Postpartum Intrauterine Device Research Articles

Hubungan Kontrasepsi IUD (Intra Uterine Device) Pascasalin 40 Hari Dengan Produksi ASI Pada Ibu Nifas

The Family Planning Service (KB) program in Indonesia is experiencing a stagnant situation which is marked by the lack of increasing several indicators of family planning services, namely the number of participation in family planning (Contraceptive Prevalence Rate = CPR) and unmet need). This study aims to analyze the relationship between 40-day postpartum IUD (Intra Uterine Device) Contraception and Breastmilk Production in Postpartum Mothers in the Work Area of Sumber Health Center, Probolinggo Regency. This research is a quantitative research design with a correlational design using a cross sectional study approach with 33 respondents using accidental sampling technique. Data collection includes coding, editing and tabulating, then analyzed manually and computer with Chi Squaren Test. Based on 33 respondents, most of the IUD Contraceptives were Exactly as many as 20 respondents (60.6%) including those whose breast milk production was current, 15 respondents (45.5%) and those that were not smooth, as many as 5 respondents (15.2%) and obtained P Value: 0.003 and a= 0 ,05 means r < a, so H0 is rejected and Ha is accepted, and there is a relationship between 40 Day Postpartum IUD (Intra Uterine Device) Contraception with Breast Milk Production in Postpartum Mothers in the Work Area of Sumber Health Center, Probolinggo Regency. It is hoped that breastfeeding who does not want to get pregnant again, of course requires safe contraception, does not interfere with the breastfeeding process nor does it affect milk production. There are various personal reasons to regulate the number and spacing of children desired, reducing the risk of contracting sexually transmitted diseases.

Postpartum IUD expulsion was lower when delayed to 6 to 14 weeks

Madigan Army Medical Center, Joint Base Lewis McChord, WA The corresponding author is Tyler R. Reese, MD; [email protected]. The author declares no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.

Postpartum Intrauterine Device: Use and Follow-Up of Users in the Maternity Ward of the Ratoma Communal Medical Center in Conakry, Guinea

Postpartum Intrauterine Device: Use and Follow-Up of Users in the Maternity Ward of the Ratoma Communal Medical Center in Conakry, Guinea

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.

A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda.

Rwanda has high unmet need for family planning (FP), especially in the postpartum period when women are advised to space pregnancies at least two years for improved maternal-child health. Despite interest in the copper intrauterine device (IUD), a highly cost-effective method, access and uptake remain low. This study aimed to determine factors associated with postpartum IUD (PPIUD) uptake after postpartum family planning (PPFP) counseling as well as provider perceptions of facilitators and barriers to clients' PPIUD uptake. Postpartum women who received PPFP counseling and were less than 6 weeks postpartum were recruited for a case-control study in Kigali, Rwanda in 2018. We recruited n = 74 women who had accepted and n = 91 women who had declined the PPIUD. Multivariate logistic regression analyses evaluated associations between women's socio-demographics, FP knowledge and decision-making, and the outcome of PPIUD uptake. Six focus groups (FGs) were conducted with FP providers (n = 24) and community health workers (n = 17) trained to deliver PPFP counseling to assess perceptions of PPFP counseling and facilitators and barriers to PPIUD uptake. FG discussions were recorded, translated, and analyzed for themes. Factors associated (P<0.1) with PPIUD uptake included citing its non-hormonal nature, effectiveness, and duration of protection against pregnancy as advantages. Exclusive male partner control over FP decisions (relative to women's control or joint decision-making) was associated with non-use. Overall, limited knowledge about some aspects of the PPIUD persisted among clients even after counseling. Provider FGs highlighted client concerns, inconsistent FP messaging, and lack of male partner involvement as factors influencing non-use. Knowledge of the IUD and its benefits was associated with PPIUD uptake. There is need to refine PPFP counseling messages to address remaining knowledge gaps and concerns. Additionally, male partner involvement in FP counseling and decisions with their partners could be a key strategy to increase both PPIUD and FP uptake in Rwanda.

