Postpartum Intrauterine Contraceptive Device Insertion Research Articles

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.

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.

Evaluation of postpartum intrauterine contraceptive device in terms of awareness, acceptance and expulsion

Introduction: Immediate postpartum period is when women are receptive to family planning counselling. Pregnancy within a year of the last delivery increases maternal and perinatal morbidity and mortality. Postpartum intrauterine contraceptive device (PPIUCD) is one method which is safe and effective method for spacing and also for limiting pregnancy. This study was done to evaluate PPIUCD insertion for its awareness, acceptance, and expulsion. Materials and methods: All pregnant women were counselled regarding PPIUCD, and those willing were included in the study. Intrauterine contraceptive device used in this study was Cu-T 380A. It was inserted after delivery of the placenta after vaginal delivery and after caesarean section using sponge-holding forceps. They were asked to follow up after 6 weeks and 6 months of insertion. Data collected was subjected to statistical analysis using SPSS V22 software, and results were drawn. Results: From 1602 deliveries, 456 (28.46%) women accepted PPIUCD, and 36.32% (n=582) were aware of this method. 60.08% (n=274) had PPIUCD insertion after vaginal delivery and 39.91% (n=182) after caesarean section. The main reason for refusal was fear of bleeding (n=280) (26.81%). The most common complication seen was lower abdominal pain (11.62%). No case was reported with uterine perforation. Conclusion: This method has shown to be a very safe, effective and economical method for contraception. In India, where there is very little access to contraception during interval period and women do not return to the hospital for a postnatal check-up and contraceptive advice, this PPIUCD method is most beneficial.

Assess the efficacy and satisfaction rate in postpartum intrauterine contraceptive device insertion in selected setting

Assess the efficacy and satisfaction rate in postpartum intrauterine contraceptive device insertion in selected setting

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.

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

Uptake and determinants of post-partum intra-uterine contraceptive device use among women in Kwazulu-Natal, South Africa: A prospective cohort study.

This study aimed to determine the uptake of the post-partum intra-uterine contraceptive device (PPIUD) and characteristics of women choosing PPIUD. The authors evaluated safety, efficacy and satisfaction following PPIUD insertion via a prospective cohort study. 276 pregnant women (age: 16-50 years) gave informed consent and received a PPIUD. Follow up was between 6-8 weeks postpartum. The mean age was 25.8 years with 74.9% being gravida 2-4. The follow up rate was 60.5%. PPIUD was found to be safe and acceptable with 79.6% of participants experiencing no side effects and 74.3% expressing high satisfaction. No pregnancies were reported. Expulsions (n=15) were not associated with gravidity, parity, gestational age or medical and surgical risk factors. (p-value >0.05). PPIUD is a safe, effective and acceptable form of contraception. Participants experienced few side effects and high satisfaction. Low follow-up is a concern.

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.

Prevalence of Complications after Interval Postpartum Intrauterine Device Insertion

Background and Aim: Postpartum intrauterine device (PPIUD) is a reversible, long-term and effective technique of contraception. The intrauterine device (IUD) is inserted within 48 hours of delivery. The immediate insertion of an intrauterine device causes certain complications. The present study aimed to assess the prevalence of complications after Interval Postpartum Intrauterine Device Insertion. Materials and Methods: This cross-sectional study was carried out on 147 women who underwent postpartum IUD (PPIUD) insertions during from January 2021 to June 2021 at Gynecology department, Mufti Mehmood Memorial Teaching Hospital (MMMTH), Dera Ismail Khan and Muhammad Teaching Hospital Peshawar. All the women who delivered and showed willingness for PPIUCD insertion were enrolled and continuously follow-up for 4 to 6 weeks after delivery. Demographic, obstetric, and clinical parameters were recorded on pre-designed medical proforma. PPIUCD insertion after 6 weeks of delivery were followed-up for the evaluation of complications. Uterine infection, medical removal of IUD, IUD expulsion, perforation, and method discontinuation were the outcome variables. SPSS version 20 was used for data analysis. Results: Of the total deliveries, 147 women inserted the postpartum intrauterine contraceptive device (PPIUCD). Of the total, about 122 (83%) women returned for follow-up after 6 weeks. All the women underwent transvaginal insertion of intrauterine contraceptive devices. The PPIUCD insertion related complications with prevalence were uterine infection 26 (21.3%), overall method suspension 17 (13.9%), perforation 20 (16.4%), interceptive uterine device expulsions 25 (20.5%), and intrauterine device removal 32 (26.2%). The severe uterine infection was in 2 (1.7%) cases who were hospitalized. Conclusion: The postpartum intrauterine device cumulative expulsion rate was higher among women compared to the expulsion rate of insertions. The longer duration of bloody lochia flow and delivery intrauterine device insertions were the key risk factors for expulsion of PPIUCD. Women can safely utilize intrauterine contraceptive devices with low complications beyond four week. Keywords: Postpartum intrauterine device; Complications; Intrauterine device expulsion

