methods: This cross sectional study was conducted in Gynae Unit-II, Shalamar Hospital, Lahore for a period of six months after approval of synopsis i.e. from 4th October 2016 to 4th April, 2017. 90 patients enrolled in this study. Informed consent was taken from all the patients. After delivery, IUCD implanted after taking approval from female and her husband and acceptability noted. All the collected data was entered and analyzed on SPSS version 20. Results: The mean age of the patients was 29.52±7.38 years. The low SES patients were 41(45.6%), middle SES patients were 40(44.4%) and high SES patients were 9(10%). In this study 54(60%) patients accepted the use of IUCD. Conclusion: In our study, the acceptability of immediate PPIUCD insertion in females presenting for delivery was 60%. Keywords: Acceptability, Post-partum, Intra-uterine Contraceptive Device, Delivery

Intrapartum versus postpartum insertion of intrauterine device in women delivering by cesarean section

BackgroundThe intrauterine device (IUD), being a reversible and effective contraception method, is the most widely used worldwide. This study aims to demonstrate the efficacy of IUD insertion during elective lower segment cesarean section (LSCS) versus its insertion six weeks postpartum.MethodsA cohort study was conducted on 200 women planned for elective cesarean delivery and desired IUD as a contraceptive method. They were allocated into two groups; group I, in which IUD was inserted during LSCS, and group II, in which IUD was inserted six weeks or more after LSCS. Both groups were compared regarding failed insertion, post-insertion pain, and uterine perforation. They were followed for one year for the incidence of menorrhagia, vaginal infection, IUD displacement/expulsion, missed threads, or unintended pregnancy.ResultsWomen in the second group showed a significantly higher incidence of failed insertion and uterine perforation than women in the first group. On the contrary, women in the first group showed a significantly higher incidence of missed threads than women in the second group. Regarding other consequences, there were no significant differences between both groups concerning menorrhagia, vaginal infection, IUD displacement/expulsion, or unintended pregnancy.ConclusionIUD insertion during elective LSCS showed a significantly lower incidence of failed insertion and uterine perforation than its insertion six weeks postoperative.

Patient acceptability, continuation and complication rates with immediate postpartum levonorgestrel intrauterine device insertion at caesarean section andvaginal birth.

Immediate postpartum long-acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. To assess self-reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates. Secondary outcomes were reason for discontinuation, patient-reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data. One hundred and ninety-three women had a hormonal IUD inserted and 143 consented to involvement (CS n= 79; VB n= 64). Six and 12months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72; 95% CI 1.07-6.90; P= 0.036). There were 60.8% of women post-CS and 56.3% of women post-VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow-up with their GP (89.5%). Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts.

Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion

Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile. To evaluate the association of postpartum timing of IUD insertion and breastfeeding status with incidence and risk of IUD expulsion. The Association of Perforation and Expulsion of Intrauterine Devices (APEX-IUD) cohort study included women aged 50 years or younger with an IUD insertion between 2001 and 2018. The breastfeeding analysis focused on a subcohort of women at 52 or fewer weeks post partum with known breastfeeding status. The study was conducted using data from electronic health records (EHRs) at 4 research sites with access to EHR: 3 Kaiser Permanente sites (Northern California, Southern California, Washington) and the Regenstrief Institute (Indiana). Data analysis was conducted from June to November 2019. Timing of IUD insertion post partum was categorized into discrete time periods: 0 to 3 days, 4 days to 6 or fewer weeks, more than 6 weeks to 14 or fewer weeks, more than 14 weeks to 52 or fewer weeks, and non-post partum (>52 weeks or no evidence of delivery). Breastfeeding status at the time of insertion was determined from clinical records, diagnostic codes, or questionnaires from well-baby visits. Incidence rates and adjusted hazard ratios (aHRs) were estimated using propensity scores to adjust for confounding. The full cohort included 326 658 women (mean [SD] age, 32.0 [8.3] years; 38 911 [11.9%] Asian or Pacific Islander; 696 [0.2%] Hispanic Black; 56 180 [17.2%] Hispanic other; 42 501 [13.0%] Hispanic White; 28 323 [8.7%] non-Hispanic Black; 137 102 [42.0%] non-Hispanic White), and the subcohort included 94 817 women. Most IUDs were levonorgestrel-releasing (259 234 [79.4%]). There were 8943 expulsions. The 5-year cumulative incidence of IUD expulsion was highest for insertions 0 to 3 days post partum (10.73%; 95% CI, 9.12%-12.61%) and lowest for insertions more than 6 weeks to 14 or fewer weeks post partum (3.18%; 95% CI, 2.95%-3.42%). Adjusted HRs using women with non-post partum IUD insertion as the referent were 5.34 (95% CI, 4.47-6.39) for those with postpartum insertion at 0 to 3 days; 1.22 (95% CI, 1.05-1.41) for those with postpartum insertion at 4 days to 6 or fewer weeks; 1.06 (95% CI, 0.95-1.18) for those with postpartum insertion at more than 6 to 14 or fewer weeks; and 1.43 (95% CI, 1.29-1.60) for those with postpartum insertion at more than 14 to 52 or fewer weeks. In the subcohort, 5-year cumulative incidence was 3.49% (95% CI, 3.25%-3.73%) for breastfeeding women and 4.57% (95% CI, 4.22%-4.95%) for nonbreastfeeding women; the adjusted HR for breastfeeding vs not breastfeeding was 0.71 (95% CI, 0.64-0.78). In this study of real-world data, IUD expulsion was rare but more common with immediate postpartum insertion. Breastfeeding was associated with lower expulsion risk.

