Post Placental Intrauterine Contraceptive Device Research Articles

Effectiveness of Antenatal Counselling in Increasing the Acceptability and Insertion of Postplacental IUCD in Postpartum

Aim: To evaluate effectiveness of antenatal counselling in increasing the acceptability and insertion of Post Placental Intrauterine Contraceptive Device in postpartum women Study design: Prospective study. Place and duration of study: Department of Obstetrics & Gynaecology, Hayatabad Medical Complex, Peshawar from 1st April 2022 to 30th September 2022. Methodology: Fifty pregnant women were enrolled. The age of the pregnant women was taken within 18-43 years. The couples were counselled for the uptake of PPIUCD through gynaecological professional assistance. The counselling was done at 28 weeks followed by at 36 weeks. The misconceptions and myths were eradicated through the use of one-to-one interview as well as focus group discussions. The fears of the patients and their spouse were addressed through detailed discussion. Results: The mean age was 24.8±4.06 years. There were 70% of the pregnant women who agreed to get PPIUCD inserted, however only 42% actually underwent the procedure. Majority of the cases were within the age group of 18-28 years. The reasons recorded for not getting PPIUCD insertion previously presented data where 23% of the pregnant women had no awareness provided about PPIUCD before while 13% preferred other contraceptive methods. Conclusion: The outcomes of the antenatal counselling are higher uptake of post placental intrauterine contraceptive device with a rate of 42% increase in post-partum women. There is an evident reduction in misconceptions and myths about post-placental intrauterine contraceptive device through antenatal counselling. Key words: Antenatal counselling, Outcome, Intrauterine contraceptive device, Post-partum

Clinical Outcomes of Post Placental Intrauterine Contraceptive Device Insertion in Women Delivering by Cesarean Section

Background: Short pregnancy interval after caesarean section increases the risks of morbidity, mortality and surgical interventions. This can be easily avoided by post placental insertion of IUCD during caesarean section. Immediate post placental IUCD insertion is defined as insertion of IUCD within 10 minutes of delivery of the placenta. It is a very promising an appealing approach as patient does not have to come for a separate postpartum visit. Objectives: To determine the outcome (safety, complications, failure and continuation rate) of post placental IUCD insertion during caesarean section. Materials and Methods: Our study was a prospective cross-sectional study, carried out in the Department of Obstetrics and gynecology at Qazi Hussain Ahmad Medical Complex, Nowshera. All the pregnant women willing for post placental intrauterine contraceptive device were included in the study. Women who had postpartum hemorrhage, chorioamnionitis, structurally malformed uterus and fibroid uterus were excluded from the study. Follow up visits were scheduled at one month, 3 months and 6 months. Results: 156 women were included in this study. Majority(35.2%) belonged to 31- 35 years age group. 46.7% of them were illiterate and 30.7% have just primary education. 40.38% of women belonged to low socio-economic group. 26.2% of women were para 4. 26.9% had previous 3 caesarean section. The most common adverse events during follow up of 6months were vaginal discharge, menstrual irregularities and pelvic pain. At the end of 6 months there were 9expulsions, 12 removals and 2 pregnancies with the gross cumulative expulsions, removal, failure and continuation rate of 5.7%, 7.6%, 1.28% and 85.2% respectively. The incidence of undescended strings at the end of 6 months was high (32.4%). Conclusion: Post placental intra uterine Copper T 380 A insertion is a safe, effective and easy reversible method of contraception with low expulsion and high continuation rates. Keywords: Intrauterine device,Intra-cesarean section, Post placental insertion

Acceptance of Post Placental IUCD Among Antenatal Patients

Objective: To see the acceptance rate of PPIUCD among antenatal patients and compare it with international standards so that strategies to increase uptake of this contraceptive device can be devised especially for low compliance patients. Background : Post placental intrauterine contraceptive device ( PPIUCD) is the method of contraception that is effective immediately after delivery and patients don’t have to come back again from home. It is long acting, reversible, cost effective, free of systemic side effects and best for women with low compliance. Material and methods: This cross sectional observational study was carried out in outpatient department of obstetrics &gynaecology of Arif Memorial teaching hospital Lahore from January ary 2022 to March 2022. 285 pregnant patients irrespective of gestational age presenting to OPD were counselled for PPIUCD insertion after taking written informed consent. Results: Out of 285 patients counselled for PPIUCD insertion only 86 women (30%) accepted its insertion while 199 women (70%) refused for it. Majority of patients 205 (72%) were in age group 21-30 years, only 61(30%) of them accepted PPIUCD insertion and acceptance was highest (61%) in age group less than 20 years . 228 (80%) patients were literate and acceptance rate was 63% among them. Acceptance of PPIUCD was lower among multi para (22%) as compared to primipara (41%). Conclusion: Acceptance of PPIUCD in our antenatal mothers is poor. So ccounseling of antenatal women and their families will be helpful for high acceptance of PPIUCD. Keywords: PPIUCD, Contraception, acceptance

