Publication:

Long term clinical outcome of intra caesarean intrauterine contraceptive device insertion

Background Adequate spacing following caesarean section prior to next pregnancy will decrease maternal and neonatal complications. Unmet need of contraception is still high in our country. Motivating women for intra caesarean copper T insertion will decrease the incidence of unintended pregnancies. Postpartum intra uterine contraceptive device (PPIUCD) insertion is an effective, long-term, reversible, nonhormonal contraceptive, best suited for Indian women. This study aims to evaluate long term complications like bleeding, pain, expulsion rate, perforation, infection, missing strings and continuation rate.

Methods This prospective observational study was carried out in a tertiary care hospital in Chennai, between January 2012-June 2015. CuT 380A was inserted immediately following placental delivery in caesarean section. They were followed up at the time of discharge, at 6 weeks, then at 6 monthly intervals till 30months.

Results A total of 235 PPIUCD acceptors were followed up for 30 months. Most of our acceptors are primipara group (n=156, 66.4%). Continuation rate is high 84.7% (n=199) at the end of 30 months. Expulsion rate was 2.55% (n=6), bleeding in 8.5% (n=20), pain in 8.9% (n=21) and infection in 0.85% (n=2) of acceptors. Removal rate at 30 months was 12.7% (n=30), majority of the removal was for opting to go for permanent method of sterilization (n=117, 7.2%), followed by planning next pregnancy (n=6, 2.55%). Pain was the cause for removal in only 0.67%, bleeding in 1.67%. Missing strings were observed in 11.9% (n=28), of which ultrasound confirmed in situ uterine cavity location in 22 acceptors.

Conclusions Intra caesarean IUCD insertion is a safe and effective method of contraception for spacing with high continuation rate, low expulsion and complication rates.