Postpartum Intrauterine Contraceptive Device Research Articles

Assessment of family welfare services with respect to couple-years of protection in a primary health center of Varanasi, Uttar Pradesh

Introduction: Program for family welfare or planning is one of the earliest health programs running in Independent India. Budget estimate of Family Welfare Schemes in India for the year 2019–2020 is 950 crores. Despite this, irregularities and under performance of various contraceptive services are reported. Objectives: To assess the family welfare services in a primary health center of Varanasi. Methods: Monthly data of family welfare from April 2018 to March 2019 were collected from PHC and analyzed with permission of Medical Officer in Charge, Chiraigaon. Services were assessed in terms of total family welfare OPD females, total counseling (antenatal case/postnatal case), deliveries, and various methods of contraception. The Couple-years of protection for the individual methods of contraception was calculated. Results: About 51% of females attending clinic were counseled, 40% of females delivering in PHC utilized postpartum intrauterine contraceptive device (PPIUCD). Correlation coefficient between females counseled and parameters such as sterilization varies from weak to strong positive. Two new services Depot Medroxy Progesterone Acetate Antara and oral contraceptive pills Chhaya were introduced, but their availability was not regular. Conclusions: Adequate services for family planning were available, but regularity of few was having issue in the year analyzed. More efforts are required to increase PPIUCD use.

Comparison of Depot Medroxyprogesterone Acetate and Postpartum Intrauterine Contraceptive Device in a Teaching Institute of Rural Bengal: A Longitudinal Cohort Study

Introduction: Contraception is one of the proximate determinants of fertility and the most important predictor of fertility transition. Depot Medroxy Progesterone Acetate (DMPA) and Intrauterine contraceptive device share some common features- both are Long Acting and Reversible Contraceptives (LARC), but the mechanisms are different. DMPA is a noninvasive, hormonal manoeuvre IUCD is an invasive, nonhormonal one. Aim: To compare the acceptance and reasons for refusal or non-compliance between DMPA and Postpartum Intrauterine Contraceptive (PPIUCD). Materials and Methods: A longitudinal cohort study was done in which total of 110 post partum women (55 in each group) using either DMPA or IUCD were selected randomly and were interviewed and followed up for minimum of six months. Data (variables- number of candidates accepting or refusing PPIUCD or DMPA) from the questionnaires were entered in Microsoft Office Excel 2007 and was transferred to IBM SPSS software, version 20.0 (SPSS Inc. Chicago, IL, USA). Pearson’s Chi-square test was used for variables and p-values were calculated using to find out the statistical significance of the variables and p-value <0.05 was considered statistically significant. Results: The overall acceptance of DMPA (87.3%) was found to be much more than that of PPIUCD (63.6%). In respect to different age groups, the acceptances of both PPIUCD and DMPA were significantly higher in women of age group 21-25. In respect to parity, acceptance of PPIUCD was more in women with one child, whereas the acceptances of DMPA were almost similar in women with either one or two children. Women using PPIUCD, 36.4% refused to continue with the method, whereas only 12.7% of DMPA users refused further injections, the main reason for both the groups being the same irregular bleeding. Conclusion: The acceptance as well as compliance of DMPA as a method of postpartum contraception is much better than PPIUCD in women of this part of part of rural Bengal.

THE EFFECTIVENESS OF INSERTION OF IMMEDIATE POSTPARTUM INTRAUTERINE CONTRACEPTIVE DEVICE (IPP-IUCD) IN TERMS OF MODES OF DELIVERY