Female’s Experience with Post-placental Intrauterine Contraceptive Device Use in a Tertiary Care Centre in Pakistan

Background: Insertion of a post-placental intrauterine contraceptive device (PPIUCD) has been recommended by the World Health Organization (WHO) as one of the safe and effective methods of temporary contraception. In the immediate post-delivery period, females are highly driven and in need of an effective method for contraception so that child-rearing can be easy without unintended pregnancy. Objective: To assess the outcome of females accepting PPIUCD in terms of insertion, complications, and discontinuation rate at 6 weeks and 6 months. Methods: Retrospective, cross-sectional study conducted at the Department of Obstetrics and Gynecology, Lahore General Hospital, Pakistan, from May 2015 to August 2019. The data were collected and analysed after approval from the hospital ethical committee and were retrieved from the maternal and neonatal child health programme. Record of clinical visit and telephonic survey for miscellaneous complaints at 6 weeks and 6 months were evaluated from the medical records department and relevant data were extracted. The data were analysed using the IBM Statistical Package for the Social Sciences (SPSS® Statistics) V21.0 software (International Business Machines Corporation [IBM], New York, USA) and the results were expressed in descriptive statistics in frequencies and percentages. Results: Total live births during the study period were 43,065. PPIUCD was inserted in 5,275 females (12.24%). Only 13% presented for clinical follow-up; 87% had a telephonic conversation. Of these, 33% were advised to have a clinical visit; 83% reported no complaints. Reassurance was needed in 11% and threads were trimmed in 2%. Problems reported were displaced intrauterine contraceptive device (IUCD; 3.3%); spontaneous expulsion (24.0%); vaginal infections (4.7%); missing strings (3.0%); cramping (25.0%); dyspareunia (6.0%); spotting (52.0%); and vaginal discharge (16.0%). Ultrasound was advised (3.0%), as were symptomatic treatment (14.0%) and antibiotics and IUCD removal (0.7%). IUCD was discontinued by 6.7% of the females for various reasons: family pressure (0.3%); wanting a further child (0.7%); and opting for another method of family planning (14.0%). IUCD was removed and reinserted in 4.9%. Conclusion: PPIUCD has a low turnover rate of follow-up but has high compliance with devices and a low complication rate; however, complications can be reduced by improving patient selection and clinical follow-up. It provides an excellent window of opportunity for providing effective long-term contraception to the patients who need it the most.

A Comparative Study of Post-placental IUCD Insertion after Vaginal Delivery versus during Caesarean Section

Introduction: Immediate postpartum period is the period from expulsion of placenta to 48 hours of delivery. The CuT-380A is effective for 10 years of continuous use. Institutional delivery provides an opportunity to the women with immediate Post-placental Intrauterine Contraceptive Device Services. Aims and Objectives: To compare complications of PPIUCD inserted after vaginal delivery and during caesarean section up to 12 weeks. To compare the rate of expulsion of PPIUCD inserted after vaginal delivery and after caesarean section. Material and Methods: Total 200 subjects were included in the study. Group A - Consisting of 100 subjects in whom IUCD (CuT 380 A) was inserted after vaginal delivery. Group B - Consisting of 100 subjects in whom IUCD (CuT 380 A) was inserted during caesarean section. Results: Whether CuT is expelled or in situ among both groups at 6 weeks and at 12 weeks shows significant difference in both groups; the rate of expulsion is more in group A at 6 weeks than group B, at 12 weeks there is no significant difference (P value = 0.0001 at 6 weeks and P value = 0.579 at 12 weeks). The reason might be early ambulation of patients after vaginal delivery compared to caesarean section. Conclusion: There should be a campaign to increase the awareness regarding lengths of PPIUCD. Health care personnel should be properly trained regarding aseptic insertion techniques and this will increase the usage of PPIUCD, reduce the unmet needs of contraception and also decrease the complications.