Outcome of Postpartum Intrauterine Contraceptive Device Insertion: Findings of an Institution Based Crosssectional Study

Background: To foster family planning activities by postpartum IUCD insertion, side effects and complications of PPIUCD insertion need to be characterized. The study was conducted to find out the outcomes of postpartum intrauterine contraceptive device insertion among women attending a tertiary level hospital.
 Methods: A cross sectional study was conducted among 130 women. Data were collected by face-to-face interview and reviewing medical records with semi- structured questionnaire and checklist. The subjects were purposively selected following specific selection criteria and maintaining ethical issues. The study was conducted during the period from October 2016- March 2017 in a tertiary hospital: Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka.
 Results: The study revealed that majority (53.1%) of women were 25-30 years and the mean (±SD) age was 26.40±4.273 years. Around 26.2% had secondary education and most of them i.e. 60.8% were housewife. Study revealed that average monthly family income was Tk. 20815.38 ± 9097.904. Majority (90%) of women choose PPIUD because it is convenient. Most of the respondents were inserted immediately after delivery within 10 minutes. Intracaesarean and manual insertion of PPIUCD was practiced in majority i.e. 79(60.8%) of the respondents. The study revealed that three fourth of the respondents had no side effect while common side effects of PPIUCD included vaginal discharge (12.3%), thread coming out (14.6%), missing thread (13.8%), lower abdominal pain (16.2%), expulsion (6.2%) and coital discomfort (10.8%). Only 18.5% respondents had abnormal uterine bleeding and 6.2% had PID. The results show expulsion rate was more in vaginal route (11.8%) than intra-caesarean route (2.5%) and this difference was statistically significant (p<0.05). All complications like abnormal uterine bleeding (15.7%) and PID (20.3%) were seen more in vaginal insertions as compared to insertion during caesarean section and was statistically significant (p<0.05).
 Conclusion: To reduce the unwanted pregnancy in postpartum period and maternal and child mortality and morbidity, PPIUCD insertion along its continuation by overcoming side effects and complications is an earnest need in a densely populated country like Bangladesh.
 JOPSOM 2020; 39(2): 1-7

Outcome of immediate postpartum insertion of IUCD - A prospective study

Introduction: Immediate postpartum intrauterine contraceptive device insertion is an excellent family planning method which provided safe effective, long term and reversible contraception to women in the delivery setting. Hence, the present study was undertaken to assess the clinical outcome of immediate postpartum insertion of intrauterine contraceptive device in terms of safety and efficacy and to compare the two routes of insertion i.e. in vaginal deliveries and cesarean section. Objective: 1. To study awareness level of PPIUCD among parturient. 2. To study safety and efficacy of PPIUCD insertion. Materials and Methods: A cohort of 100 vaginal and 100 cesarean deliveries with PPIUCD insertion were studied over a period of 1 year and followed for three months in this prospective interventional study. Outcome measures of safety were perforation, irregular bleeding, unusual vaginal discharge and infection. Outcome measures of efficacy were pregnancy, expulsions, discontinuation and incidence of coiled up/ undescended strings. The data was compiled and analyzed. Results: In the present study only 34.5% (N=69) of the study sample were aware of the PPIUCD while the rest 65.5% were unaware. No serious complications such as pregnancy or perforation were encountered in our series. Most common complication reported in both the groups was excessive bleeding PV followed by pain in lower abdomen. Spontaneous expulsion of the device was noted in 3% of vaginal insertions and none in the cesarean insertion. Conclusion: PPIUCD is an excellent method to limit or space child births. It is offered to a woman in a setting when she is highly motivated and genuinely needs it. Keywords: PPIUCD, Postpartum contraception, Insertion of IUCD.