Experience of Women after Immediate Postpartum Insertion of Intrauterine Contraceptive Device (PPIUCD), a Long-Acting Reversible Contraception

ABSTRACT
 Objective: To assess the experience (during and post procedure) of women after immediate postpartum and post placental Insertion of intrauterine contraceptive device (IUCD), a long acting reversible contraceptive (LARC).
 Methods: This prospective and longitudinal study was conducted during February 2019 to September 2019 in Gynae and Obstetrics department Unit 1 at Abbasi Shaheed Hospital. All 141 booked and non-booked patients who delivered in the hospital and received immediate postpartum intrauterine contraceptive device (PPIUCD),either post placental, intra cesarean or within 48 hours after delivery were included in the study regardless of the mode of delivery either intra-cesarean or spontaneous vaginal delivery. Written consent was taken for the contraceptive device insertion and verbal consent was taken to fill the proforma which included basic demographic information, their overall experience with postpartum intrauterine contraceptive device. Immediate experience was measured by assessing the pain during procedure and post insertion period. Further all participants were followed at six weeks and 6 months to collect information about any complains removal of IUCD and overall experience.
 Results: The mean age was 27.3 years with a standard deviation (SD) of 4.42. Among all the participants, 77(54.6%) had Cesarean section and 64(45.4%) had vaginal delivery. During procedure only 5(3.5%) had complain of mild pain and no immediate post procedural complains was recorded. 86(73.5%) participants at 6 weeks and 78(69.03%) participants at 6 months had no complained. Overall experience was found satisfactory in 86(73.5%) participants.
 Conclusion: Postpartum intrauterine contraceptive device (PPIUCD) provided satisfactory experience to majority of the women. So we recommend its use for better maternal and child health.

Effectiveness, safety and overall satisfaction of early postpartum placement of hormonal IUD compared with standard procedure: An open-label, randomized, multicenter study.

In this open-label, randomized controlled, non-inferiority, multicenter study we aimed to study the risk of termination of pregnancy within 1year postpartum, the safety profile and patient acceptability after early postpartum insertion of a hormonal intrauterine device (LNG-IUS, Mirena®) compared with standard placement 6-8weeks postpartum. April 2018 to January 2020 women with uncomplicated vaginal delivery at four urban birth centers in Sweden, were randomized to either early placement within 48h after delivery (early group) or standard placement 6-8weeks postpartum (standard group) of a hormonal intrauterine device. The main outcome measure was the proportion of terminations of pregnancies in each group during the first year after placement of the intrauterine device. Registration EudraCT database no. 2017-001945-29. The study was prematurely stopped according to the protocol due to an expulsion rate >20% in the early group. No pregnancies occurred. Fifty-two women were randomized to early and 49 women to standard insertion. In the early group, 23/52 (44.2%) of the intrauterine devices were expelled. After expulsion, 10 women chose to have another hormonal intrauterine device placed but still significantly fewer women (39/52, 75%, p=0.22) in the early group used the hormonal intrauterine device method at study completion. No expulsions occurred in the standard group, but 5/49 (10.2%) requested removal and 41/49 (83.7%, p=0.22) had used the hormonal intrauterine device method continuously for 1year. Early hormonal intrauterine device insertion after vaginal delivery is associated with high expulsion rates. Despite this, a high continuation rate of the hormonal intrauterine device method is seen among women once choosing the method. In the light of high continuation rates, the advantages of early insertion could balance the risk of expulsion for well-informed women.