BACKGROUND: Family planning helps couples to attain their desired number of children and proper timings of their births (1). It is best achieved with different contraceptive methods. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is an excellent contraception providing safe, effective and long term reversible contraception in women after both normal delivery and c/section(2). It reduces postpartum undesired pregnancies and thus induced abortions (3). It is coitus independent, easy to insert and does not affect breastfeeding. Both care provider and client are available in the same setting, securing time and cost of interval IUD insertion.
 PPIUCD is associated with primary complications like pregnancy and secondary ones as irregular vaginal bleeding, abdominal pain, infection, expulsion and uterine perforation. PPIUCD counselling services regarding its common side effects and complications are important. There is minimal research comparing follow up outcomes between vaginal and caesarean insertions. The objective of study is to compare outcomes of IPPIUCD as a factor of route of insertion.
 METHODS: In this prospective comparative study 200 patients in whom postpartum IUCD was inserted within 10 minutes of delivery of placenta after normal vaginal delivery or c/section were included. About first 100 cases of vaginal and first 100 cases of intra-cesarean PPIUCD insertions formed study groups. Record of clients was maintained and analysis at 6 weeks to 12 weeks post insertion follow up visit was done at gynae and obstetric unit of Lady Reading Hospital Peshawar.
 RESULTS: Of total 1005 IPPIUCD inserted during the study period, about 156( 15.5%) were inserted intra-cesarean and 849 (84.4%) after vaginal delivery. Follow up of 200 (19.9%) clients i.e. about 100 intra-cesarean and 100 vaginal insertions was recorded. Complications rate was low. No life threatening complication such as perforation was recorded. Most common complications observed between vaginal vs intra-cesarean insertions were irregular vaginal bleeding in (11% vs 5%), abdominal pain(6% vs 9%), vaginal discharge(8% vs 5%),spontaneous expulsions (8% vs 2%) and lost strings (14% vs 1%). Statistically significant difference was found between two groups with respect to lost strings (P=0.0006).
 CONCLUSION: IPPIUCD is an acceptable, safe (in terms of complications) and effective contraceptive option after both vaginal and intra-cesarean insertions. Early follow up examinations are helpful in identifying spontaneous expulsions and dealing common problem.

Comparative evaluation of IUCD insertion in postpartum period with interval period in a tertiary health care center of north India

Introduction: Postpartum IUD insertion provides long term and effective contraception but there are concerns regarding increase in the risk of expulsion or perforation among researchers and clinicians. This study compares PPIUCD versus interval IUCD. Materials and Methods: In study 125 postpartum (post placental and intra-caesarean) and 140 interval IUCD insertions (total 265 IUCD) were done. 245 cases completed the study 21 were lost to follow-up. Cu T 375 was used in the study. Exclusion criteria were -women with active PID, uterine anomaly, current carcinoma, chorioamnionitis or puerperal sepsis, prolonged rupture of membranes >18hrs, genital trauma, PPH history of ectopic pregnancy, any hemorrhagic disorder, genital infection, diabetes mellitus, heart disease, pelvic tuberculosis and woman or husband having multiple sexual partners. All were followed up for 6 months. Various socio-demographic factors and complications like expulsion, bleeding, pain, infection and medical removal were compared among groups. Results: Most women came for follow up in both the groups (PPIUCD-75.8% and Interval-71.2%). The expulsion rate in PPIUCD group (9.2%) was significantly higher than interval group (2.4%) (p Conclusion: There is an increased risk of expulsion in PPIUCD insertion but its benefits outweigh the risks. So this method should be popularised across the country as a very effective method of interval contraception. Keywords: Postpartum intrauterine contraceptive device complications, Satisfaction, Removal rate.

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.

Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: a mixed methods study

BackgroundRwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital.MethodsA concurrent mixed-method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using a structured questionnaire and in-depth interviews respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data.ResultsThe prevalence for PPIUCD use was 28.1%, women who had spontaneous vaginal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95% CI = 2.017–6.507 compared to those who had cesarean section; women who received PPIUCD counselling during the antenatal period were more likely to use PPIUCD ((AOR 2.072, 95% CI = 1.018–4.218) as compared to those who didn’t receive any form of counselling; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95% CI = 1.485–4.492); as compared to those who didn’t receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95% CI = 1.472–3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477–2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative findings, health education of mothers and partners on PPIUCD, training of health care providers, and availability of supplies to provide PPIUCD influenced the use of PPIUCD.ConclusionThe acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers, and availability of supplies to provide PPIUCD influenced uptake of PPIUCD.