Tales of Hysteroscopic Evaluation of PPIUD with Missing String in a Tertiary Care Government Hospital

Background: The safety and efficacy of the postpartum intrauterine device (PPIUD) has been documented worldwide with increasing institutional deliveries. It was relative new concept therefore a close observation should be kept on potential complication arising from it. Removal of an IUD can be easily done when the string is visible during speculum examination but the task become challenging when the string no longer visible. Objectives: To evaluate the role of hysteroscopy for removal of PPIUD with missing string. Methods: This descriptive study was conducted in tertiary government hospital over six months from July 2020 to December 2020. PPIUD clients with lost strings were included in this study. Before the procedure complete history about reason for retrieval, duration of insertion, complication related to IUD was recorded. Furthermore, speculum examination &amp; USG was performed then decided for hysteroscopic evaluation and removal. Per-operative location of PPIUD in uterine cavity and any complication &amp; associated pathology encountered were recorded. The size and model of hysteroscope also noted. Results: Thirty one patients were included among them more than two third of PPIUD given following caesarean section (LSCS). Reason for PPIUD removal of most clients due to menstrual irregularities 29% displaced &amp; fragmented CuT on USG 25.8% and desires for pregnancy. Nineteen respondents removed within three years due to complication like irregular menses ,displaced IUD on ultrasonography.. Most of the PPIUD 64.5% in normal location rest of them deviated from normal among those three PPIUD were inverted &amp; tip of the five PPIUD near the external os. Arms of cu-T were embeded in five clients, some difficulties faces to remove those. Polyp were found in two clients with menstrual irregularities. Postoperative outcome of all patients were uneventful. Conclusion: Hysteroscopy is a good modality for the removal of PPIUD with lost strings. J Shaheed Suhrawardy Med Coll 2021; 13(1): 63-67

Provision of postpartum long-acting reversible contraception: A quality improvement intervention with pre- and postintervention evaluation.

Background. Unintended pregnancies remain an important health challenge in South Africa (SA) and worldwide. Improving access to contraception and long-acting reversible contraception in particular, may reduce the number of unintended pregnancies.Objective. To determine the impact of a training and supportive mentoring programme on postpartum uptake of long-acting reversible contraceptive (LARC) methods.Methods. A quality-of-care improvement intervention with pre- and post-intervention evaluation of LARC uptake was conductedat a midwife-led, on-site obstetric unit in the Eastern Cape, SA. Midwives were trained in contraceptive counselling and postpartum etonorgestrel implant insertion. The researcher provided counselling and postpartum intrauterine device (IUD) insertion services.Results. In the 10 weeks prior to the intervention, neither the IUD nor the implant were provided in the unit. In the 10 weeks after the intervention, uptake of the IUD was n=27/289 (9.3%) and the implant n=21/289 (7.3%). Use of no contraception or condoms increased from n=22/273 (8.1%) to n=41/289 (14.2%) (p&lt;0.02). The increase was accounted for by a change in staff in the last 4 weeks of the intervention period (n=33/105 (31.4%) v. n=8/184 (4.4%) during the first 6 weeks; p&lt;0.00).Conclusion. Competing responsibilities of maternity staff may limit the contraceptive options offered to postpartum women. Aprogramme of training and supportive supervision resulted in a substantial increase in levels of LARC uptake. Strategies are needed to institutionalise comprehensive postpartum contraceptive provision nationally.

Ultrasound-Guided Compared With Non–Ultrasound-Guided Placement of Immediate Postpartum Intrauterine Contraceptive Devices

Immediate postpartum placement of intrauterine devices (IUDs) can help reduce unintended short-interval pregnancy; however, the rate of spontaneous device expulsion is increased. The objective of this study is to evaluate the risk of expulsion with ultrasound-guided placement of immediate postpartum IUDs. Retrospective review of all patients receiving immediate postpartum IUDs after vaginal delivery at Prisma Health Richland Hospital from 2018 to 2020 was performed. Outcomes were available for 78 patients in the ultrasound-guided cohort and for 226 in the control cohort. The expulsion rate was 15.4% (95% CI 8.2-25.3%) for the ultrasound-guided cohort and 14.2% (95% CI 9.9-19.4%) for the control cohort. Our data suggest that using ultrasonography to guide placement of IUDs immediately after vaginal delivery is not associated with the risk of expulsion.

The Effect of Family Planning Counseling on Incident Pregnancy in Nepal.