Status of Postpartum Intra Uterine Contraceptive Device in a Tertiary Care Hospital in Dhaka

Background: Timing of insertion, counseling, provider training and institutional support are critical factors for intrauterine contraceptive devices (IUCD) use during the postpartum period.
 Objective: The objective of the study was to determine the rate of acceptation, discontinuation, expulsion, infection and displacement of PPIUCD after vaginal delivery and cesarean section along with other complications among the study population.
 Methodology: This was a prospective observational study done in Shaheed Suhrawardy Medical College and Hospital from July 2015 to June 2016 among the pregnant women who delivered healthy baby by normal vaginal delivery and cesarean section. Data was collected by a structured questionnaire. Women who gave informed consent and who gave birth of healthy baby without complications were included. Women who had premature ruptured membrane with chorioamnionitis, pelvic inflammatory disease intrauterine fetal death or who did not give consent were excluded.
 Result: In this study, only 8.4% gave consent for this method, 77.1% had regular follow up after this method. Only 5.05% had removal and 1.8% had spontaneous expulsion. 10.5% had lower abdominal pain and 4.13% had per vaginal bleeding after this method.
 Conclusion: This study showed that post-partum intrauterine contraceptive devices insertion rate is low even in a tertiary center, which means, there is a lot of space for counseling the target population in our country. On the contrary, follow up rate was quite high which means that people are being concerned about this health care service. Similarly, the removal rate was also satisfying with minimum expulsion rate.
 Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 165-168

Common Complications after Immediate Postpartem Intrauterine Contraceptive Device Insertion

Introduction: Low contraceptive rates in poor nations are caused by numerous causes including a lack of information about contraceptives, the inability to get family planning methods, and cultural and geographic constraints on women's movement in these countries. If the birth takes place at a health care institution, women with limited access to medical care have a unique chance to address their contraception needs. Objective:To determine the frequency of common complications in immediate postpartum intrauterine contraceptive device insertion. Material and Methods: This study was conducted at Gynae and Obs department, QaziHussain Ahmed Medical Complex, Noshehra. This was a cross sectional descriptive study in which consecutive non probability sampling technique was used. Duration of the study was 6 months from 21st August 2020 to 20th February 2021,in which a total of 292 patients were studied. All multigravida females undergoing Normal Vaginal delivery and who gave consent for Immediate IUCD insertion were included, while patients with known history of pelvic inflammatory disease or sexually transmitted infection, patients having cavity distorting uterine fibroids, known uterine or cervical malignancy as seen through medical records and women with bleeding disorders as detected from past medical records were excluded.Data wascollected on a pre-designed proforma and analyzed by the SPSS version 20. Results: In this study mean age was 27 years with standard deviation ±1.26. Two hundred and four patients had delivery of placenta and IUCD insertion in 1-5 hours and 88 patients had delivery of placenta and IUCD insertion in 5-10 hours. Regarding complications 44 patients had expulsion in which partial expulsion was found in 9 patients and complete expulsion was found in 35 patients, uterine perforation was found in 6 patients while pelvic inflammatory disease was found in 29 patients. Conclusion: Despite the fact that IUCD's verbal approval was low, its real insertion was even less so. The only time these women have to learn about contraceptive options is during childbirth, when they are in direct touch with medical workers. That's why some people think family planning can help increase the uptake of contraceptives among women who otherwise wouldn't seek them out on their own. Keywords:Common complications, Immediate postpartum, Intrauterine contraceptive device insertion.

A Prospective Study of Acceptability, Safety and Efficacy of Postpartum Insertion of Intrauterine Copper Device (CU-T380a) in Tertiary Care Teaching Hospital in South India

A Prospective Study of Acceptability, Safety and Efficacy of Postpartum Insertion of Intrauterine Copper Device (CU-T380a) in Tertiary Care Teaching Hospital in South India

Making the financial case for immediate postpartum intrauterine device: a budget impact analysis