Follow Up & Outcome Assessment in Patients with Postpartum IUCD Insertion for Birth Control

Introduction: India is world’s 2nd largest populated country. It is first to introduce family planning services. IUCD is most effective, safe, long acting and do not interfere with coitus. Postpartum intrauterine contraceptive device (PPIUCD) is a lucrative postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Our aim is to study the clinical outcomes of PPIUCD insertions and compare them as a factor of route of insertion (vaginal versus caesarean).
 Method: This is a prospective analytical study done in a tertiary care teaching institute. A total of 180 vaginal and caesarean deliveries with PPIUCD insertions, over 8 months period, was studied and compared for follow-up results. Outcome measures were safety (perforation, irregular bleeding, unusual vaginal discharge, and infection), efficacy (pregnancy, expulsions, and discontinuations), and incidence of undescended IUCD strings.
 Results: Overall complication rates were low. No case of perforation or pregnancy was reported. Spontaneous expulsions were present in 4.4% cases and were significantly higher in vaginal insertions. The incidence of undescended strings was high (30%), with highly significant difference between both groups.
 Conclusion: PPIUCD is a strong weapon in the family planning armory and should be encouraged in both vaginal and caesarean deliveries. Early follow-up should be encouraged to detect expulsions and tackle common problems.

Acceptability and Feasibility of Postpartum Intra Uterine Contraceptive Device Insertion in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Worldwide intra uterine contraceptive device (IUCD) is a reversible method of contraception. Postpartum IUCD insertion is labeled when IUCD is inserted within 10 minutes to 48 hours of expulsion of placenta. The objective of the study was to analyze the acceptability and feasibility of immediate postpartum intrauterine contraceptive device (PPIUCD) in a tertiary care hospital of Bangladesh. A cross sectional study was conducted among eligible postpartum women at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Bangladesh. Counseling was done about the procedure of PPIUCD in details. After having the consent, Cu-T 380A was inserted in 343 women. The women were followed up at six weeks after delivery. A total number of 18190 women were counseled during antenatal period and at labor ward. A total number of 6441 were admitted for delivery. Among the admitted patients, 343 accepted this method. Forty nine percent of the acceptors belonged to the age group of 25 – 30 years. Majority were from urban area and had studied up to secondary level. More women from the group who had undergone caesarean section accepted this method than the women who undergone vaginal delivery. Expulsion rate was 1.6% and removal rate 5.8%. Most common reason for removal was irregular per vaginal bleeding. The immediate PPIUCD method appeared to be a safe and effective method of contraception.
 Bangladesh Med J. 2018 Jan; 47 (3): 25-31

Efficacy and Satisfaction Rate in Postpartum Intrauterine Contraceptive Device Insertion: A Prospective Study.

BackgroundPostpartum intrauterine contraceptive device (PPIUCD) reduces the rate of abortions and it is a cost-effective, reversible, and convenient choice of contraception. The objective of our study was to evaluate the efficacy and satisfaction rate in women with postpartum intrauterine contraceptive device insertion.MethodsThis prospective study of immediate PPIUCD insertion was conducted at our institute from March 2016 to February 2019. Approval from the Institutional Review Board (IRB) was taken before starting the study. A total of 372 women were enrolled in the study after taking informed consent. All the women were counseled regarding different methods of contraception and birth control during antenatal checkups, early labor and immediately postpartum (within 48 hours). All the enrolled women in the study were followed for three years to determine the satisfaction and success rate of PPIUCD continuation. We also kept the record of women who discontinued PPIUCD. ResultsAfter the exclusion criteria, 372 women were recruited in the study. The mean gestation age at the time of delivery was 38.5 weeks with a standard deviation (SD) of 1.45. All the women were followed for short-term and long-term complications and satisfaction rates. Out of 372, 51.07% of women (n = 190) had a spontaneous vaginal delivery, and 48.9% of women (n = 182) had a cesarean section but there was no significant long-term satisfaction outcome difference in both the groups. The highest success rate of the postpartum long-acting intrauterine contraceptive device was noted in patients who were counseled thoroughly in the antenatal and intrapartum period 61.5% as compared to those patients who were counseled either antenatally 42.2 %, intrapartum 35.4%, or immediate postpartum 22.4% alone.ConclusionPPIUCD insertion is an opportunity not to be missed. It allows women to obtain safe, long-acting, highly effective contraception while already within the medical system. More research data are needed in the literature with regard to counseling timings for PPIUCD insertion during the antenatal and postnatal period as it can affect the decision of women to prevent unplanned pregnancy. PPIUCD has one of the highest patient satisfaction rates among all the contraceptives.