Postpartum intra-uterine contraceptive device utilization among mothers who delivered at debre tabor general hospital: cross sectional study design

Introduction: Rapid population growth is a major concern of many states globally including our country Ethiopia. The intrauterine device (IUD) is a long term reversible contraceptive method that is suitable for women of all reproductive ages, and represents the most cost effective reversible method for preventing unwanted pregnancies. However, its utilization in Ethiopia is very low as compared to other contraceptive methods. Objective: To assess postpartum intra-uterine contraceptive device utilization among mothers who delivered and seek immunization service at DTGH, North Central Ethiopia. Methods: Facility based cross sectional study design was conducted from November 17, 2017, to January 01, 2018. A total of 182 respondents were interviewed. Systematic random sampling procedure was used to select each eligible study unit as a participant. Data were collected by Midwifery professionals through face to face interview through structured questionnaires under supervision. The data collectors and supervisors were trained prior to data collection. Pretest was conducted on 5% of the study population to check for the accuracy of tools. Confidentiality was also protected by making the data collection procedure anonymous. The association between dependent and independent variables were determined by descriptive statistics of chi square test using SPSS version 20.0 software and p-values of <0.05 were considered as statistically significant. Result: One hundred eighty two mothers were interviewed to assess IUCD utilization after giving birth at DTGH with a response rate of 97%. Only 6 respondents (3.3%) are currently using IUCD after giving birth to 9 months of their post partum period. Acceptances of IUCD with P of 0.004 and Reasons for refusal of IUCD with P value of 0.035 were some of statistically associated variables for utilization of PP IUCD. Conclusion: PP IUCD utilization in the study area is low as compared to other similar studies (3.3%). There are major discrepancy between acceptance level (37.91%) and PP IUCD utilization. Responsible bodies should address the reason for this major discrepancy to minimize the gap.

Women’s experiences of accessing postpartum intrauterine contraception in a public maternity setting: a qualitative service evaluation

Objectives The aims of the study were to explore women’s experiences of an immediate postpartum intrauterine contraception (PPIUC) service recently introduced in a UK maternity setting, to identify areas for improvement and inform service provision. Methods Qualitative research was carried out in hospital and community maternity services in Lothian, UK. In-depth interviews were conducted with 35 women who had received PPIUC at vaginal or caesarean delivery. The interview data were analysed thematically to explore the women’s experiences of PPIUC service provision. Results Women’s decisions to choose PPIUC were influenced by their perception of intrauterine contraception (IUC) as a suitable and effective method and the convenience of immediate postpartum insertion. Most women were satisfied with their experience of PPIUC. Women delivering vaginally sometimes reported concerns about delays to insertion, particularly where they perceived a lack of communication from staff about when and where insertion would occur. PPIUC information was described as being difficult to absorb in the context of ante/postnatal information overload. Those receiving PPIUC at caesarean delivery sometimes expressed concerns about what post-insertion support might be available in primary care. Conclusion Women typically reported satisfaction with their decision to have PPIUC. For maternity services considering introducing PPIUC, our findings reinforce the importance of anticipating and addressing implementation challenges in order to enhance women’s experience of the service. These include ensuring that: clear and appropriate PPIUC information and support are provided antenatally; women are able to access PPIUC immediately after delivery; robust clinical pathways are in place to support post-insertion IUC care; and both staff and women are familiar with the clinical pathways.

A Correlation Study to assess the Knowledge and Attitude regarding Post-Partum Intrauterine Contraceptive Device (PPIUCD) among Women admitted in Antenatal and Post- Natal wards: An Institutional Study. (Preprint)

A Correlation Study to assess the Knowledge and Attitude regarding Post-Partum Intrauterine Contraceptive Device (PPIUCD) among Women admitted in Antenatal and Post- Natal wards: An Institutional Study. (Preprint)

Determinants of Postpartum IUCD Utilization Among Mothers Who Gave Birth in Gamo Zone Public Health Facilities, Southern Ethiopia: a Case-Control Study.

