Global Journal of Medical Research, E: Gynecology and Obstetrics, Volume 21 Issue 3

Immediate Postpartum Insertion of Intrauterine Contraceptive Device after Vaginal Delivery: It’s Safety, Efficacy and Expulsion Heena Kaurani α , Suhail Iqbal σ & Nidhi Golecha ρ Abstract- Background: India is the second most populated country in the world with 1.32 billion people. It contributes 17.5% of the world’s population by adding 25 million births annually. Family planning with adequate spacing between the pregnancies can prevent about 32% of maternal deaths and 10% of child mortality. Postpartum period is the ideal time for family planning. Pregnancies with less than the recommended spacing can lead to obstetric complications like spontaneous abortion, preterm labour, postpartum haemorrhage and maternal mortality and fetal complications like SGA babies and fetal deaths. Hence practice of contraception is mandatory. Among the options available, Cu T 380A is the most cost effective, safe, rapidly reversible, long acting, coital independent method of contraception with relatively few side effects. Aims and Objectives: To evaluate the safety, efficacy and expulsion rate of immediate postpartum intrauterine contraceptive devices (PPIUCD). Materials and Methods: This is a prospective observational study to assess the safety and efficacy of PPIUCD use in women inserted immediately (within 48 hours) after vaginal delivery. The study was conducted at Department of Obstetrics & Gynecology, Jhalawar Medical College, Jhalawar over a period of one year from November 2018 to October 2019. Ethical approval for the study was obtained from hospital ethical committee prior to the commencement of the study. 203 women delivering in the hospital fulfilling the inclusion criteria were included in the study. Postpartum insertion of IUCD Cu T 380A was done under sterile conditions and antibiotic coverage to ensure asepsis in the mother. Informed written consent was taken from mother before insertion after elaborating the possible complaints following insertion and reassurance. Result: In this study, acceptance of PPIUCD was more in educated and multipara women with having at least one male child. The gross cumulative removal, expulsion and continuation rates were 7.9%, 12.8% and 68.9%.There was one case of pregnancy with IUCD in situ and no cases of perforation or other major complications were noted. Conclusion: PPIUCD is a safe because there were only few complications and no case of perforation. It is also effective because there was only one case of IUCD failure which results Corresponding Author α : Department of Obstetrics and Gynaecology, Dr. Sampurnannd Medical College, Jodhpur, Rajasthan, India. e-mail: heenakaurani222gmail.com Author σ : Department of Obstetrics and Gynaecology, Government Medical College, Baramulla, Jammu and Kashmir, India. Author ρ : Department of Obstetrics and Gynaecology, Jhalawar Medical College, Jhalawar, Rajasthan, India. in pregnancy. Although the expulsion rates are high, it provides an effective contraception in countries with limited access to health care personnel. Keywords: postpartum intrauterine contraceptive device (PPIUCD), contraception, expulsion. I. I ntroduction ndia is the second most populated country in the world with 1.32 billion people. It contributes 17.5% of the world’s population by adding 25 million births annually. Family planning with adequate spacing between the pregnancies can prevent about 32% of maternal deaths and 10% of child mortality. 1 Postpartum period is the ideal time for family planning. Pregnancies with less than the recommended spacing can lead to obstetric complications like spontaneous abortion, preterm labour, postpartum haemorrhage and maternal mortality and fetal complications like SGA babies and fetal deaths. 2-8. Hence practice of contraception is mandatory. In countries like India, the only time a healthy woman contacts a health care provider is during delivery. With the increased number of institutional deliveries, due to provision of Janani Suraksha Yojana- a cash transfer scheme there is increased access to the pregnant women for promoting family planning services. In the immediate postpartum period, the insertion of intrauterine device is convenient and these women are highly motivated. The postpartum IUCD insertion is particularly suitable for our country where even para medical personnel can insert the Cu T and delivery is the only time these patients come in contact with the hospital. The intra uterine device is highly effective, safe, long acting, coitus independent and cost effective 9 method of contraception with relatively few side effects and fertility returns quickly as soon as it is removed. 10- 14 This study helps to determine the socio economic and demographic factors associated with immediate postpartum insertion of copper T and it also helps to determine the complications. II. M aterial and M ethods This is a prospective observational study to assess the acceptability, safety, efficacy and outcome of PPIUCD use in women inserted immediately after vaginal delivery. The study was conducted at I 21 Year 2021 Global Journal of Medical Research Volume XXI Issue III Version I ( D ) E © 2021 Global Journals