COMPARISON OF POST PLACENTAL INTRAUTERINE CONTRACEPTIVE DEVICE INSERTION BETWEEN VAGINAL DELIVERY AND CAESAREAN SECTION IN A TERTIARY CARE HOSPITAL

Objective: To compare the acceptability of insertion of post placental intra uterine contraceptive device, withrespect to gravidity between vaginal deliveries and caesarean sections.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Frontier Corp Hospital, Quetta, from Jan 2019 to Jan 2020.
 Methodology: A total of 399 females with age of 18 to 45 years with gravidity (primi, multi and grand multigravida) were counselled during antenatal visits about benefits and risks of post placental intrauterine contraceptive device (PPIUCD) insertion. For complications, females were assessed at 1 and 6 weeks after delivery.
 Results: A total of 399 females with mean age 27.95 ± 5.07 years were included in study. About 235 (55.9%)women delivered vaginally and 164 (41.4%) women by caesarean section. Acceptance rate was 3.8% and 4.3% for vaginal and caesarean deliveries respectively. Eleven (73.3%) women were grand multi gravida and 4 women(26.6%) were multi gravid in vaginal delivery acceptance group versus 8 women (47%) grand multi and 9 women (52.9%) multi gravida in caesarean acceptance group. Five (15%) females presented with complications (3 with abdominal pain and 1 each with infection and expulsion).
 Conclusion: The overall acceptance rate of PPIUCD was low in this study, the acceptance rate was higher inwomen undergoing normal vaginal delivery (NVD) as compared to lower segment caesarean section (LSCS),similarly more of the grand multiparas accepted the method as compared to other participants however thedifferences were not statistically significant.

Effectiveness of prenatal intensive counselling on knowledge, attitude and acceptance of post placental intrauterine contraceptive device among mothers

<strong>Introduction:</strong> Contraception is a method or device used to prevent pregnancy. In the first year of postpartum period around 65% of women are having unmet need of family planning. Post Placental Intrauterine Contraceptive Device is not only advantageous to the women and couples; even the service providers benefit from PPIUCD. PPIUCD insertion on the same delivery table saves time and separate clinical procedure is not required.

A prospective study to assess the safety and efficacy of postplacental intrauterine contraceptive device

A prospective study to assess the safety and efficacy of postplacental intrauterine contraceptive device

Post Placental intrauterine contraceptive device (PPIUCD): Women's experience at Combined Military Hospital Lahore

Background& Objectives: The objective of this study was to evaluate post placental intrauterine contraceptive device (PPIUCD) in terms of awareness, acceptance, and expulsion in women. Place & duration of study: It was a prospective longitudinal study, conducted at Department of Obstetrics and Gynecology, Combined Military Hospital Lahore over a period of six months. Methods: All patients visiting antenatal clinic or labor room in early labor were counselled for insertion of Cu T-380A after vaginal delivery or at lower caesarean section. A total number of 232 women were included in the study after informed consent. Women with ruptured membranes for more than 18 hours,antepartum , postpartum hemorrhage, and evidence of chorioamnionitis were excluded from study.All the collected data was entered and analyzed through SPSS version 20. Results: Total number of deliveries were 1814 and acceptance rate is 12.8%.Only 4.5% of patients were aware about PPIUCD insertion. Maximum patients were between 25-29 years of age(36.6%).Patients with two children have highest acceptance rate of 32.8%. At six week postpartum,the expulsion rate is 1.9% while 3.3% of patients have missing strings which were coiled up in the uterus. The discontinunation rate is 6.5% (15),the reason being irregular vaginal bleeding in 3.5% cases, infection in 1.3% cases and other causes in 1.7%. The patients willing to continue PPIUCD were 93.5%. Conclusion: Insertion of IUCD in immediate postpartum period is an acceptable ,effective, safe and convenient contraceptive intervention in both caesarean section and vaginal deliveries.

Insertion of intrauterine devices after cesarean section: a systematic review update.

BackgroundWomen who undergo a cesarean section (CS) are in a unique position to receive the intrauterine contraceptive device (IUD). They may also want to use the IUD as a long-acting reversible contraceptive method provided the IUD is safe and effective in the presence of a CS scar.Search strategyWe researched and reviewed the MEDLINE, POPLINE, Google Scholar, and ClinicalTrials.gov databases from January 1968 to June 2015.Selection criteriaEligible studies reported event rates or practical problems relating to IUD usage in post-placental or interval insertion (>90 days) after CS. Studies with ≥20 subjects were included.Data collection and analysisAnalysis of eligible data collected from the search followed the PRISMA guidelines.Main resultsTwelve eligible studies of post-placental IUD insertion after CS included four randomized controlled trials of post-placental versus delayed insertion. Women randomized to delayed insertion were less likely to receive a device. Six studies examined the problem of missing IUD threads at follow-up with only 30%–60% presence of strings observed.ConclusionThe IUD is a long-acting reversible contraceptive method that is suitable for use in all women undergoing CS. The problems of device expulsion, missing threads at follow-up, and the tendency of increased puerperal bleeding need to be solved. Solutions are proposed.