Critical Factors Influencing the Acceptability of Post-placental Insertion of Intrauterine Contraceptive Device: A Study in Six Public/Private Institutes in India.

To determine critical factors and barriers to postpartum intrauterine contraceptive device (PPIUCD) use in India in order to guide programs aimed at reducing maternal and child mortality. All pregnant women were enrolled for contraception counseling during their visit to the antenatal outpatient clinic. Women who opted for PPIUCDs were enrolled in the study and offered PPIUCD insertion, irrespective of mode of delivery. Those who withdrew consent when in labor or soon after delivery, experienced severe bleeding, or exhibited unstable vital signs were excluded, as were febrile women and those diagnosed with chorioamnionitis. A total of 66,508 women were enrolled in the study. 86.1% indicated they discussed family planning options with their partners/husbands before making a decision. 178 respondents (0.3%) could not mention one advantage of PPIUCDs, while 23.1% could not mention one disadvantage. 13.9% of the women withdrew consent. Family member objections (43.44%), husband/partner objection (27.94%), and deciding on another method (15.59%) were the main reasons for consent withdrawal. Awareness of PPIUCDs is not a limiting factor in women's consent to PPIUCD insertion. As a woman's decision to use a PPIUCD is significantly influenced by family members and her partner/husband, awareness initiatives that target these populations should be considered.

Janani Suraksha Yojana - cash assistance scheme for maternal and child health: Retrospective analysis of acceptance of postpartum intrauterine contraceptive device insertion among its beneficiaries

Background: Janani Suraksha Yojana (JSY) was launched on April 12, 2005, under the National Health Mission for the benefit of maternal and child health. JSY is a centrally sponsored scheme, which integrates cash assistance with delivery and post-delivery care. Just after delivery, women are more receptive to accept a contraceptive method. With increased institutional deliveries influenced by JSY, the health-care providers have an excellent opportunity to counsel and provide them with safe and appropriate contraceptive method. The Government of India launched postpartum intrauterine contraceptive device (PPIUCD) services in the year 2000; although acceptance of PPIUCD in JSY beneficiaries is a real concern. Objectives: The objectives of this study were as follows: (1) To study the acceptance of PPIUCD in JSY beneficiaries and (2) to study the sociodemographic factors in relation to PPIUCD acceptance. Materials and Methods: The retrospective study was conducted in Rural Government Hospital in Maharashtra during 2016–2017. We studied sociodemographic variables of JSY beneficiaries and their acceptance to PPIUCD. The sample size was 353 (n = 353). The sociodemographic factors studied included age, type of delivery, sex of newborn, and educational status of patient and her husband. Results: The total postpartum women included in the study were 353 who had taken JSY benefit, of which, 116 (32.6%) accepted for PPIUCD, whereas 237 (67.4%) rejected the same. Around 43% of primipara patients were accepted PPIUCD. Among multiparous women with three living children, only 6% accepted it. The educational status of both, the postpartum women and their husband, showed statistically significant association with the acceptance of PPIUCD (P < 0.05) in JSY beneficiaries. Conclusions: The acceptance PPIUCD was low (32.6%) in JSY beneficiaries. Primipara or young age patients are easy to counsel about PPIUCD, and hence, the acceptance is high. All efforts should be made to increase acceptance of PPIUCD among JSY beneficiaries.

Economic Analysis of Delivering Postpartum Intrauterine Contraceptive Device Services in India.

