Postplacental Intrauterine Device Research Articles

The Effect of Post-Placental Intrauterine Contraceptive Devices on Decreasing in Uterine Fundus Height in Postpartum SC Mothers

Introduction: Contraception and family planning services are an essential part of reproductive health. Postpartum IUDs in SC postpartum have a much lower expulsion rate than vaginal delivery. Objective: to determine the effect of post-placental intrauterine devices on the decrease in fundus uteri. Methods: Using a correlational analytical research design, the research design used is a prospective cohort with a sample size of 30 for the treatment group and 30 for the control group. Result: It can be concluded that the effect 2 hours after the installation of post-placental IUD is known (p-value = 0.279), which indicates that there is no influence between the variable of post-placental IUD installation of SC delivery mothers and the decrease in fundus uteri height. The effect of post-placental IUD insertion on the decrease in fundus uteri height in SC postpartum mothers at Karanganyar Regional Hospital on day 3 shows a p-value of 0.262, and it shows that there is no influence between the variable post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. On day 7, the p-value = 0.008 means that the p-value is smaller than the value of α = 0.05 (p-value < 0.05) and that there is an influence between the variable of post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. Post-placental IUD is a reference for making birth control choices during the postpartum period without interfering with breast milk. Conclusion: The conclusion does not prove the hypothesis in part because the rapid effect on the decrease in TFU in SC postpartum mothers is only after 7 days from the insertion of the IUD, while at 2 hours of IUD insertion and day 3 of IUD insertion, it does not have a rapid effect on reducing TFU in SC postpartum mothers. implications for the management of maternity women who plan to postpone the next pregnancy and this research can be used as empirical evidence that a post-placental intrauterine device acceptor has the potential to increase uterine contractions and accelerate the decrease in fundus uteri height on day 7.

Health Promotion Quality Regarding Post-Placental IUDs in Malang Regency

Introduction: Community welfare is confronted with a substantial challenge by Indonesia's burgeoning population, and the government's principal aim is the promotion of Long-acting reversible contraceptives (LARC). Post-placental IUD is an efficacious method that incorporates health promotion by means of midwife-delivered contraceptive counseling. Counseling promotes the development of positive relationships, knowledge, attitudes, and behaviors, thereby fostering responsible behavior and individual agency in decision-making. Nevertheless, the low utilization rate of postpartum IUD contraception can be attributed to the scarcity of information regarding the mother. The objective of this study is to examine the level of health promotion regarding post-placental IUD family planning in Malang Regency. Material and Methods: Descriptive methods will be employed, including verbal and written observations of behavior and descriptive data on individuals. The interview-based data collection process spanned the months of June to August 2023. Results: The research results suggest that inadequate efforts to promote postpartum IUD contraception are due to a dearth of understanding, motivation, resources, geographical proximity, and community customs. The objective is to improve the existing insufficiency of post-placental IUD family planning promotion in Malang Regency. Conclusion: From the beginning of pregnancy onwards, expectant women must be consistently motivated and educated about health promotion and family planning in order to develop an interest in and understanding of the choice of post-placental IUD family planning.

92. Outcomes of an Immediate Postplacental Intrauterine Device Placement Program in Adolescents and Young Adults

92. Outcomes of an Immediate Postplacental Intrauterine Device Placement Program in Adolescents and Young Adults

Effectiveness of Counseling in Increasing Mothers' Behavior (Knowledge and Attitudes) Regarding Post-Placental IUD Selection to Realize the SDG Goals of Good Health and Well-Being

Background: The low coverage of post-placenta IUDs is due to the non-optimal family planning counseling for third-trimester pregnant women. Aims: This study aims to analyze the effectiveness of ABPK and SKB counseling in increasing mothers' knowledge and attitudes about choosing a post-placenta IUD at Tawangrejo Health Center, Madiun City. Methods: This type of research is quasi quasi-experimental nonequivalent control group design. Data were analyzed using Marginal Homogeneity, Mann-Whitney, Mc Nemar, and Chi-Square. Results: The results showed that the Marginal Homogeneity test in the experimental group (SKB) obtained an increase in knowledge with a p-value of 0.000 (<0.05) and the control group (ABPK) obtained an increase in knowledge with a p-value of 0.000 (<0.05) so that it can be interpreted both effective in increasing the mother's knowledge about the selection of the Post Placenta IUD at the Tawangrejo Health Center. The result of the McNemar test on the attitude of the ABPK group was 0.227 (> 0.05) and the attitude of the SKB group was 0.146 (> 0.05) so it can be interpreted that both were not effective in increasing the attitude of mothers about the selection of the Post Placenta IUD at the Tawangrejo Health Center. The results of the Mann-Whitney test on knowledge after ABPK with knowledge after LCS show a p-value of 0.02 the mean rank at ABPK is 23 and the mean rank SKB is 28 meaning that there is a difference between ABPK counseling and SKB counseling in improving mothers' attitudes about choosing the Post Placenta IUD and counseling SKB is more effective. Conclusion: The conclusion of SKB counseling is more effective in increasing the mother's knowledge about the selection of the Post Placenta IUD at the Tawangrejo Health Center. Suggestions to further improve SKB counseling in Post Placenta IUD family planning services.