BackgroundThe postpartum intrauterine contraceptive device (PPIUCD) is an effective, reliable, safe and recommended contraceptive method for the postpartum women. However, only a small proportion of women who gave birth at health facilities in the world have used it. There are limited studies about determinants of PPIUCD utilization. Therefore, this study aimed to assess determinants of postpartum IUCD utilization among mothers who gave birth in Gamo zone health facilities, southern Ethiopia.MethodsA facility based unmatched case-control study was done at Gamo zone public health facilities, southern Ethiopia. Data were collected using a pretested interviewer-administered questionnaire from March 1 to April 15, 2019. The data were coded, cleaned and entered into Epi-Info version 3.5.1 and exported to SPSS version 25 for advanced analysis. Binary logistic regression was performed to identify the determinants of PPIUCD utilization.ResultsA total of 510 (175 cases and 335 controls) participants were involved in the study yielding a response rate of 95.1%. Partner support for IUCD insertion (AOR [95% CI]: 10 [4.03, 24.3]), birth interval (AOR [95% CI]: 9.7 [1.7, 55.1]), fertility plan (AOR [95% CI]: 4 [1.44, 10.84]), and timing of counseling (AOR [95% CI]:1.25 [0.034, 0.46]) are the determinant factors for postpartum IUCD.Conclusion and RecommendationBirth interval, fertility plan, timing of counseling, pregnancy plan and partner support were the determinant factors identified in this study. Therefore, counseling of both partners during antenatal follow-up, delivery and immediately after delivery by health professionals are recommended.

Focused Family Planning Counseling Increases Immediate Postpartum Intrauterine Contraceptive Device Uptake: A Quasi-Experimental Study.

PurposeThe aim of the study was to assess the effectiveness of focused family planning counseling (FFPC) in increasing postpartum intrauterine contraceptive device (PPIUCD) uptake among mothers who gave birth in the public health facilities of the towns of Adama and Olenchiti from April 1 to May 30, 2017.MethodsA quasi-experimental study design was employed, taking a sample of 726 postpartum mothers: 484 in the non-intervention group (NIG) and 242 in the intervention group (IG). Focused family planning counseling was given to the IG using a newly designed cue card adapted from World Health Organization (WHO) guidelines and developed based on the constructs of the health belief model. Counseling based on a routine counseling approach was given to the NIG. The interviewer administered a semi-structured questionnaire for data collection. Data were analyzed using SPSS software, version 20. Descriptive statistics were used to characterize the study participants. The difference in the proportion of PPIUCD uptake in the two groups was tested using an independent Z-test at an alpha level of 0.05. Binary logistics regression was used to identify factors associated with the odds of taking IUCD. The significance of association was declared for P-values less than 0.05.ResultsThe proportion of PPIUCD uptake in the IG [12.4%; 95% CI: 8.6, 17.4] was significantly higher than in the NIG [4.8%; 95% CI: 2.9, 6.7] with a P-value = 0.000. The odds of IUCD uptake among the IG was about 6 times higher (AOR: 5.92; 95% CI: 2.79, 12.60) than in the NIG. In addition, being unmarried women (AOR: 12.96; 95% CI: 4.30, 34.56), having higher education (AOR: 3.07; 95% CI: 1.13, 8.36), grand multiparity (AOR: 3.76; 95% CI: 1.58, 8.95), making a mutual decision (AOR: 0.16, 95% CI: 0.07, 0.38) and having a better knowledge of family planning (AOR: 5.92, 95% CI: 2.79, 12.60) were factors associated with uptake.ConclusionProviding FFPC immediately increases PPIUCD uptake. The uptake was also associated with marital status, education, parity, decision and knowledge on family planning.

