Postpartum Insertion Research Articles

Comparison between Intrauterine Contraceptive Device Insertion during Cesarean Section and Postpartum Insertion

Comparison between Intrauterine Contraceptive Device Insertion during Cesarean Section and Postpartum Insertion

The virtual reality classroom: a randomized control trial of medical student knowledge of postpartum hemorrhage emergency management.

To investigate the use of a virtual reality learning environment (VRLE) to enhance medical student knowledge of postpartum hemorrhage (PPH) emergency management and insertion of a postpartum balloon. A randomized control trial involving medical students from University College Dublin, Ireland. Participants were randomly allocated to the intervention group (VRLE tutorial) or control group (PowerPoint tutorial on the same topic). All participants completed pre-learning experience and post-learning experience surveys. Both groups were timed and assessed on postpartum balloon insertion technique on a model pelvis. The primary outcome was assessment of student knowledge. Secondary outcomes included confidence levels, time taken to complete the task, technique assessment, satisfaction with the learning environment, and side effects of VR. Both learning experiences significantly (p < 0.001) enhanced student performance on the post-learning experience multiple choice questionnaire, with no difference between the intervention and control groups. In the intervention group, time for task completion was significantly less compared to the control group (1-2 min vs. 2-3 min, p = 0.039). Both learning experiences significantly (p < 0.001) enhanced student confidence, with no significant difference between intervention and control groups. 100% of the students using the VRLE enjoyed the experience, and 82.4% were very likely to recommend use of VRLE in medical education. 94.1% of the students felt the VRLE was beneficial over didactic teaching. Receiving formal instruction, regardless of format, enhances students' knowledge and confidence of the topic covered. Students who received instruction via the VRLE assembled the postpartum balloon faster than students who received didactic teaching. VR may be beneficial in teaching hands-on procedural skills in obstetrics and gynecology education.

COMPARISON OF CONTINUATION OF POST-PLACENTAL INSERTION OF COPPER T AFTER CESAREAN SECTION AND NORMAL VAGINAL DELIVERY

Objective: The objective of this study was to assess the efficacy of post-placental copper T insertion following vaginal and cesarean delivery. Methods: This is a prospective study conducted for the period of 1 year on pregnant females undergoing deliveries at Department of Obstetrics and Gynecology, Sardar Patel Medical College and AGH, Bikaner. The total number of postpartum intrauterine contraceptive device inserted participants included in the study were 200, divided into two groups vaginal (group A) and lower segment cesarean section (LSCS) (group B) groups. Results: Mean age of the patients was 26.15±4.02 years. Most of the acceptors in both the groups were para-2 with 30% in vaginal group and 76% in LSCS group. The complaints at 6 weeks follow-up, in both groups, were similar, but the rate of removal was higher in vaginal group (9%) compared to LSCS group (2%). At 3 months follow-up, in vaginal group, the most common complaint was bleeding per vagina (PV) in 7.31% cases whereas missing thread 31.25% in LSCS group. Over a period of 3 months, the main reason for intrauterine contraceptive devices (IUCD) removal was bleeding PV in both group (six cases in vaginal group and three cases in LSCS group). Conclusion: Immediate post-partum insertion of IUCD appears to be safe and effective method of contraception.

Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion.

To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0-10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥ 7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.

Risks of Uterine Perforation and Expulsion Associated With Intrauterine Devices.

