Evaluation of Safety, Efficacy, and Expulsion of Post-Placental and Intra-Cesarean Insertion of Intrauterine Contraceptive Devices (PPIUCD)

Abstract

Background: This study examines to describe the factors associated with acceptability of immediate PPIUCD insertion in women according to their socio-demographic and obstetrics characteristics, and future pregnancy desires and to determine the rates of uterine perforation, expulsion, pelvic infection, lost strings and displacement following PPIUCD insertion among the acceptors by 6 to 18 months.

Aim: An intrauterine device (IUD) is an effective form of Long Acting Reversible Contraception. Present study is aimed at determining the safety, efficacy, and expulsion of Post-placental and intra-cesarean insertion of Intrauterine contraceptive device (PPIUCD).

Materials & methods: The study was conducted at District Head Quarters Hospital, Bolangir, Odisha, India. From 1st. January 2012 to 31st. December 2012. Women admitted and delivered at D.H.H. Bolangir, were counseled. CuT 380A was inserted within 10 minutes of delivery of placenta in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications for PPIUCD. They were followed up till 30th June 2013.

Results: Total women counseled 3209, Accepted 564, Declined 2645, lost to follow up 130, Followed up 434, COMPLICATIONS: 190 (Expulsion 39, Bleeding 102, String problem 49), Removal 43, Continuation 352.

Conclusions: The PPIUCD (Inserting CuT 380 A by 10 minutes after placental delivery) was demonstrably safe, effective, has high retention rate. The expulsion rate was not very high and it can be reduced with practice. With the high level of acceptance despite low levels of awareness, the government needs to develop strategies to increase public awareness of the PPIUCD through different media sources. It is also important to arrange training on PPIUCD in order to increase knowledge and skills among healthcare providers. This will also further promote PPIUCD use and aid in reduction of the expulsion rates. Cash incentives to the accepter, motivator and of course provider would bring about a substantial progress in the PPIUCD use in developing countries like India.

Keywords: Intracesarean insertion; Intrauterine device; Intrauterine device insertion; Postpartum contraception.

Fig. 1

Recruitment of participants and summary of findings