Assessment of Intention to Use Postpartum Intrauterine Contraceptive Device and Associated Factors among Pregnant Women Attending Antenatal Clinics in Ambo Town Public Health Institutions, Ethiopia, 2018

Assessment of Intention to Use Postpartum Intrauterine Contraceptive Device and Associated Factors among Pregnant Women Attending Antenatal Clinics in Ambo Town Public Health Institutions, Ethiopia, 2018

The Effectiveness of Counselling on Knowledge, Acceptance and Choice for Postpartum Intrauterine Contraceptive Device (PPIUCD) among Primi mothers

Background: Post-partum contraception is the best evidence based intervention in prevention of pregnancy and abortion related maternal morbidity and mortality in the developing countries. The spacing for contraception among women in the postpartum period can be effectively fulfilled by post partum insertion of PPIUCD, in a single visit under the Government scheme of providing free maternity services during institutional delivery. Despite optimal efforts by family planning program, very few primi mothers are opting for spacing method and lack of awareness has resulted in discontinuation of family planning method particularly PPIUCD. This study is designed to PPIUCD and causes for discontinuation at follow up in our hospital. The objectives of the study were study PPIUCD practices at Talera hospital and Akurdi hospital, Pune; causes for discontinuation of PPIUCD. Research Methodology: Research Approach: Quantitative approach, Research design-Quasi experimental design one group Pre-test Post-test design, Population–primi mothers, Sample–The sample of the study comprised of Primi mothers, Sample size: 60 primi mothers, Sampling technique: Simple Random Sampling Technique was used. Setting: the selection of the study setting is on the basis of the feasibility of conducting study and availability of sample. Study will be conducted in Talera Hospital and Bhosri Hospital, PCMC, Pune. Result: In pre-test, majority of 91.7% of the primi mothers had poor knowledge and 8.3% of them had average knowledge regarding PPIUCD. In post-test, majority of 86.7.7% of the primi mothers had average knowledge and 13.3% of them had poor knowledge regarding PPIUCD. This indicates that the knowledge among primi mothers regarding PPIUCD improved remarkably after individual counselling. Researcher applied paired t-test for effectiveness of individual counselling on knowledge among primi mothers regarding PPIUCD. Average knowledge score in pre-test was 8.4 which increased to 11.9 in post test. t-value for this test was 12.2 with 59 degrees of freedom. Corresponding p-value was small (less than 0.05), the null hypothesis is rejected. This is evident that the knowledge among primi mothers regarding PPIUCD improved significantly after individual counselling.

Evaluation of Safety and Efficacy of Postpartum Intrauterine Contraceptive Devices (PPIUCD) in Vaginal and Caesarean Section Deliveries: A Hospital Based Study

Background: Immediate postpartum intrauterine contraceptive device (PPIUCD) is a lucrative postpartum family planning method which provide an effective reversible contraception for women in delivery settings. PPIUCD can be inserted post-placental, intra-caesarean and within 48 hours postpartum. We conducted this study to determine the outcome, satisfaction rate and continuation rate of PPIUCD. Materials and Method: This was a prospective observational study conducted in a tertiary care teaching institute. CuT 380A was inserted within 10 minutes of placental delivery in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications for PPIUCD. They were then followed up for 3 months. A Cohort of 260 vaginal and caesarean deliveries with PPIUCD in situ were studied over seven months period and follow-up results were compared between Vaginal and Caesarean groups. Result: Overall expulsion rate was 8.47%, removal rate was 14.83% and continuation rate was 76.7%. There was no significant difference in removal rate of two groups. Spontaneous expulsion occurred in 8.47% cases and were significantly higher in vaginal insertion group (p value 0.0017). Overall complication rate was low. No case of perforation or accidental pregnancy was reported. Conclusion: PPIUCD is a safe, highly effective, long acting, cost effective method of postpartum contraception, which can be used during institutional delivery visit and eliminates the need for a return visit to start contraception. PPIUCD is a strong weapon in the family planning armory and should be encouraged in both vaginal and caesarean deliveries.