An intervention aimed at institutionalizing postpartum intrauterine device (PPIUD) services was introduced in Nepal between 2015 and 2019. The intervention was evaluated using a cluster-randomized stepped-wedge trial, with data on women being collected immediately after delivery and at one- and two-year postpartum follow-ups. The sample consists of 19,155 women. We used intention-to-treat (ITT) analysis and structural equation model (SEM) to investigate how the intervention affected the occurrence of a new pregnancy (incident pregnancy). The ITT analysis showed that women in the intervention group had a reduced probability, -0.7 percentage points (95 percent CI: -3.0, 1.4), of having an incident pregnancy compared to women in the control group. The SEM analysis showed that the intervention increased the probability of receiving antenatal family planning counseling and PPIUD-specific counseling by 22.2 percentage points (95 percent CI: 20.0, 24.4) and 26.5 percentage points (95 percent CI: 24.8, 28.3), respectively. The intervention had an unintended spillover effect, increasing the probability of receiving postnatal family planning counseling by 11.4 percentage points (95 percent CI: 7.3, 15.5). In the SEM, we find the expected impact of the intervention on increased counseling and induced effects on contraceptive method initiation, lowering the probability of an incident pregnancy by 0.3 percentage points (95 percent CI: -0.5, -0.1).

Complications of Post-Partum Intrauterine Contraceptive Device Insertion

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

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

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

Immediate vs Routine Postpartum Intrauterine Device Placement After Teen Pregnancy: A Cost-Effectiveness Analysis [A02

INTRODUCTION: The time surrounding a teen’s first pregnancy represents an ideal period to counsel on effective contraception and prevent additional unplanned pregnancies. It has yet to be examined if post placental intrauterine device (IUD) placement is cost effective in teenage patients relative to routine placement in the office. METHODS: A decision analytic model was built using TreeAge software to compare outcomes and costs among teenagers receiving either post placental or routine IUD placement. Outcomes, associated health care costs, and maternal quality-adjusted life years (QALY) were compared. All probabilities, utilities, and costs were derived from the literature. Costs were in 2021 US dollars with a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to assess how variation in baseline assumptions impacted model outputs. RESULTS: In a theoretical cohort of 300,000 teen births, post placental IUD placement yielded 35,620 more QALYs but cost $32 million more than routine placement. Post placental placement prevented 9,740 additional unplanned births—including 1585 preterm births—and 5595 abortions. Post placental placement was no longer cost effective when the likelihood of IUD removal within the next year rose from our baseline estimate of 0.14 to 0.46 or when the rate of subsequent unplanned teen pregnancy without an IUD fell to 0.007. CONCLUSION: Post placental IUD placement is cost effective for teenage patients from the maternal perspective. The cost effectiveness of the strategy is contingent on the likelihood of removal within the next year and of unplanned pregnancy without an IUD in place.

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

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

Efficacy of Immediate Post-Partum Intrauterine Contraceptive Device in a Tertiary Care Hospital

Objective: To determine efficacy of post-partum intrauterine contraceptive device (IUCD) in women presenting to a tertiary hospital.To compare efficacy of post-partum Intrauterine device between vaginal Insertion and Intra-Cesarean Insertion. Material and Method: A Prospective, cross sectional study was conducted at Department of Gynecology and Obstetrics Unit III, Abbasi Shaheed Hospital, Karachi from Jan2020 to June, 2020. Total 234 patients were included in this study. Patients fulfilling the inclusion criteria were enrolled in the study after taking Informed consent. Copper containing IUCD was inserted. Follow up was done at 6weeks and six months of delivery. All women were counseled to report missing threads, heavy vaginal bleeding, and vaginal discharge with pain in abdomen on each visit during follow-up. Abdominal, speculum and vaginal examinations was done. Efficacy was determined by the expulsion rate. Statistical analysis was done by SPSS Version 20. Results: Out of total insertions 103(44.01%) were intra caesarean and 131 (55.98%) IUCDs were placed after vaginal delivery. Symptoms of unusual vaginal discharge were reported by 28(11.9%) women, missing thread were reported by 67(28.5%), abdominal pain was reported by 92(39.2%) and heavy bleeding was reported by 44(18.8%) patients at follow-up. efficacy of vaginal insertion was 79(60.30%) and intra-cesarean insertion of PPIUCD was 65(63.10%). Conclusion: It can be concluded that PPIUCD in the field of postpartum family planning is a promising approach. Whatever may be the mode of delivery, PPIUCD is safe and effective. Keywords: Efficacy, Vaginal Insertion, Post-Partum Intrauterine Contraceptive Device, missing threads

