Publication:

Immediate postpartum intrauterine contraceptive device insertion: a prospective follow up study

Background India’s population of over 1.2 billion is slated to overtake China as the world’s most populous country, in less than one and a half decade. This population size is more than the population of USA, Brazil, Bangladesh, Pakistan, Indonesia and Japan put together. Family planning is important not only for population stabilization, but it has been increasingly realized that family planning is central to improve maternal and newborn survival and health.Family planning can avert more than 30% of maternal deaths and 10% of child mortality if couples spaced their pregnancies more than 2 years apart (Cleland J et al, 2006). In 1951, India was the world’s first nation when Government of India (GoI) launched a family planning programme. Postpartum women who breastfeed their infants can also use Cu IUCD safely, as it does not interfere with breastfeeding. Postpartum IUCD can be inserted immediately after vaginal delivery, during caesarean section and up to 48 hours after birth, before women get discharged from the health facilities. The objectives of this study was The study was conducted to assess the safety, efficacy, and acceptance and follow up of PPIUCD insertion in women delivering vaginally and during caesarean within 48 hours postpartum.

Methods This prospective study was carried out in a tertiary care hospital, Government Raja Mirasdhar hospital, Thanjavur where the number of deliveries per month is more than 1000.The study period was from 01 January 2015 to 30 June 2015 for the period of 6 months. The IUCD was inserted for all the women who fulfill the criteria for PPIUCD insertion. Women with chorioamnionitis, extreme birth canal injuries, unresolved PPH, more than 18 hours from rupture of membranes to delivery of baby were excluded from the study. Clients were counseled during the routine antenatal visits. Post insertion counseling given at 6 weeks and at 6 months during the follow up visits. Clients were advised to come for follow up to assess their satisfaction, acceptance, expulsion rate and complications. During follow up visits per speculum examination done to assess the descent of IUCD strings in to the vagina. USG performed in whom strings were not visible.

Results A total of 3046 women were included in the study. 1966 Insertions were done after vaginal delivery, 450 insertions done during caesarean and 630 were within 48 hours. The follow up rate at 6 weeks was 70% and40% at 6 months. There were no complications. The expulsion rate at 6weeks is 6% and at 6 months is 5%.The removal rate was 5% at 6 weeks and 6% at 6 months. The continuation rates were 90% At 6 weeks and 80% at 6 months.

Conclusions This study concludes that immediate postpartum insertion is safe and effective. However the expulsion rate for immediate PPIUCD is slightly higher than the interval insertion. Since most women resume sexual activity by 2 to 4 weeks postpartum, in order to avoid the risk of unintended pregnancy immediate postpartum insertion is a good opportunity for the delivering women who are not willing for permanent sterilization and willing for temporary method of contraception.