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.

Determinants for Utilization of Post-Partum Intra-Uterine Contraceptive Device: A Cross-Sectional Study

Background: India ranks second in terms of population in the world. Sehore district of Madhya Pradesh has total fertility rate more than or equal to 3.0 and is a Mission ParivarVikas district.Objectives:This study assesses the level of satisfaction amongst the acceptors of Post-Partum Intra Uterine Contraceptive Device (PPIUCD), identify the reasons for removal of PPIUCD, assesses the quality of PPIUCD related counselling given to Antenatal women.Methods: A cross-sectional study was conducted between February to July 2018. The sample included 255 beneficiaries of PPIUCD. Only those women who got PPIUCD inserted before six months were part of the study. In addition, 30 counselling session were assessed to evaluate the quality of counselling.Results: Higher acceptance for PPIUCD was seen among primiparous, expulsion was reported in 10.98% of the cases, abdominal pain was a complaint in 12.94% and bleeding in 21.96% of the women. Majority stated bleeding issues as the reason for removal. Gaps observed during counselling werefailure to offer basket of choices, non-involvement of partner or family member emphasizing the advantages and failure to inform about the limitations and side effects of PPIUCD.Conclusion: Government is taking many efforts in bringing down the TFR. With such low expulsion rates, PPIUCD can be the solution for the countries facing population crises. It can help bring down the high maternal and neonatal mortality.Acceptance for PPIUCD can be improved by counselling the women during antenatal period through dedicated family planning counsellors.

Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation.

IntroductionExpanding access to postpartum intrauterine contraception (PPIUC) can reduce unintended pregnancies and short inter‐pregnancy intervals; however, provision across Europe is limited. Our aim was to determine the feasibility, clinical outcomes and patient satisfaction of providing immediate PPIUC after vaginal birth using a health services research model.Material and methodsPhased introduction of PPIUC across two Lothian maternity hospitals; all women intending vaginal birth during the study period without a contraindication to use of the method were eligible to receive PPIUC. Midwives and obstetric doctors were trained in vaginal PPIUC insertion using Kelly forceps. Women received information antenatally and had PPIUC insertion of either a levonorgestrel intrauterine system or a copper intrauterine device within 48 hours of vaginal birth. Follow‐up was conducted in‐person at 6 weeks postpartum and by telephone at 3, 6 and 12 months. Primary outcomes were: uptake, complications (infection, uterine perforation), expulsion and patient satisfaction at 6 weeks; and method of continuation up to 12 months. Secondary outcomes included hazard ratio for expulsion adjusted for demographic and insertion‐related variables.ResultsUptake of PPIUC was 4.6% of all vaginal births; 465/447 (96.1%) of those requesting PPIUC successfully received it and most chose a levonorgestrel intrauterine system (73%). At 6 weeks postpartum, the infection rate was 0.8%, there were no perforations and 98.3% of women said they would recommend the service. The complete expulsion rate was 29.8% (n = 113) and most had symptoms (n = 79). Of the additional 121 devices removed, 118 were because of partial expulsion. The rate of complete/partial expulsion was higher for insertions by midwives compared with those by doctors. The re‐insertion rate after expulsion/removal was 87.6% and method continuation at 12 months was 79.6%.ConclusionsRoutine PPIUC at vaginal birth is feasible. Complications were extremely rare. High expulsion rates may be observed in early stages of service introduction and with inexperienced providers. Re‐insertion and therefore longer‐term continuation rates of intrauterine contraception were very high. In settings with low rates of attendance for interval postpartum intrauterine contraception insertion, PPIUC could be a useful intervention to prevent unintended and closely spaced pregnancies.