COMPARISON OF SATISFACTION AND OUTCOME OF PPIUCD AND INTERVAL IUCD AT A TERTIARY CARE CENTER IN WESTERN RAJASTHAN

Objectives: A prospective study is to compare satisfaction and outcome of post-placental intrauterine device (PPIUCD) and interval intrauterine device (IUCD) at a tertiary care center in western Rajasthan. Methods: This is an observational study on 150 women of reproductive age group (19–45 years) who had been inserted with copper-T 380A in postpartum period and within 6 weeks of delivery between July 21 and June 22, done at department of Obstetrics and Gynaecology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India. Women were categorized into Group A (postpartum IUCD) and Group B (interval IUCD). In Group A, the Cu-T-380-A was inserted intrauterine in postpartum period. In group B, CuT-380-A was inserted after 4–6 weeks of delivery by withdrawal technique. Results: The risk of other complications such as bleeding, pain in lower abdomen, and infection is relatively high in interval IUCD insertion as compared to PPIUCD insertion (p>0.05). The removal rate for bleeding and/or pain was found to be lower in PPIUCD group. Expulsion rate for group A (PPIUCD) was 6% and 2.66% in group B (p=0.257). Of total 13 removal, in group A, maximum 9 (69.23%) were removed at 6 months and 4 (30.77%) were removed at 6 weeks. Of total 16 removal, in group B, 13 (81.25%) were removed at 6 months and 3 (18.75%) were removed at 6 weeks. (0.752). Satisfaction rate for group A (PPIUCD) was 88.67% and 88% in group B. Conclusion: PPIUCD insertion is equally effective and safe method of contraception as interval IUCD insertion with lower incidence of side effects.

Evaluation of IUD Insertion During CS In 100 Patient. A Prospective Study

Background: The application of an IUD to the female after placenta delivery during a caesarean section had several benefits since the female was under anesthetic, which reduced the need for additional manipulation and pain, and the female at the time of delivery had a strong desire for family planning. IUDs placed postpartum experienced numerous disengagements, including bleeding and displacement. Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section in 100 patients. Patient and methods: A prospective study was conducted at obstetrics and gynecology department of Damanhur Medical National Institute in the period from March 2022 to March 2023. Group I: included 52 women who agreed to insert immediate post placental IUD at the cesarean delivery. Group II: included 48 women as control group. The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: In both groups, the demographic information was comparable. The medical histories of the investigated patients and the control group did not differ significantly according to our research. The study group's caesarean procedure took a little longer to complete. There were no appreciable differences between the two groups in terms of infection, puerperal hemorrhage, or IUD displacement. Both groups' satisfaction levels were displayed as either pain or displacement. In the research and control groups, the expulsion rates were 3.92% and 0.00%, respectively. Conclusion: Based on our research, we draw the conclusion that IUD insertion during CS is safe and effective, avoiding the reasons why it can be challenging to insert an IUD after puerperium and having a low expulsion rate; so, it can be considered a standard procedure.