The APEX-IUD (Association of Perforation and Expulsion of Intrauterine Devices) study evaluated the association of postpartum timing of intrauterine device (IUD) insertion, breastfeeding, heavy menstrual bleeding, and IUD type (levonorgestrel-releasing vs copper) with risks of uterine perforation and IUD expulsion in usual clinical practice. We summarize the clinically important findings to inform counseling and shared decision making. APEX-IUD was a real-world (using U.S. health care data) retrospective cohort study of individuals aged 50 years and younger with IUD insertions between 2001 and 2018 and with electronic health record data. Cumulative incidences of uterine perforation and IUD expulsion were calculated. Adjusted hazard ratios (aHRs) and 95% CIs were estimated from proportional hazards models with control of confounding. Among the study population of 326,658, absolute risk of uterine perforation was low overall (cumulative incidence, 0.21% [95% CI 0.19-0.23%] at 1 year and 0.61% [95% CI 0.56-0.66% at 5 years]) but was elevated for IUDs inserted during time intervals within 1 year postpartum, particularly among those between 4 days and 6 weeks postpartum (aHR 6.71, 95% CI 4.80-9.38), relative to nonpostpartum insertions. Among postpartum insertions, IUD expulsion risk was greatest for insertions in the immediate postpartum period (0-3 days after delivery) compared with nonpostpartum (aHR 5.34, 95% CI 4.47-6.39). Postpartum individuals who were breastfeeding had a slightly elevated risk of perforation and lowered risk of expulsion than those not breastfeeding. Among nonpostpartum individuals, those with a heavy menstrual bleeding diagnosis were at greater risk of expulsion than those without (aHR 2.84, 95% CI 2.66-3.03); heavy menstrual bleeding also was associated with a slightly elevated perforation risk. There was a slightly elevated perforation risk and slightly lower expulsion risk associated with levonorgestrel-releasing IUDs compared with copper IUDs. Absolute risk of adverse outcomes with IUD insertion is low. Clinicians should be aware of the differences in risks of uterine perforation and expulsion associated with IUD insertion during specific postpartum time periods and with a heavy menstrual bleeding diagnosis. This information should be incorporated into counseling and decision making for patients considering IUD insertion. Bayer AG. EU PAS register, EUPAS33461.

Acceptability of telemedicine for follow up after contraceptive implant initiation at an obstetrics and gynecologic training center

BackgroundDuring the COVID-19 pandemic, telemedicine has become a popular adjunct to in-person visits, including for family planning services. This study determined the proportion of clients participated in telemedicine services and the association between sociodemographic factors and telemedicine participation during the COVID-19 pandemic. The adverse effects within the first seven days post-insertion were also reported.MethodsThis retrospective cohort study considered data from all women initiating contraceptive implantation between June 2020 and August 2021 at King Chulalongkorn Memorial Hospital. Clients were offered the following two options for follow-up visits: in-person or communication via an online LINE® Official Account (LINE® OA), a free chat application widely used among the Thais. Logistic regression analyses were used to assess the association between socio-demographic factors and telehealth usage.ResultsIn total, 574 of 947 (60.6%) clients participated in telemedicine follow-up services during the period considered. A significant association between telemedicine usage and the following were observed: the peak of second wave COVID-19 outbreak in Thailand, using the period preceding the second wave as a reference [adjusted odds ratio (aOR) = 1.47 (95% confidence interval [CI]: 1.12–1.96)]; participants receiving governmental benefits for contraceptive implant payment (aOR: 3.23, 95% CI: 1.86–5.60), and timing of contraceptive implant(s) initiation, using interval insertion as a reference for which aORs of postpartum and immediate postpartum insertions were 0.62 (95% CI: 0.43–0.90) and 0.35 (95% CI: 0.24–0.52), respectively. Significant ecchymosis at the insertion site was observed in 13.1% of participants.ConclusionThis study emphasizes the significance of telemedicine during the COVID-19 epidemic, particularly in facilitating contraceptive implant initiation. Our data show a significant increase in the uptake and utilization of telemedicine during the pandemic’s peak. The data also shows that during the period of Thailand’s second COVID-19 epidemic, government benefits for contraceptive implant payment, and the timing of contraceptive implant initiation, are significantly associated with telemedicine use. This finding supports the continued use of telemedicine in healthcare, particularly for services like family planning, where remote follow-ups can provide safe, efficient, and timely care.

Outcome of Immediate Postpartum Insertion of IUCD - A Prospective Study

Outcome of Immediate Postpartum Insertion of IUCD - A Prospective Study

The Acceptance of Postpartum Intrauterine Contraceptive Devices Among Women Who Receive Focused Family Planning Counseling in the Antenatal Period Compared to Those Who Receive Routine Counseling: A Randomized Controlled Trial.

