Publication:

A cross-sectional study to evaluate the safety and efficacy of post-placental and intra-cesarean insertion of intrauterine contraceptive device

Background India’s growing population necessitates effective postpartum contraceptive methods to reduce unintended pregnancies and to improve reproductive health outcomes. Postpartum intrauterine contraceptive devices (PPIUCDs) offer a reversible, long-term solution, but insertion timing- post-placental or intra-cesarean may affect their safety and efficacy. Objective was to compare the safety and efficacy of post-placental versus intra-cesarean insertion of IUCDs among postpartum women in a tertiary care hospital in Assam, India.

Methods This prospective observational study enrolled 210 postpartum women from June 2023 to May 2024 at the Fakhruddin Ali Ahmed Medical College and Hospital, Assam. Eligible participants underwent either post-placental or intra-caesarean insertion of CuT 380A IUCDs. Data on demographics, complications, and continuation status were collected at six months post-insertion. Statistical analysis was done using appropriate statistical tests.

Results Participants’ mean age was 28±4.1 years; 79.5% were primipara. Continuation rates of PPIUCD was 77.6%, with 26.4% and 19.3% discontinuing in the post-placental and intra-caesarean groups, respectively. Expulsion rates were higher in the post-placental group (15.4%) compared to intra-caesarean (1.7%) (p<0.001). Complications included excessive bleeding, pain, missing thread and expulsion. Factors such as age, parity, and insertion type influenced continuation, with multiparous women and intra-caesarean insertions demonstrating higher retention rates.

Conclusions Intra-caesarean IUCD insertion is associated with lower expulsion rates and comparable continuation rates compared to post-placental insertion. Addressing social barriers and managing complications can further enhance PPIUCD utilization. These findings can help to design strategies for improving family planning interventions in similar settings.