Introduction:We estimated the unit costs for implementing postpartum intrauterine contraceptive device (PPIUCD) services from the perspective of both health system and development agencies.Methodology:Seven districts from two Indian states, i.e., Uttarakhand (UK) and Madhya Pradesh (MP), were selected to study the cost of PPIUCD service. Data on costs incurred both by health system and development agencies for PPIUCD service were collected. Unit costs were estimated for providing PPIUCD and IUCD services by state and district level of care in public health-care system. We also estimated unit cost per couple-year protected (CYP) by the level of the health facility.Results:We found that the unit cost per PPIUCD insertion including all costs, i.e., for service delivery and program support, was INR 522 ($8.7) and INR 502 ($8.4) in MP and UK, respectively. Similarly, the unit costs per interval IUCD insertion were INR 287 ($4.8) in UK and INR 281 ($4.7) in MP. Development partners have a share of >50% in overall costs. From a health system's perspective, PPIUCD and interval IUCD cost per CYP at the level of district hospital were INR 440 ($7.3) and INR 449 ($7.5), respectively.Conclusions:In India, PPIUCD, being a low-cost procedure, should be considered as a primary strategy targeted toward pregnancy spacing over other contraceptory methods.

Outcome Of Immediate PPIUCD At Follow Up Visit In Women At A Tertiary Care Hospital In Karachi, Pakistan

Objective: To evaluate the outcome of Immediate Post Partum Intrauterine Contraceptive device (PPIUCD) insertion among married women of reproductive age at a tertiary care Creek General Hospital, Karachi, Pakistan. Study Design: Prospective Interventional study. Methodology: The clinical study was conducted in department of Obstetrics &amp; Gynaecology, Creek General hospital Karachi from August 2015 to July 2016. One hundred and twenty five women were selected for immediate PPIUCD insertion, however the result was analysed for hundred women as twenty five were lost to follow-up. PPIUCD was inserted within 10 minutes of delivery of placenta. Follow up was done at 6 weeks, the primary outcome measures were the clinical outcomes in terms of safety (irregular vaginal bleeding, abnormal vaginal discharge, infection and perforation) and efficacy (un-descended IUCD strings, expulsion, discontinuation and pregnancy). The results were analyzed by SPSS data analysis software (IOBM). Results: Among hundred women in whom PPIUCD was inserted and returned for follow-up, majority (44%) were in age group 26-30 years; around 52% had primary or less education, and considerably high (84%) belonged to the low socio economic status. Moreover, majority (46 %) had 3 or more alive children. Importantly, 73% women had IUCD inserted after vaginal delivery. As safety was evaluated, irregular vaginal bleeding was observed in 15%, abnormal vaginal discharge (20%), infection (11%), abdominal pain (4%) and perforation in only 1% of cases. Finally, in terms of efficacy the undescended IUCD strings were observed in 7%, expulsion incidence (6%), discontinuation requested by (5%) and none of the case ended up in pregnancy. Conclusion: Post partum IUCD insertion immediately following delivery is an effective, safe, and acceptable long-term reversible method available for postpartum contraception.

Efficacy and safety of Post-Partum Intrauterine Contraceptive device (PPIUCD) insertion-A prospective study

Introduction: Significantly increased institutional deliveries in India provide an opportune time for offering postpartum family planning services to the women. Although the available contraceptive methods are many, need of a single efficacious, feasible and cost effective method is desirable especially in a low resource country like India. This study was done to evaluate the acceptance, efficacy and safety of intrauterine contraceptive device as an immediate family planning method following delivery, and the complications associated with it. Materials and Method: A total of 115 women who underwent PPIUCD insertion were followed up at 1, 3 & 6 weeks and at 3 & 6 months post-partum. Outcome in terms of side effects, removal and expulsion was noted and compared in vaginal delivery and caesarean section insertions. Results: Out of 280 women who were counselled, only 115 women (41.07%) accepted the PPIUCD insertion. Insertion in literate women was high and extremely statistically significant (P

Comparative Study on Outcomes of Immediate Postpartum Intrauterine Contraceptive Device Insertions in Vaginal deliveries and Caesarean section

Comparative Study on Outcomes of Immediate Postpartum Intrauterine Contraceptive Device Insertions in Vaginal deliveries and Caesarean section