Background and objective Unplanned pregnancies are very common in the postpartum period, and they often lead to negative outcomes such as abortion, low-birth-weight neonates, early delivery, postpartum bleeding, and fetal mortality. In the first 12 months after delivery, closely spaced and unintentional pregnancies can be prevented with postpartum contraception. The postpartum intrauterine contraceptive device(PPIUCD) is a method of family planning that may be used during the first few weeks after giving birth, and it is highly successful, reliable, affordable, non-hormonal, immediately reversible, long-acting, and does not interfere with lactation. Urban and educated women are largely aware of IUCD and its benefits, but the proportion of these women who use them is still small. In light of this, this study aimed to assess if providing focused antenatal counseling led to a greaterpostpartum IUCD acceptance ratewhen compared to routine counseling. Method We conducted arandomized controlled trial in the Department of Obstetrics and Gynaecology of a tertiary care center from January 2021 to December 2022. Based on the inclusion and exclusion criteria, 220 women were enrolled and were classified into two groups. Group A comprised 110 women (the focused counseling group) who received focused postpartum family planning (PPFP) counseling, and Group B consisted of the control group involving 110 women who received routine counseling. Results In both groups, the women who inserted IUCD were mostly gravida 2. Additionally, willingness to use IUCD was shown by 68% of women in the focused counseling group and 58% of women in the routine counseling group, and PPIUCD was accepted by 22% of women in the focused counseling group and 9% of women in the routine counseling group. Post-placental insertion was carried out in 18 (75%) cases in the focused counseling groupand seven (70%) cases in the routine counseling group. Extended postpartum insertion (insertion within one year of delivery) was carried out in six (25%) cases in the focused counseling group and three (30%) cases in the routine counseling group. The most common reasons for the refusal were a preference for tubal ligation (TL) and afear of side effects. When the patients were enquired about their contraceptive use over the past yearon telephone conversations after one year of delivery, it was observed that 21.81% inserted PPIUCD, 30% used injectable depot-medroxyprogesterone acetate (DMPA), 13.63% had undergone TL, 11.81% used barrier contraception, while 22.72% did not use any contraception in the focussed counseling group. In the routine counseling group, 16.36% of women inserted PPIUCD, 20% used injectable DMPA, 12.72% underwent TL, 18.18% used barrier contraception, and 32.72% did not use any contraception. Conclusion Although PPIUCD is a long-acting reversible contraceptive that is safe and reliable, only a few women choose it as a method of birth control. This may be due to ignorance, misconceptions, and worries/fears about potential difficulties/adverse effects associated with IUCD insertion. The IUCD stigma mostly results from misconceptions about the fear of complications. Hence, we recommend that proper IUCD counseling be provided during antenatal care visits to dispel misunderstandings and concerns regarding potential complications associated with PPIUCD insertion.

How does immediate postpartum insertion of contraceptive implants and intrauterine devices (IUDs) compare with delayed insertion for women needing contraception?

How does immediate postpartum insertion of contraceptive implants and intrauterine devices (IUDs) compare with delayed insertion for women needing contraception?

Awareness and Acceptance of Post-Partum Intrauterine Contraceptive Device Insertion (PPIUCD) among Patients Attending a Tertiary Care Hospital Karachi

Background: The knowledge, awareness and acceptance regarding contraceptives are variable in different parts of world. Family planning is still considered a stigma in most parts of the world. Contraceptive use for family planning is a key to understand the profound changes in fertility and to improve reproductive health worldwide. Objective: To evaluate the awareness and acceptance of the post-partum intrauterine contraceptive Device Insertion (PPIUCD) among the pregnant women visiting the Outdoor Department of Obstetrics and Gynecology in a tertiary care Hospital Malir Cantt Karachi. Study design and setting: A cross sectional study was conducted during the period January 2022- June 2022. Material and Methods: This cross sectional study was conducted at the Tertiary care Hospital, Malir cantt, Karachi, for six months from (January 2022-June 2022) Data were collected using interviewer administered structured questionnaire was filled after the informed consent. The inclusion criteria: were the women agreed to participate the study and agreed to fill the questionnaires Urdu version, who visited outdoor department. The exclusion criteria were the women who refuse to ill the questionnaire. Results: This study shows the acceptance rate of PPIUCD is 12% of 200 women who participated this study. The commonest reasons for their denial were the inadequate information or knowledge of PPIUCD. The acceptance rate of PPIUCD was associated with their awareness and the long term effectiveness. Women who have completed their secondary or higher education were more informed and accepted than uneducated women. (AOR = 3, CI = 11.81, 53.91). The age group ranging from 25-30 years showed positive acceptance for PPIUCD. Conclusion: The rate of acceptance for postpartum intrauterine contraceptive device turns out to be low in this study, though this is an effective and safe method of postpartum family planning. The perceived concerns and fears about the PPIUCD are due to lack of awareness regarding its use among women attending the antenatal clinics. Keywords: PPIUCD, Contraception, Postpartum FP, awareness.