EFEKTIVITAS DAN EFEK SAMPING PENGGUNAAN IUD PASCA PLASENTA DI RSPAL DR. RAMELAN PERIODE JANUARI 2019 – DESEMBER 2021

Background : In 2020 Indonesia has experienced an increase in population which has become a problem in Indonesia. In preventing the population explosion, the government established a program, named Family Planning (KB). In the family planning program, there is a contraceptive method, named the Intra Uterine Device (IUD). Post-placental IUD contraception is a safe, easy dan effective contraceptive for inserting a long-term intrauterine contraceptive device (IUD) with convenience in use, dan ease dan lower side effects.
 Study aims : To determine the effectiveness dan side effects of using a post-placental IUD at Dr Ramelan Hospital for the period January 2019 – December 2021.
 Methods : The research design was a descriptive research design using quantitative methods. Researchers used secondary data in the form of electronic medical records (SIMRS) with a total sample of 88 people. The data examined included age, parity, duration of use of the post-placental IUD, the effectiveness of the post-placental IUD, the side effects of the post-placental IUD such as: pain, menstrual disorders, bleeding, dan IUD removal.
 Results : From a total sample of 88 people, the effectiveness of the post-placental IUD was 96.6%, dan the side effects that occurred were frequent pain in 26 people (29.5%), menstrual disorders in 33 people (37.5%) ), bleeding disorders in 21 people (23.9%), dan removing the IUD in 31 people (35.2%).
 Conclusion : The effectiveness of the post-placental IUD is 96.6%, dan the side effects that occur during post-placental IUD users are pain, menstrual disorders, bleeding, dan IUD removal.

Conventional manual technique of post placental IUD insertion versus intra-cesarean post placental introducer withdrawal IUD insertion technique: a new standardized technique for IUD insertion during cesarean section: a randomized controlled trial

BackgroundInserting IUDs during cesarean section reduces the need for more manipulation and discomfort. The current conventional manual technique for IUD insertion during cesarean section is not standardized with many modifications and high rates of expulsion, displacement, missed threads, and discontinuation. This study aims to find a standard technique for IUD insertion during cesarean section with the least possible problems, especially displacement and missed threads.MethodsA randomized controlled study was conducted at Kasr Al-Ainy Maternity Hospital, Cairo University, Egypt. The study was performed over 12 months, from September 2020 to September 2021. Two groups of patients were selected; each group included 420 patients with a desire for IUD insertion during cesarean section. Group (A) (Control group) was subjected to a post-placental intrauterine device (Copper T380) during cesarean section using a conventional manual method; Group (B) (Study group): the IUD (Copper T380) was placed at the top of the uterine fundus using a new technique (intra-cesarean post placental introducer withdrawal IUD insertion technique).ResultsThere was a significant statistical difference between the two groups regarding displacement of the IUDs at the end of puerperium, at 6 months, non-visibility of IUD threads, and continuation of use with p-value < 0.05. There was no significant statistical difference in the term of duration of surgery.ConclusionThe new technique of post-placental IUD insertion can be the standard technique of intra-cesarean section IUD insertion as it is associated with more favorable outcomes among the included women in the form of lower incidence of IUD displacement, non-visibility of IUD threads, and higher rates of continuation without increasing the duration of surgery as compared with the conventional manual technique.Trial registrationClinicalTrial.gov ID: NCT05788354, registration date: 28/03/2023 (retrospectively registered).

Postpartum contraception: A matter of guidelines.

The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin-only pill postpartum in non-breastfeeding women (category 1). Differences are found in women who breastfeed. In non-breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high-income countries. Postpartum contraception is not a 'matter of guidelines': it is the best customization for each woman, as early as possible but at the ideal timing.

Statement of Retraction [Post-placental intrauterine device insertion vs puerperal insertion in women undergoing caesarean delivery in Egypt: a 1 year randomised controlled trial

This article refers to:RETRACTED ARTICLE: Post-placental intrauterine device insertion vs puerperal insertion in women undergoing caesarean delivery in Egypt: a 1 year randomised controlled trial

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

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

Incidence of Post-Placental IUD Expulsion in Women of Childbearing Age

Background:The United States Medical Eligibility Criteria for Contraceptive Use and the American College of Obstetricians and Gynecologists recommend insertion of an Intra Uterine Device (IUD) immediately after delivery, due to the low complication rate. Postplacental IUD insertion is the insertion of an IUD immediately after delivery of the placenta during vaginal delivery. This method serves to reduce the number of births. However, post-placental insertion is believed to have a high expulsion rate. which is around 2-27%Purpose : To analyze and summarize the results of one study with another regarding the incidence of postplacental IUD expulsion in women of childbearing ageMethod:The research method used is literature review by searching for articles related to the theme taken from several search engines namely Pubmed, and Google Scholar and Search is done using the keyword IUD expulsion, Postplacental, women of childbearing age.Results: the installation of post placental IUDs has the opportunity to experience an expulsion eventConclusion: From all the journals that have been reviewed It can be concluded that the installation of post placental IUD has the opportunity to experience an expulsion event.

