Outcome Of Immediate PPIUCD At Follow Up Visit In Women At A Tertiary Care Hospital In Karachi, Pakistan
DOI:
https://doi.org/10.51985/JBUMDC2018100Keywords:
Complications, contraception, efficacy, Postpartum IUCD, safetyAbstract
Objective: To evaluate the outcome of Immediate Post Partum Intrauterine Contraceptive device (PPIUCD) insertion
among married women of reproductive age at a tertiary care Creek General Hospital, Karachi, Pakistan.
Study Design: Prospective Interventional study.
Methodology: The clinical study was conducted in department of Obstetrics & Gynaecology, Creek General hospital
Karachi from August 2015 to July 2016. One hundred and twenty five women were selected for immediate PPIUCD
insertion, however the result was analysed for hundred women as twenty five were lost to follow-up. PPIUCD was inserted
within 10 minutes of delivery of placenta. Follow up was done at 6 weeks, the primary outcome measures were the clinical
outcomes in terms of safety (irregular vaginal bleeding, abnormal vaginal discharge, infection and perforation) and efficacy
(un-descended IUCD strings, expulsion, discontinuation and pregnancy). The results were analyzed by SPSS data analysis
software (IOBM).
Results: Among hundred women in whom PPIUCD was inserted and returned for follow-up, majority (44%) were in age
group 26-30 years; around 52% had primary or less education, and considerably high (84%) belonged to the low socio
economic status. Moreover, majority (46 %) had 3 or more alive children. Importantly, 73% women had IUCD inserted
after vaginal delivery. As safety was evaluated, irregular vaginal bleeding was observed in 15%, abnormal vaginal discharge
(20%), infection (11%), abdominal pain (4%) and perforation in only 1% of cases. Finally, in terms of efficacy the undescended
IUCD strings were observed in 7%, expulsion incidence (6%), discontinuation requested by (5%) and none of
the case ended up in pregnancy.
References
Pakistan economic survey 2014- 2015. Population, Labor Force and Employment Ministry of Finance, Available at: www.finance.gov.pk/survey/chapters_15/ 12_Population.pdf
National Institute of Population Studies Pakistan (NIPS) and Macro International Incorporated (2013) Pakistan demography and health survey report. Pakistan Demographic and Health Survey 2012-2013. Available at: http://www.nips.org.pk/ abstract_files/PDHS%20Final%20Report%20as%20of%20Jan%2022-2014.pdf.
Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. The Lancet. 2006; 368(9549):1810-27.
Rutstein SO. Further evidence of the effects of preceding birth intervals on neonatal infant and under-five-years mortality and nutritional status in developing countries: Evidence from the Demographic and Health Surveys. Macro International. 2008; 41.
Kathpalia SK, Mustafa MS. Awareness about postpartum insertion of intrauterine device among antenatal cases. Med J Armed Forces Ind. 2015; 71(3):221-4.
Marston C. Report of a WHO Technical Consultation on Birth Spacing Geneva Switzerland 13-15 June 2005. Available at: http://www.who.int/maternalÿchildÿadolescent /documents/birthÿspacing.
Valliappan A, Dorairajan G, Chinnakali P. Postpartum intrauterine contraceptive device: Knowledge and factors affecting acceptance among pregnant/parturient women attending a large tertiary health center in Puducherry, India. Int J Adv Med Health Res. 2017; 4(2):69.
Katheit G, Agarwal J. Evaluation of post-placental intrauterine device (PPIUCD) in terms of awareness, acceptance, and expulsion in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2016; 2(4):539-43.
Verma A, Chawla I. A follow up study of postpartum intrauterine device insertion in a tertiary health care centre. Int J Reprod Contracept Obstet Gynecol. 2017; 6(7):2800-5.
Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Women's health. 2010; 2:211.
Byrd JE, Hyde JS, DeLamater JD, Plant EA. Sexuality during pregnancy and the year postpartum. J Fam Pract. 1998; 47(4):305-9.
Suri V. Post placental insertion of intrauterine contraceptive device. Indian J Med Res. 2012; 136(3):370.
Elahi N, Koukab H. Diagnosis and management of lost intrauterine contraceptive device. JPMA 2002; 52: 18-21.
Mustafa R, Qamar H, Nasreen K. Immediate Post-Placental Insertion versus Interval Insertion of Intrauterine Devices for Contraception. JBUMDC 2015; 5(2): 77-80.
Hooda R, Mann S, Nanda S, Gupta A, More H, Bhutani J. Immediate postpartum intrauterine contraceptive device insertions in caesarean and vaginal deliveries: a comparative study of follow-up outcomes. Int J Rep Med. 2016.
Goldstuck ND, Steyn PS. Insertion of intrauterine devices after cesarean section: a systematic review update. Int J Women's health. 2017; 9: 205-12.
Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Millennium Development Goals indicators. Available at: http://mdgs.un.org /unsd/ mdg/ Data.aspx
Jairaj S, Dayyala S. A cross sectional study on acceptability and safety of IUCD among postpartum mothers at tertiary care hospital, Telangana. J Clin Diagn Res 2016; 10:1-4.
Mohamed SA, Kamel MA, Shaaban OM, Salem HT. Acceptability for the use of postpartum intrauterine contraceptive devices: Assiut experience. Med Princ Pract 2003; 12:170-5.
United Nations Population information network (POPIN), UN Population division, Department of Economic and Social Affairs with support from UN Population Fund. Network Intrauterine devices. Fam Health Int. 1996; 16(2).
Shukla M, Sabuhi Qureshi C. Post-placental intrauterine device insertion-A five year experience at a tertiary care centre in north India. Indian J Med Res. 2012; 136(3):432.
Gupta G, Goyal R, Kadam VK, Sharma P. The Clinical Outcome of Post Placental Copper-T-380A Insertion with Long Placental Forceps (Kelly’s Forceps) After Normal Vaginal Delivery and Cesarean Section. J of Obstet & Gyne Ind. 2015; 65(6):386-8.
Mishra S. Evaluation of safety, efficacy, and expulsion of post-placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD). J of Obstet & Gyne Ind. 2014; 64(5):337-43.
Araujo VB, Ortiz L, Smith J. Postpartum IUD in Paraguay. A case series of 3000 cases. Contraception. 2012;86(2):173-4.
Kumar S, Sethi R, Balasubramaniam S, Charurat E, Lalchandani K, Semba R, Sood B. Women’s experience with postpartum intrauterine contraceptive device use in India. Rep health. 2014;11(1):32.
Gupta V et al,. A Rare case of Perforation following PPIUCD insertion. J Obstet Gynaecol India. 2016;66(4):292-4.
Çelen Þ, Sucak A, Yýldýz Y, Danýþman N. Immediate postplacental insertion of an intrauterine contraceptive device during cesarean section. Contraception. 2011;84(3):240-3.
Ragab A, Hamed HO, Alsammani MA, Shalaby H, Nabeil H, Barakat R et al. Expulsion of Nova-T380, Multiload 375, and Copper-T380A contraceptive devices inserted during cesarean delivery. Int J Gynaecol Obstet. 2015;130(2):174-8.
Ali R, Kausar S, Akram A. Post-placental Intrauterine Contraceptive Device at Cesarean Section. APMC 2015; 9(4):189-93.
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