Long Term Evaluation of Post-Partum Intrauterine Device (PPIUD) In Terms of Safety and Efficacy

Objectives: The purpose of this study was to evaluate the long term safety and efficacy of postpartum IUCD at a tertiary level hospital.&#x0D; Materials &amp; Methods: This cross sectional study was carried out in Shaheed Suhrawardy Medical College &amp; Hospital (ShSMCH) from March 2019 to December 2019. International Federation of Gynecology and Obstetrics (FIGO) in collaboration with Obstetrical and Gynecological Society of Bangladesh (OGSB) have been launched a project in Bangladesh to foster family planning activities by postpartum IUCD insertion since July 2015 in this hospital. All patients who were inserted PPIUD following delivery under FIGO- PPIUD project since 1st January 2017 to 31st December, 2017 were included in this study. Phone number of those PPIUD inserted women were collected from the register book. Clients were evaluated after 2 years of insertion. The outcome measures analyzed were safety measures – menstrual irregularities, vaginal discharge, pelvic infection, perforation and efficacy measures – continuation, removal, expulsion and failure rate.&#x0D; Result: Total number of patients delivered at ShSMCH in 2017 were 2,593. Out of them deliveries, 329 (12.70%) were introduced PPIUD. Among 329 PPIUD users, after about 2 years, 175 (53.20%) could be traced for follow up and rests couldn’t be reached by repeated attempts on phone call. After telephone call they attended our hospital and thorough interview and examination was done. All the informations were collected in a predesigned data collection sheet. Among 175 study population, 25 (14.28%) IUCD introduction were following vaginal delivery and 150 (85.71%) were during cesarean section operation. Those who are continuing PPIUD, 100 (82.0%) had no complications and few, 22 (18.0%) had some minor complaints for which they received treatment. The most common adverse event was the menstrual irregularities. There was no case of perforation. By the end of 2 years, out of 175 PPIUD inserted clients, missing string was found in 85 (69.7%) cases, continuation rate of PPIUD was 122 (69.7 %), spontaneous expulsion was 10 (5.7%), removal was 43 (24.6%) and failure rate was 3 (1.7%).&#x0D; Conclusion: PPIUCD is a safe, effective and convenient method of contraception and should be encouraged after both vaginal and Cesarean deliveries.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 81-89

A non-inferiority analysis of hemoglobin levels in postpartum IUD users in Bangladesh.

ObjectiveThe objective of this study was to compare postpartum hemoglobin (Hb) between postpartum intrauterine device (PPIUD) and non‐PPIUD users.MethodsA sample of 3697 postpartum women (475 PPIUD users, 3222 non‐PPIUD users) from 5 tertiary referral hospitals in Bangladesh were assessed at multiple time points between 6 weeks and 12 months postpartum. Non‐inferiority linear regression analysis compared changes in Hb levels at 29–52 weeks postpartum between the two groups. Non‐inferiority was declared if the lower 95% confidence interval of the estimated difference in Hb change since delivery between PPIUD and non‐PPIUD users was greater than −0.05 g/dl.ResultsAt approximately 9 months postpartum, 276 women in the PPIUD group (58.1%) and 1086 women in the comparison group (33.7%) attended follow‐up. In total, 57.9% of PPIUD users and 61.0% of non‐PPIUD users had taken iron supplementation. Change in Hb was 0.02 g/dl (95% CI: −0.16, 0.19) higher in the PPIUD users than the comparison group. The lower limit of the 95% CI was greater than −0.05 g/dl, providing good evidence that PPIUD users were non‐inferior to the comparison group in their Hb levels.ConclusionIn the presence of offering iron supplementation, and an uptake of just over 60%, no difference in anemia was observed between the PPIUD and control group.

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

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

The Effectiveness of Postpartum IUD Compared to Interval IUD in ‘Aisyiyah Hospital Klaten