Evaluation of factors associated with acceptance of post-partum intrauterine contraceptive device in a tertiary care hospital

Objective: The post-partum intrauterine contraceptive device (PPIUCD) is a highly effective, long acting, reversible, economical and easily accessible family planning method. The aim of the study was to estimate the proportion of pregnant women aware of immediate post-partum intrauterine contraceptive device and to analyze the factors associated with acceptance.
 Methodology: This is a cross sectional study in which 300 pregnant were selected who were visiting the antenatal clinics and admitted in early labor in labor ward. Their awareness and acceptance for PPIUCD was assessed through a structured questionnaire. Factors associated with acceptance were analyzed and the reasons for acceptance or refusal were determined.
 Results: In this study the awareness of PPIUCD was found to be 46% and the acceptance rate of PPIUCD was 18%. The major reason for refusal was that women don’t think they need contraception immediately after delivery and secondly, they need to talk to their partners for the decision. Most common reasons for acceptance of PPIUCD was that it is long acting and reversible.
 Gravidity (p= 0.006), parity (p< 0.001), unplanned pregnancy (p= 0.002) and inter pregnancy interval (p= 0.004) were the factors significantly influencing the acceptance of PPIUCD.
 Conclusion: This study revealed that awareness regarding PPIUCD is increasing in women but acceptance is still poor. It was due to misconception that no contraception is needed in postpartum period. Provision of adequate knowledge regarding convenience and effectiveness of post-partum contraception in preventing unintended pregnancies can play vital role to increase its acceptance.

Acceptance of postpartum intrauterine contraceptive device among women attending antenatal care in a low-resource setting in Nigeria.

To assess the level of awareness, acceptance, and any identifiable barriers to the use of postpartum intrauterine devices (PPIUDs) among pregnant women receiving care in a low-resource setting in Nigeria. A pretested interviewer-administered questionnaire was used to obtain relevant data from all consenting pregnant women receiving antenatal care at Polyclinic and Uwani health center in the city of Enugu from January 1 to March 31, 2018. Data were entered and analyzed using Epi Info statistical software. P<0.05 was considered statistically significant. About two-thirds (65.6%) of the 620 respondents were unaware of PPIUDs. After counseling, about one-third (36.8%, n=228/620) of the respondents accepted having an immediate PPIUD, while the majority (63.2%, n=392/620) declined. The identified barriers towards accepting immediate PPIUDs were fear of side effects (57.9%), religious reasons (20.7%), and preference for other contraceptive methods. None of the respondents had ever inserted a PPIUD previously. The low level of acceptance of PPIUDs in the study appears to be a reflection of the low level of awareness of PPIUDs in the region. Efforts in creating awareness and health education to dispel the myths and misconceptions about PPIUDs are required in order to promote its uptake in the region.

Knowledge and predictors of retention of postpartum intrauterine contraceptive device among users in rural areas of Nadia district, West Bengal, India

Background: Postpartum intrauterine contraceptive device (PPIUCD) is a safe, highly effective postpartum contraceptive, yet to be popularized at the community level in a diversified developing country like India where still the unmet need for spacing remains high. This study aimed to assess the knowledge regarding PPIUCD among users and the predictors of its retention.Methods: A case-control study had been conducted using multi-stage sampling technique in Nadia district of West Bengal. Face to face interviews of the cases and the controls had been done with the help of a predesigned pretested semi-structured schedule. Data were entered in MS Excel and analysed in SPSS 20.0 version.Results: Majority of the acceptors (55.2%) had poor knowledge regarding PPIUCD. Most of the participants (62.2%) retained their PPIUCD at least for 6 months. Acceptors who belonged to Hindu religion, higher socio-economic class (I and II), nuclear family, educated up to or above secondary level, ever counselled on PPIUCD, satisfied using that in day to day life, undergone follow-up visits and had correct knowledge regarding different aspects of PPIUCD had higher odds of retention of PPIUCD.Conclusions: Regular awareness campaigns, counselling at household level, advocacy are the utmost needs of the hour to motivate the eligible couple for its acceptance and retention.