ABSTRACT
Background & objectives: Postpartum intrauterine contraceptive device (PPIUCD) is well accepted and recommended for contraception. However, anxiety at the time of delivery may restrict the acceptance of a PPIUCD for its immediate insertion. So far there is limited evidence to conclude anything concrete on the association between the expulsion rates and the timing of insertion following a vaginal delivery. Thus, this study was undertaken to compare the expulsion rates in immediate and early insertions and their safety and complications. Methods: This prospective comparative study was carried out over 17 months on women delivering vaginally in a tertiary care teaching hospital in South India. A copper device (CuT380A) was inserted using Kelly’s placental forceps either within 10 min of placental delivery (immediate group, n=160) or between 10 min upto 48 h postpartum (early group, n=160). Ultrasound was done before discharge from the hospital. The expulsion rates and any other complications at six-week and three-month follow up were studied. Chi-square test was used to compare the difference in expulsion rates. Results: The expulsion rate was five per cent in the immediate compared to 3.7 per cent in the early group (no significant difference). In ten cases, the device was found to be in the lower uterus upon ultrasound before discharge. These were repositioned. There was no case with perforation, irregular bleeding or infection up to the three-month follow up. Higher age, higher parity, lack of satisfaction and motivation to continue were predictors of expulsion. Interpretation & conclusions: In the present study PPIUCD was found to be safe with overall expulsion in 4.3 per cent. It was marginally, though not significantly, higher in the immediate group.
ABSTRACT
Background: In India almost 65% of the women have an unmet need for family planning in the first postpartum year. Increasing rates of institutional deliveries creates an opportunity for providing quality post-partum family planning services. Post-partum Intrauterine contraceptive device (PPIUCD), a form of long acting reversible contraception (LARC) is one of the most affective and safest method available. The present study aims at evaluating the safety, efficacy, rate of acceptance and rate of discontinuation of Intra caesarean inserted contraceptive device Copper T-380A.Methods: This was a prospective study conducted at ESIC Medical College, Sanathnagar in women delivered by caesarean section during the period between March 2018 to February 2019. Recruitment was done based on the WHO medical eligibility criteria (MEC) for PPIUCD and also their willingness to participate in the study. Follow-up visits were scheduled at 6 weeks, 3 months and 6 months.Results: Of the 265 women fulfilling the WHO MEC, 180 (67.92%) were willing to participate in the study. Total acceptance rate was 67.7%. Majority of them belonged to the age group 21-30 years (80%) and para 2 (53.88). 93.3% of the women were literates. 12 (6.66%) cases lost to follow up and the complications were studied in the rest 168 women. During follow up -38.69% had missing strings, 12.5% menstrual disturbances, 4.76% abdominal pain and spontaneous expulsion in 4.1%. No cases of perforation and pregnancy were reported. Total continuation rate was 84%.Conclusions: PPIUCD is a safe and convenient option of contraception with low expulsion rates and high continuation rates.
ABSTRACT
Objective: To evaluate and study the demographic and clinical profile among the users of these 2 different contraceptive methods, to assess the continuation rates of these 2 methods as well as the frequency of Pap smear screening plus the resultsof Pap smears in each contraceptive method. Methods: This was a case note-based study in which the data were transferred to a standardized pre-tested proforma. Results: During 1 January - 31 December 2001 There were 162 Copper T 380 A users and 307 Norplant 6 users. The age group of IUD users were found higher than Norplant-6 users with a statistical difference. The continuation rates after 5 years were 39.5% for copper T 380 A and 11.4% for Norplant users. The frequency of Pap smear screening as well as the follow up rate was found much higher in copper T 380 A. The results of Pap smear of these two groups using long-acting contraception were statistically different : IUD users had a higher infection rate but Norplant users had higher abnormal cells. After treatment all users return to normal Pap smear. Conclusion: This contraceptive study was conducted in 2001. The continuation rate for copper T 380 A was significantly higher than Norplant 6 and encouraged the participants to have Pap smear screening as well as keeping the appointment for follow up. The report of Pap smear screening was found abnormally higher in the Norplant users. Actinomyces infection was commonly found with copper T 380 A.