Publication:

A randomized study for two techniques of immediate post-partum intrauterine contraceptive device insertion in India

Background Postpartum women are susceptible for unintended pregnancy in the first postpartum year. They should be counselled by cafeteria approach and those who opt for Postpartum Intrauterine Contraceptive Device (PPIUCD), it should be inserted in the same sitting. Aims of current study were to compare 1) The technical feasibility in terms of client discomfort, immediate expulsion, perforation and time taken in insertion of the two insertion techniques, Manually vs Kelly's placental forceps. 2) The complications of the two techniques of insertion. 3) The expulsion rates at 1, 3 and 6 months.

Methods This was a randomized study in which 150 women were recruited. Group A had 75 subjects and insertion of PPIUCD was done manually. Group B had 75 subjects and insertion was done with Kelly’s placental forceps.

Results There was no statistically significant difference in the mild discomfort during insertion by either technique. Time taken for insertion was significantly lower in group A. The combined expulsion rate (spontaneous complete expulsion and partial expulsion) at the end of 6 months was 11.9% in group A and 10.5% in group B (not statistically significant). Pain (16% in group A and 12% in group B) was the most common problem encountered by IUD users followed by menstrual problems (10.7% in group A and 8% in group B). There was no significant difference in the complication rate for the two groups (P >0.05).

Conclusions Manual technique of insertion of PPIUCD is equally good as compared to Kelly’s placental forceps and it has no economic implications for purchasing and maintenance.