Uptake of postplacental intrauterine device placement at cesarean delivery

Several studies have investigated the effectiveness of intrauterine device placement at cesarean delivery as a contraceptive method. However, national-level use and outcomes of a postplacental intrauterine device at cesarean delivery are currently understudied in the United States. This study aimed to examine the trends, characteristics, and outcomes of patients who received a postplacental intrauterine device at cesarean delivery. This retrospective cohort study used the National Inpatient Sample. The study cohort included patients who underwent cesarean delivery from October 2015 to December 2018. The exclusion criteria included hemorrhage, chorioamnionitis, uterine anomaly, hysterectomy, and permanent surgical sterilization. Eligible cases were grouped on the basis of the use of a postplacental intrauterine device at cesarean delivery. The primary outcome measures were temporal trends and characteristics associated with the use of a postplacental intrauterine device at cesarean delivery, assessed using the generalized estimating equation model in multivariable analysis. The secondary outcome measure was perioperative morbidity (leukocytosis, endometritis, myometritis, and sepsis). Propensity score matching was used to balance the baseline characteristics. Among 2,983,978 patients who met the inclusion criteria, 10,145 patients (0.3%) received a postplacental intrauterine device at cesarean delivery. The use of a postplacental intrauterine device increased from 0.1% in the fourth quarter of 2015 to 0.6% in the fourth quarter of 2018 (P<.001). In a multivariable analysis, the use of a postplacental intrauterine device increased by 14% every quarter-year (adjusted odds ratio, 1.14; 95% confidence interval, 1.13-1.15). In addition, (1) patient characteristics of young age, non-White race, obesity, tobacco use, lowest quartile median household income, and insured with Medicaid; (2) hospital characteristics of large bed capacity and urban teaching setting in Northeast region; and (3) pregnancy characteristics of early gestational age at cesarean delivery, hypertensive disease, previous cesarean delivery, multifetal pregnancy, grand multiparity, placenta previa, and nonelective cesarean delivery represented the independent characteristics associated with the use of a postplacental intrauterine device (all P<.05). A regression tree model identified 35 discrete patterns of the use of a postplacental intrauterine device based on 8 factors (time, race or ethnicity, primary expected payer, obesity, hospital bed capacity, hospital teaching status, hospital region, and previous cesarean delivery). There were 9 patterns, representing 8.8% of the study population, exhibiting a use rate of ≥1.0%, whereas there were 7 patterns, representing 16.0% of the study population, exhibiting no use of a postplacental intrauterine device (absolute rate difference from the highest group to the lowest group, 4.7%). In a propensity score-matched model, postplacental intrauterine device placement at cesarean delivery was not associated with increased risk of measured morbidity (any, 1.8% vs 1.7%; odds ratio, 1.06; 95% confidence interval, 0.66-1.69; P=.812), including postpartum endometritis (1.2% vs 1.0%; odds ratio, 1.19; 95% confidence interval, 0.67-2.14; P=.554). The use of a postplacental intrauterine device at cesarean delivery increased significantly in recent years in the United States.

Comparison between two methods of the immediate post-placental insertion of copper intrauterine device in vaginal birth—a protocol for a randomized clinical trial

BackgroundEnsuring effective and long-term contraception in the immediate postpartum period is an effective strategy for reducing unplanned pregnancies. In the meantime, the intrauterine device (IUD) is an excellent option. The aim of our study was to evaluate the best way to insert post-placental IUDs in the immediate postpartum period. Discomfort during insertion, expulsion rate, uterine perforation rate, and proper positioning 40–60 days postpartum will be analyzed.MethodsRandomized, controlled, open clinical trial. The study group will be composed of women between 18 and 43 years old who are admitted for vaginal birth at the Women’s Hospital of the State University of Campinas and who wish to use the IUD as a contraceptive method. The sample will be randomized into two insertion groups: manual and forceps. To calculate the sample size, the method of comparing the proportion between 2 groups was used, setting the level of significance alpha at 5% (alpha=0.05) and the power of the sample at 80% (beta=0.20). Based on the results, it was estimated that a sample of n=186 women (n=93 with manual insertion and n=93 with forceps) would be representative for comparison of expulsion between the 2 groups. All participants will undergo a postpartum consultation 40–60 days after birth with transvaginal ultrasound to assess the proper placement of the IUD.DiscussionInsertion of an IUD in the immediate postpartum period has been considered a good option to increase coverage and access to contraception, and its benefit outweighs the inconvenience of a higher expulsion rate.Trial registrationThis study was approved by the Ethics and Research Commission of UNICAMP (CAAE: 50497321.4.0000.5404) and the Brazilian Registry of Clinical Trials (REBEC) (number RBR-4j62jv6). This is the first version of the study protocol approved on 11/12/2021 prior to the start of participant recruitment.