Clinical guidelines support inpatient postpartum intrauterine device insertion. However, inpatient placement remains infrequent, in part because of inconsistent private insurance reimbursement. The purpose of this study was to explore how the payer's costs and number of unintended pregnancies associated with a postpartum intrauterine device differed on the basis of placement timing. Using a decision tree model and following a hypothetical cohort of people who intend to use an intrauterine device after their delivery, we conducted a cost analysis comparing the planned approach of inpatient vs outpatient postpartum insertion. Using a 2-year time horizon, the probability and cost estimates were derived from literature review. Our primary outcome was the total accrued costs to the payer. Secondarily, we examined the rates of early repeat pregnancy and sensitivity to estimates of key inputs, including the expulsion rates and the intrauterine device cost. Although an inpatient intrauterine device placement's upfront costs were higher, the total cost of this approach was lower. Including the costs of managing expulsions and complications, our model suggests that for every 1000 people desiring a postpartum intrauterine device, the intended inpatient intrauterine device placement resulted in total cost savings of $211,100 and the prevention of 37 additional pregnancies compared with outpatient placement. The inpatient cost savings were superior to the outpatient savings, largely because of a known high proportion not returning for outpatient placement and the resulting higher number of unintended pregnancies among the patients desiring outpatient placement. In sensitivity analyses, we found that the total cost to the payer was sensitive to the probability of expulsion after immediate postpartum intrauterine device placement. For beneficiaries desiring postpartum intrauterine device, payers are likely to save money by fully reimbursing inpatient intrauterine device placement rather than incentivizing placement at the frequently missed postpartum visit. These results support the financial case for private insurers to fully and separately reimburse (ie, "unbundle" from the single payment for delivery) inpatient postpartum intrauterine device placement.

Utilization of Immediate Postpartum Long Acting Reversible Contraceptives among Women Who Gave Birth in Public Health Facilities in Eastern Ethiopia: A Cross-Sectional Study.

Objective Although importance of postpartum family planning is essential and immediate postpartum insertion of long acting and reversible contraceptives (LARC) is recommended, evidence on its uptake and associated factors is limited in Ethiopia. This study was conducted to assess utilization of immediate postpartum LARC among women who gave birth in selected public health facilities in eastern Ethiopia. Method An institution-based cross-sectional study was conducted among randomly selected women who gave birth in selected public health facilities in eastern Ethiopia from 10 March to 09 April 2020. At discharge, all eligible women who gave birth in the facilities were interviewed using a pretested structured questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with utilization of immediate postpartum LARC. Adjusted odds ratio (aOR) with 95% confidence interval was used to report association, and significance was declared at p value < 0.05. Results From a total of 546 women invited to the study, 530 (97.1%) participated in the study and 98 (18.5%; 95% CI: 15.1%, 22.0%) reported starting long acting reversible contraceptives. Women who reported discussing about contraceptives with partners (aOR = 6.69, 95% CI: 3.54, 12.61) and receiving postpartum counselling on contraceptives (aOR = 5.37, 95% CI: 3.00, 9.63) were more likely to using contraception. However, women who live >30-minute walking distance from the nearest health facility (aOR = 0.47, 95% CI: 0.26, 0.85) and reported disrespect and abuse during childbirth (aOR = 0.22, 95% CI: 0.12, 0.40) were less likely to start LARC. Conclusions Almost one in five women delivering in public health facilities in eastern Ethiopia started using LARC. Provision of respectful maternity care including counselling on the importance of immediate postpartum family planning is essential for increasing its uptake.

Efficacy and Safety of Immediate Postpartum Intrauterine Contraceptive Devices in C-Section and Vaginal Deliveries

Aim: To determine the safety and efficacy of immediate postpartum intrauterine contraceptive devices insertion after vaginal and caesarean and vaginal deliveries. Study Design: Retrospective study Place &amp; Duration: Conducted at Gyne &amp; Obs Department, Shahida Islam Teaching Hospital Lodhran, during from 1-06-2020 to 30-06-2021. Methods: In this study 120 patients were included in this study. Patients’ ages were ranging from 20 to 45 years. Patients’ detailed medical history including age, residence and socioeconomic status were examined after taking written consent. All the patients divided into two groups, 60 caesarean, 60 vaginal. IPPIUCDs were inserted in all the patients. Outcomes were examined at follow-up and compared between both groups. Data was analyzed by SPSS 24.0. P-value &lt;0.05 was considered as significant. Results: 48 (40%) patients had ages between 20 to 30 years, 56 (46.7%) patients had ages 31 to 40 years and 16 (13.3%) patients had ages above 40 years. Complications rate was low. Perforation and pregnancy rate was 0%. Menstrual disturbance reported in 20 (16.7%) which was significantly higher in vaginal group. Expulsion rate was 9 (7.5%) and significant higher in vaginal group p&lt;0.05. Removal was done in 14 (11.7%) cases and rate of removal of IUCD was high in vaginal group. Continuation rate at follow-up was 106 (88.3%). Conclusion: It is concluded that the insertion of immediate postpartum intrauterine contraceptive devices was effective and safe method with low complications rate.