Use of contraceptive implants at 12 months in women who intended to undergo immediate versus delayed postpartum insertion following high-risk pregnancy.

To assess the correlation between the intention to undergo immediate versus delayed postpartum contraceptive implant insertion following high-risk pregnancy, and the proportion of utilization and adverse effects. We conducted a retrospective cohort study of women who gave birth after a high-risk pregnancy (according to the criteria defined by the Society for Maternal-Fetal Medicine) and intended to use contraceptive implants. The participants were classified into two groups based on whether they underwent immediate or delayed insertion. The primary outcome was the proportion of utilization of contraceptive implants at 12 months postpartum. We performed multivariate analyses to determine the relationships between the timing of insertion, characteristics, and methods used. Of the 482 women classified as having high-risk pregnancies, 103 intended to use contraceptive implants (54 immediate and 49 delayed insertions). Women in the immediate group were more likely to use contraceptive implants than those in the delayed group at 6 (95.2% vs. 26.2%, P<0.01) and 12 months (92.7% vs. 26.2, P<0.01). A higher proportion of participants in the immediate group reported spotting and prolonged bleeding at 12 months (51.1% vs. 23.8%, P=0.01 and 26.8% vs. 7.1%, P=0.01; respectively). However, satisfaction at 12 months was higher in the immediate group than in the delayed group. Intention to undergo implant insertion during the immediate postpartum period appears to improve the utilization of highly effective contraception. Patients who underwent immediate implantation experienced more spotting, prolonged bleeding, and dysmenorrhea. This study supports the recommendation to provide immediate postpartum contraceptive implants to women following high-risk pregnancies.

Demographic, Reproductive, and Medical Risk Factors for Intrauterine Device Expulsion

ABSTRACT Intrauterine device (IUD) expulsion is more common among women with heavy menstrual bleeding, parity, higher body mass index (BMI), younger age, dysmenorrhea, or immediate postabortion or postpartum insertion. The APEX-IUD study was an observational cohort study of 326,658 individuals examining the association with breastfeeding, IUD type, and timing of postpartum IUD insertion with IUD expulsion and uterine perforation. This data set provides an opportunity to examine specific demographic, reproductive, and medical risk factors associated with IUD expulsion. This analysis of APEX-IUD data aimed to determine the associations of 6 risk factors (age, race/ethnicity, parity, BMI, heavy menstrual bleeding, and dysmenorrhea) and IUD expulsion, as well as the extent to which these associations differed for LNG-IUD compared with copper IUD users. Individuals aged 50 years or younger at the time of IUD insertion without a delivery 52 weeks or less before insertion were included. Individuals were followed from IUD insertion until IUD expulsion, uterine perforation, removal, reinsertion, expiration, pregnancy, hysterectomy, death, disenrollment from the health care system, or end of study period (June 2018). Crude incidence rates for each risk factor category were calculated using the number of expulsions during the time at risk divided by the total person-years at risk and were reported as the number of expulsions per 1000 person-years at risk. Hazards ratios (HRs) and 95% confidence intervals from Cox regression models were used to evaluate associations of the risk factors with IUD expulsion. These models were adjusted for potential confounding effects and were separately used to assess the association of covariates with IUD expulsion varied by IUD type. The total study cohort included 228,834 individuals (LNG-IUD: 184,733 [80.7%]; copper IUD: 41,123 [18.0%]; unknown type: 2978 [1/3%]). The average length of follow-up was 2.0 years, and there were 6762 expulsions with a crude incidence rate of 14.9 per 1000 person-years (95% confidence interval, 14.6–15.3). Adjusted hazards ratios (aHRs) showed the younger age groups having a higher risk of IUD expulsion and a trend toward lower aHRs with increasing age. Individuals with parity of 4 or more had the highest risk of IUD expulsion, and a parity of 2 was associated with the lowest risk on adjusted analysis. Adjusted analysis revealed a greater risk of IUD expulsion among individuals with higher BMI or heavy menstrual bleeding diagnosis compared with the comparator group. Multiple racial and ethnic groups including non-Hispanic Black, Hispanic Black, Hispanic White, Asian, or Pacific Islander were associated with a greater risk of IUD expulsion compared with non-Hispanic Whites when adjusting for covariates. When comparing aHRs by copper IUD or LNG-IUD; younger age was more strongly associated with expulsion among copper IUD users than LNG-IUD users, the risk for expulsion associated with obesity was significantly attenuated for copper IUD users compared with LNG-IUD users, and the risk of expulsion for those with heavy menstrual bleeding was partially attenuated by copper IUDs. Adjusted analysis revealed no association between dysmenorrhea and IUD expulsion. The results of this study show that, among the 6 risk factors investigated here, the risk of IUD expulsion was highest among individuals with a diagnosis of heavy menstrual bleeding, particularly in recent and past periods.