Infectious outcomes following immediate postplacental intrauterine device placement in the setting of chorioamnionitis: An exploratory, retrospective study

ObjectiveTo evaluate infectious outcomes following postplacental intrauterine device (PPIUD) placement in patients with suspected chorioamnionitis. Study designThis retrospective cohort study identified individuals desiring PPIUD who subsequently developed suspected chorioamnionitis, treated with antibiotics. We followed 12-month infectious outcomes amongst two cohorts: (1) those who received PPIUD and (2) those with placement deferred. ResultsOf 55 followed, 18 of 22 PPIUDs were placed before chorioamnionitis was suspected; 33 placements were deferred. Neither group experienced acute infectious complications. Notably, IUDs were more often deferred when chorioamnionitis was more clearly diagnosed (20/33, 60.6% vs 4/22, 18.2% p < 0.01). Overdiagnosis of chorioamnionitis prevented IUD uptake in 10 of 55 (18.2%) individuals in this sample. ConclusionsPPIUD placement in individuals with early signs of chorioamnionitis may not result in severe morbidity, in a study limited by sample size. Larger, prospective studies are needed in well-defined cohorts. ImplicationsIncidental, immediate postplacental IUD placement in individuals with treated, suspected chorioamnionitis was not associated with severe morbidity within 1-year postpartum. Larger-scale, prospective studies are needed to guide the management of incidentally-placed, postplacental IUDs in the setting of mild chorioamnionitis.

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

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

Factors Related to Willing Mom for Post Placenta IUD Installation

The most ideal contraception for postpartum mothers childbirth and breastfeeding is not suppressing the production of breast milk, namely the Intra Uterine Device (IUD). The purpose of this study was to determine the factors associated with the mother's willingness to insert a post-placental IUD. This research is a quantitative research using the dynamics of correlation between phenomena with a cross sectional study design . The population in this study were all pregnant women over 30 weeks in April. The sample of this research was 47 pregnant women with gestational age above 30 weeks which were taken from the total sampling technique . Based on the results of the chi square statistical test with a 95% confidence level (α = 0.05) it was found that there was a significant relationship between knowledge (P 0.000), attitude (P 0.002), husband's support (P 0.001), mother's interest (P 0.001) , the support of health workers (P 0.001) with the mother's willingness to insert a post-placental IUD. It is hoped that mothers will be able to participate in the use of contraceptives.

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

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

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.

Clinical Outcomes of Incidental, Postplacental Intrauterine Device Placement in the Setting of Chorioamnionitis [A26

INTRODUCTION: This case-control study reviews complications and contraceptive outcomes following incidental, immediate post-placental intrauterine device (IUD) placement in the setting of chorioamnionitis (CDC contraindication category 4), versus waiting to receive an interval IUD per standard guidelines. METHODS: We conducted an institutional review board (IRB)-compliant retrospective chart review of individuals delivering an infant and desiring an IUD for postpartum contraception in the setting of chorioamnionitis (2015-2020). We collected demographics, histopathologic confirmation of chorioamnionitis, timing of IUD placement, duration of use, short term outcomes/complications (e.g., worsening infection), and long-term outcomes/complications (e.g., IUD retention, IUD expulsion, pelvic inflammatory disease). Data were compared between individuals receiving post-placental IUDs and those waiting to receive outpatient, interval IUDs. We conducted phone interviews to validate and follow-up on medical record data. RESULTS: Fifty-five individuals with chorioamnionitis desired an IUD for postpartum contraception (mean age: 27 years, gestational age at delivery: 39 weeks); 25% provided phone interviews. Nearly half (45%) of clinician-diagnosed chorioamnionitis was confirmed on histopathology. Among IUD recipients (22 post-placental, 10 interval), four re-presented with five complaints (one vaginal discharge, three pelvic pain, one IUD malposition). Incidence of re-presentation did not differ by timing (P=.77) or presence (P=.91) of IUD. Individuals who received a post-placental IUD were significantly more likely (P&lt;.01) to have their IUD in place at 12 months than those intending to receive a post-partum interval IUD. CONCLUSION: No severe complications occurred among individuals receiving a post-placental IUD in the setting of chorioamnionitis. Recipients of immediate versus interval IUDs were more likely to have an IUD at 1 year follow-up.