Postpartum Intrauterine Contraceptive Device (PPIUCD) Versus Interval Intrauterine Contraceptive Device (IUCD) Complications: Which is better?

Introduction: Intrauterine Contraceptive Device (IUCD) is an effective mode of contraception. But its timing of insertion remained debateable. Studies has shown that Postpartum Intrauterine Contraceptive Device (PPIUCD) is associated with less complications as compared to interval IUCD. But controversial results have been noted. This study aims to compare intricacy &amp; efficacy of PPIUCD Vs interval IUCD. &#x0D; Aims &amp; Objectives: To compare the complications of postpartum versus interval intrauterine device insertion (Copper T) in females seeking contraception in teaching hospital of Lahore.&#x0D; Place and duration of study: The six months study was conducted in Department of Obstetrics &amp; Gynecology, Shaikh Zayed Medical Complex, Lahore from 15-3-2018 to 15-9-2018.&#x0D; Material &amp; Methods: In this Randomized controlled trial 200 women were enrolled and divided into 2 groups. In group A, IUCD (Copper T) was implanted within 10 minutes of delivery of placenta (PPIUCD). In group B, IUCD (Copper T) was implanted after 6 weeks of delivery (Interval IUCD) and both groups were asked to follow up for 6 months and present in case of any complication. Data was analyzed using SPSS version 21.&#x0D; Results: In this study, the frequency of bleeding was (Group-A: 12% &amp; Group-B: 18%, p-value=0.235), per vaginal discharge (Group-A: 4% &amp; Group-B: 9%, p-value=0.152), abdominal pain (Group-A: 4% &amp; Group-B: 14%, p-value=0.013), pelvic inflammatory disease (Group-A: 5% &amp; Group-B: 11%, p-value=0.118) and IUCD removal (Group-A: 9% &amp; Group-B: 14%, p-value=0.268) was higher in Group-B patients. However, expulsion rate was observed to be higher in Group-A patients (8% Vs 3% in Group B).&#x0D; Conclusion: Based on this study, it can be analyzed that Postpartum Intrauterine Contraceptive Device (PPIUCD) is more effective than Interval IUCD in terms of lower bleeding, PV discharge, pelvic inflammatory disease, abdominal pain and IUCD removal.

Hubungan Metode Persalinan dengan Penggunaan IUD Pascasalin di RSUD Panembahan Senopati Bantul

Latar Belakang: Periode pascasalin merupakan masa yang penting untuk memulai kontrasepsi, namun masih kurang dimanfaatkan, utamanya untuk penggunaan IUD pascasalin. Hal ini ditunjukkan oleh penggunaan IUD pascasalin hanya 14,06% dari keseluruhan metode kontrasepsi pascasalin. Angka seksio sesarea meningkat signifikan akhir-akhir ini, mencapai 29,6% di Indonesia. Peningkatan angka seksio caesarea (SC) tidak diikuti peningkatan penggunaan IUD pascasalin. Padahal peluang penggunaan IUD pascasalin pada persalinan abdominal/seksio sesarea lebih besar. Tujuan: Penelitian ini bertujuan untuk melihat hubungan antara metode persalinan dengan penggunaan IUD Pascasalin di RSUD Panembahan Senopati. Metode: Penelitian ini merupakan penelitian analitik dengan desain cross sectional atau potong lintang, sampel penelitian diambil dari pasien yang melahirkan di RSUD Panembahan Senopati, data dikumpulkan dengan metode wawancara. Uji Chi square dan prevalence ratio dipakai untuk analisis statistika. Hasil dan Pembahasan: Penelitian ini melibatkan 260 subyek, 161 (61,92%) persalinan vaginal dan 99 (38,08) SC. Total pengguna IUD pascasalin sebanyak 128 (49,23%). Persalinan SC memiliki hubungan bermakna dengan penggunaan IUD pascasalin (p 0,000; PR 1,49; CI 1,19-1,89). Faktor lain yang mempengaruhi penggunaan IUD pascasalin secara bemakna adalah riwayat penggunaan metode kontrasepsi jangka panjang (MKJP) sebelumnya (p 0,002; PR 1,68; CI 1,38-2,06), adanya asuransi Jaminan Kesehatan Nasional (JKN) (p 0,038; PR 1,71; CI 1,04-2,80), dan konseling (p 0,000; PR 2,84; CI 1,85-4,35). Alasan terbanyak subyek menolak penggunaan IUD pascasalin adalah takut efek samping (35%). Kesimpulan: Penggunaan IUD pascasalin lebih tinggi secara bermakna pada seksio sesarea dibandingkan persalinan vaginal. Faktor lain yang mempengaruhi penggunaan IUD pascasalin secara bermakna adalah riwayat penggunaan MKJP, adanya asuransi JKN dan konseling. Kata Kunci: IUD pascasalin; metode persalinan; angka pemasangan; persalinan vaginal, SC