BACKGROUND: Postpartum IUD (PPIUD) insertion is performed 10 min after the placenta is born until 48 h postpartum, interval method is installed after 4 weeks postpartum. The use of this contraception will provide a distance between pregnancies not to be too close. AIM: To assess the effectiveness of PPIUD and the interval on complaints and complications in acceptors. METHODOLOGY: This study used a cross-sectional design. The subjects were women who gave birth vaginally and cesarean section at the ‘Aisyiyah Hospital Klaten with PPIUD and interval acceptors installed. Complaint data obtained through history taking, complications obtained from ultrasound, inspeculo examination, and vaginal swab. Data were analyzed by univariate, bivariate, and multivariate analysis. RESULTS: One hundred and twenty-nine subjects consisted of 82 (63.6%) PPIUD and 47 (36.4%) interval. On ultrasound examination, 126 (97.7%) subjects had no abnormalities, two (1.6%) had abnormalities, and one (0.8%) found ovarian cysts. On inspeculo examination, 89 (69.0%) subjects found no erotion, and 40 (31.0%) did not find abnormalities. Vaginal swab examination showed that 119 (92.2%) subjects had pathogenic bacteria, ten (7.8%) were normal. The fungus was positive in 75 (58.1%) subjects, and no fungus was in 54 (41.9%), while in NGO, positive was 18 (14.0%) subjects, and negative was 111 (86.0%). There was a significant relationship that the type of IUD insertion had husband’s complaints (p = 0.021), the erosion incidence (p = 0.011), the presence/absence of threads (p = 0.01), and the presence of fungus (0.00). PPIUD is more effective than interval IUD. CONCLUSION: PPIUD is more effective in terms of the lack of complaints from the husband, the incidence of erosion, the presence or absence of threads, and found of fungus on the vaginal swab than interval IUD.

Immediate postpartum intrauterine contraceptive device utilization and associated factors among women who gave birth in public health facilities of Adama town, Ethiopia.

The evidence on utilization of immediate postpartum intrauterine contraceptive devices (IPPIUCDs) and its associated factors are limited in Ethiopia. Hence, this study intended to assess IPPIUCD utilization and related factors among women who gave birth in Adama town public hospitals, Ethiopia. A facility-based cross-sectional study was done among 493 postpartum mothers at selected government health facilities in Adama town from January 20 to February 20, 2021. All women who gave birth in selected government health facilities and within 48 h of postpartum were included in the study. Data were collected using an interviewer-administered questionnaire. Logistic regression models were used to identify the factors associated with IPPIUCD utilization. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were calculated to measure the strength of association and statistical significance was declared at p < 0.05. In this study, 22.1% (95% CI: 17.3-25.2) of the mothers used IPPIUCDs within 48 h of giving birth. Having three or more children (AOR = 4.18, 95% CI: 1.79-9.79), having no desire to have another child (AOR = 3.9, 95% CI: 1.86-8.17), counseling after delivery (AOR = 3.1 95% CI: 1.52-6.34), and having good knowledge about PPIUCD (AOR = 3.82, 95% CI: 1.94-7.49) were significantly associated with IPPIUCD utilization. The utilization of IPPIUCD in this study was low. Strategies to raise pregnant mothers' awareness of IPPIUCD through mass media, and integrating standard counseling on immediate postpartum intrauterine device (IPPIUD) during antenatal care, and the immediate postpartum period are required to improve IPPIUD utilization.

Study of the client experience and continuation rate of postpartum intrauterine Copper-T device in semi-urban population in India

Background: Postpartum intrauterine copper device (PPIUCD) is a reliable and efficient method of contraception for women. In spite of its ease of administration, its acceptance is very low owing to a number of factors. The current study was undertaken to analyze the continuation rates and problems among women accepting PPIUCD as contraceptive method. Methods: The present study was undertaken in the family planning department of a teaching hospital in New Delhi. It was an ambispective, observational study in which 880 beneficiaries of PPIUCD were telephonically contacted and interviewed. A pro forma containing demographic profile, obstetric history of the women, date and timing of insertion of PPIUCD, source of information about PPIUCD, side effects encountered, willingness to continue, and reasons of discontinuation, if applicable, was filled and the data, collected thus, were analyzed. Results: Most of the women enrolled in the study had a mean age of 26.5 (±4.1) years; the average parity was two. The timing of insertion of PPIUCD was postplacental in majority of women (91.7%). Most of the women received information about PPIUCD from health-care workers (90.1%). It was found that 86.7% of women were using PPIUCD at the time of interview and 73.3% were satisfied with it and willing to continue further. The predominant side effect observed was pain abdomen (15%), followed by menstrual irregularity. Conclusion: The present study revealed a high continuation rate of PPIUCD. Health-care professionals were the foremost source of information for PPIUCD. It is a highly effective method which needs to be popularized among the masses by the active participation of media and other agencies as it has the potential to bridge the gaps in existing family planning services.