Integrating postpartum IUD counselling and insertion into routine maternity care in Nepal: Assessing trends over time.

To meet the postpartum family planning (PPFP) needs of women in Nepal, an intervention was launched to integrate PPFP counselling and postpartum IUD (PPIUD) insertion into maternity care. Women delivering in study hospitals over a period of 18 months were interviewed at the time of delivery and at 15 months following the end of the study enrollment period to assess if the impact of the intervention observed at the end of the study was maintained. Data were collected prior to the intervention, at the middle month of the intervention roll out, at the end of the enrollment period and 15 months after the end of the enrollment period. We compared PPFP counselling and insertion rates before, during, at the end of and after the intervention study period, using cross-tabulation and chi-square tests. Overall, PPFP counselling rates increased from 11% at the baseline month to 45% at the end of the enrollment in February 2017 and remained the same 15 months later in July 2018. PPIUD uptake, however, rose from a negligible 0.1% at the baseline to 4.3% in February 2017, but declined to 3.4% in July 2018. PPIUD uptake among women who were counselled showed a similar trend, increasing from 1.9% at the baseline to 9.6% in February 2017 and declining to 6.0% in July 2018. The intervention had an appreciable continued impact on PPIUD counselling rates and although PPIUD uptake rose during the intervention, this trend was not observed in the 15 months post-study follow up. The impact of the intervention was greater and persistent in hospitals that had a longer period of exposure to intervention. The results suggest that counselling was well integrated with the maternity care, though uptake of PPIUD dropped after intervention activities such as active monitoring, technical supervision, provision of IUDs and training were withdrawn. Trial registration: This study has been registered with Clinical Trial.gov. The registration number is NCT02718222. Details about the study design have been published by Canning et al, 2016.

A Prospective Multi-centric Study of Acceptance, Insertion and Follow-Up of Postpartum Insertions of IUCD.

The unmet need for contraception in the postpartum period is a major challenge in our country. Unintended pregnancies are highest in the first year after birth, and postpartum IUCD insertion is an effective way to counter this problem. This study was planned to build up data for acceptance and follow-up of postpartum IUCD insertions. The present study has included data of PPIUCD insertions and follow-up from seven institutions over a period of 6months. The case recruitment lasted for 3months, including only those who had PPIUCD insertions in this period, and they were followed up for a period of 6months. The follow-up of patients was at 6weeks and 6months. All issues were addressed including side effects, expulsions, myths surrounding the device, etc., along with routine postnatal care. There were 5227 deliveries and 1895 insertions. The acceptance rate was 36%, and a follow-up at 6weeks and 6months showed up an expulsion rate of approximately 4% and a removal rate of 5%. Overall, at the end of 6months we have a continuation rate of 90%. This shows that a dedicated approach to postpartum contraception will definitely bring down incidence of unintended pregnancies.