Risk factors for postpartum intrauterine device expulsion among women delivering at a tertiary Hospital in Uganda: a prospective cohort study

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.

STUDY OF AWARENESS ABOUT POSTPARTUM INSERTION OF INTRAUTERINE DEVICE AMONG ANTENATAL CASES IN RAIGARH

Background: In spite of many available contraceptives numerous unwanted and unplanned pregnancies occur. Though the couples desire contraception but are not able to accept it due to their ignorance and misconceptions. Ministry of Health &amp; Family Welfare, Government of India has taken initiative for provision of IUCD in immediate postpartum period. Several training programs and awareness camps are conducted by NHM for health service providers and also for the public. The study was corresponding to nd out the choices about contraception after delivery and awareness about postpartum insertion. Methods: The present observational study was conducted in LSLAMMC Raigarh hospitals. The study population included 400 women who planned to deliver at Government Medical College, RAIGARH during the study period including vaginal and caesarean section. Their choice of contraception after delivery and awareness was determined through a questionnaire. Reasons for refusal of postpartum insertion were recorded. Results: 400 cases were included in the study, a large number had decided about contraception; mainly breast feeding supplemented by barrier contraceptive. 78 of 400 were willing for insertion of contraceptive device but not immediately after delivery due to apprehension in general and fear of side effects. Conclusion: The results of this study showed Knowledge and acceptance of postpartum insertion is very low among antenatal women; probably because the concept is new in the community. There is a strong need to increase the knowledge and awareness about this by health education and counseling.

Impact of immediate postpartum insertion of TCu380A on the quantity and duration of lochia discharges in Tanzania

BackgroundThe insertion of Intrauterine Contraceptive Device (PPIUD) for the purpose of contraception immediately after delivery is becoming popular in countries where the use of IUD for contraception has been extremely low. Since 2015, Tanzania implemented the initiative by the International Federation of Gynecology and Obstetrics (FIGO) to institutionalize PPIUD. As a result of capacity building and information delivery under the initiative, there have been increased uptake of the method. Working in this context, the focus of the study was to generate evidence on the effect of TCu380A IUD on amount and duration of lochia and equip service providers with evidence-based knowledge which can help them in counselling their PPIUD clients.ObjectiveEstablish impact of postpartum TCu380A on amount and duration of lochia.MethodsA prospective cohort study of delivered women in two teaching hospitals in Tanzania with immediate insertion of TCu380A or without use of postpartum contraception in 2018. TCu380A models; Optima (Injeflex Co. Brazil) and Pregna (Pregna International, Chakan, India) were used. Follow-up was done by weekly calls and examination at 6th week. Lochia was estimated by Likert Scale 0–4 relative to the amount of lochia on the delivery day. An estimated 250 women sample (125 each group) would give 80% power to detect a desired 20% difference in the proportion of women with prolonged lochia discharges among the Exposed and Unexposed groups. Data analysis was by SPSS.ResultsTwo hundred sixty women were analysed, 127 Exposed and 133 Unexposed. Medical complaints were reported by 41 (28.9%) Exposed and 37 Unexposed (27.8%), p = 0.655. Lack of dryness by end of 6th week was to 31 (23.3%) Exposed and 9 (7.1%) Unexposed, p < 0.001. Exposed had higher weekly mean lochia scores throughout with the difference most marked in 5th week (3.556 Versus 2.039, p < 0.001) and 6th week (1.44 Versus 0.449, p<0.001).ConclusionPPIUD is associated with increased amount of lochia and slows progression to dryness within 6 weeks of delivery. The implications of PPIUD clients’ needs to be informed about the possibility of delayed dryness of lochia at time of counseling are discussed.