Evaluation of awareness, acceptability, and clinical outcome of postpartum vaginal insertion and intra-cesarean insertion of intrauterine contraceptive device

Background: Post-placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD) is a lucrative family planning method which provides safe, effective reversible, inexpensive, non-hormonal, and long-acting contraception. Aims and Objectives: The objective of the study is to evaluate the postpartum insertion of intrauterine contraceptive device in terms of awareness, acceptance, safety, efficacy, continuation, and removal rate and its complications in both vaginal as well as intra-cesarean section (CS) insertion. Materials and Methods: Prospective observational study conducted in Obstetrics and Gynaecology Department GMERS sola for 6 months. Two thousand and ninety-four pregnant women from labor room who delivered vaginally or by CS during study period were asked regarding their knowledge and acceptability for PPIUCD. Results: Total 2094 women evaluated for awareness and acceptance for PPIUCD. About 68.66% were familiar with the concept with 29.99% giving verbal consent for its insertion. About 60.01% women refused for various reasons. Conclusion: This study shows that PPIUCD insertion is a safe and convenient method which requires more population awareness, counseling, and usage.

Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates.

To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Determinants and perception of postpartum intrauterine contraceptive device services in Maharashtra, India

&lt;h2&gt;Undesired and unintended pregnancies increase unwanted births or induced abortions, consequently increasing maternal morbidity and mortality. Postpartum insertion of the intra uterine contraceptive device (PPIUCD) is an effective method for population control. The researchers conducted the study to assess the determinants of PPIUCD services by identifying beneficiaries and healthcare workers' perceptions. We conducted this study in Maharashtra state, India having five geographical divisions and 36 districts. The researchers visited 10 primary health centers and three community health Centers from five districts, randomly selecting one from each division. We interviewed 45 women who had undergone insertion one day to one year prior and 17 health care workers. About one-third of women received counseling during pregnancy. The medical officers obtained the consents mostly during delivery. They inserted about 85% of devices within one hour of delivery. About 38% of women had at least one complication. Lower abdominal pain (22.22%), irregular bleeding (20.00%), the expulsion of CuT (13.33%), pain during periods (13.33%) were common. The removal rate was 6.67%. The complication rates observed in the present study are comparable to the hospital studies. Thus, the study reassures that the services in small institutions are very safe, and governments can fearlessly implement the program.&lt;/h2&gt;

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Intracesarean Postpartum Insertion of Intrauterine Contraceptive Device as an Alternative to Delayed Insertion: Safety and Complications

Intracesarean Postpartum Insertion of Intrauterine Contraceptive Device as an Alternative to Delayed Insertion: Safety and Complications

Barriers and Facilitators to Implementing Immediate Postpartum Contraceptive Implant Programs: A Formative Implementation Research.

ObjectiveThis study sought to identify the factors that act as barriers and facilitators to developing and implementing Immediate postpartum (IPP) insertion of contraceptive implants service according to the Consolidated Framework for Implementation Research (CFIR).MethodsWe conducted in-depth interviews and focus group discussions to explore IPP contraceptive implantation programs implemented in community, regional, and university hospitals in Thailand. The CFIR was used to guide the data collection and analyses.ResultsAll CFIR domains were found to have an impact on planning and implementation. Out of 38 constructs, nine were identified as either barriers or facilitators, and four were determined to be both. Barriers included an insufficient training budget, lack of policy to support non-teenagers, disconnect among organizations, and lack of knowledge on the part of the clients. Facilitators included the relative advantage of implants over other contraceptive methods, reimbursement policy, laws that promote teenage autonomy, setting IPP implants as a key performance indicator (KPI), identifying project champions, and educating clients through antenatal counseling or multimedia intervention.ConclusionBarriers and facilitators to the successful implementation of an IPP contraceptive implant program were identified. In order to successfully implement this service, modifiable barriers should be overcome and facilitators should be strengthened. Strategies tailored to the local context should be developed to ensure the sustainability of the program. Educating clients is crucial and need both hospital- and community interventions.