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Background: Post-partum family planning is prevention of unintended and closely spaced pregnancies during first 12 months following childbirth. Postpartum IUCD is the best method of all as it is the safest, most effective, has no effect on breast feeding, reliable and with minimum complications.Methods: The cross-sectional study was conducted in AIMSR Bathinda on 400 postpartum patients. It was a prospective, observational study of women who received PPIUCD in our region.Results: Out of total 400, 58% had normal vaginal delivery and 42% had cesarean section. PPIUCD was done in all cases after applying exclusion criteria and the females were called for follow up. 53% cases who had cesarean and 47% of normal vaginal delivery turned up for follow up. Acceptance is more in multipara (20.7%) than in primi patients (13.7%). Almost 90% patients had good continuation rate. There were few problems faced by patients like irregular bleeding for first few months, pain lower abdomen, leucorrhea etc. which were removed by good counseling and some treatment like NSAIDs for bleeding.Conclusions: The acceptance of PPIUCD was high in present study in both types of females delivered by normal vaginal delivery or post LSCS but with good counseling efforts. It was safe and effective and had high retention rate when done at good timing by trained service provider that is within 10 minutes of placental delivery. So the need of time is creating awareness of public towards it and removing fear from minds, breaking taboos and myths.
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Background: The acceptance for PPIUCD in our country, especially in rural areas is very low despite all the efforts. Counselling during the antenatal visits may play a vital role in improving the acceptance of PPIUCD. Objective of this study was to assess the factors associated with the acceptability of immediate PPIUCD insertion in women; counselled during antenatal and postpartum period; according to their sociodemographic and obstetric characteristics, and future pregnancy desires.Methods: One-year prospective study carried out in the department of obstetrics and gynecology, S. S. Medical College Rewa, Madhya Pradesh, India. a total of 4850 women were counselled for PPIUCD insertion; 2540 during their antenatal visits, and 2310 during postpartum period who visited in study centre for first time and their follow up was done. Chi square tests were applied to compare proportions.Results: After antenatal counselling in 2540 women, (with multiple counselling sessions) about half of the women gave verbal acceptance for PPIUCD. However, during postpartum counselling in 2310 women, (where only single short session of counselling could be done) majority of the women declined (80.9%) for PPIUCD insertion with only about a fifth (19.1%) of the women giving verbal acceptance. Women who had antenatal counselling one third of them had PPIUCD insertion. In the postpartum counselling group, a meagre 15.1% women had PPIUCD insertion.Conclusions: Counselling during antenatal and postpartum period is the key to improve the awareness and acceptance of PPIUCD in our community. Multiple counselling sessions during antenatal visits make it easier for the women to slowly understand the process and accept PPIUCD as compared to the short counseling during postpartum period.
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Background: IUCD (intrauterine contraceptive device) to prevent pregnancy are among the oldest method of contraception. The modern IUCD are highly effective, safe private, long acting and rapidly reversible contraceptive method. Aims and objective of this study was to study the acceptability and safety of postpartum intrauterine contraceptive device (PPIUCD) in postpartum period and to assess the feasibility, safety, efficacy and expulsion rate of IUCD.Methods: A prospective observational study was conducted at tertiary care teaching hospital in Maharashtra from January 2018 to October 2018 and patients were followed up to a period of one-year post IUCD insertion.Results: Majority of patients in this study were in age group 21 to 26 years of age (58.7%) and the least number were in the age group more than 30 years (3.3%). This study showed that majority of patients were primigravida (44%) and the lowest number belonged to gravida 6 (0.3%). Regarding timing of IUCD insertion 73% were done intra caesarean, 22.3% were done post placental and 4.7% were done within 48 hours of delivery. In this study authors found that 4% of patients had per vaginal discharge, 5% had missing IUCD thread and 2% of patients had IUCD expulsion. It was found in this study that 98% of patients continued to use IUCD and only 2% discontinued the usage.Conclusions: From the study authors came to conclusion that PPIUCD insertion is a safe, feasible, effective and reversible method of contraception.
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Background: The choice of a contraceptive method is a complex decision. Health care providers have an important role in providing information and supporting patients' decision making about contraceptive choices through counselling. Non-use of contraceptive methods, use of less effective methods, and incorrect and inconsistent use of methods underlie the high frequency of unintended pregnancy. Prospective cross-sectional study was undertaken to study the role of peri-partum counselling in improving choice of postpartum contraception at Pravara Rural Hospital Loni, Ahmednagar, Maharashtra, India.Methods: Four hundred and fifty women in third trimester of pregnancy were individually counselled about the postpartum contraception, using educational material and pamphlets. The choice of postpartum contraception before and after the counselling was noted.Results: Among primi gravidas, the most favored choices for postpartum contraception before counselling were condom (25%) and lactational amenorrhea method (12%). In the same group of women, the post counselling choices were PPIUCD (45%), condom (17%) and interval IUCD (7%). Among multi-gravida, the most favored choices for postpartum contraception before counselling were postpartum tubal ligation (26%), condom (20%) and lactational amenorrhea method or calendar method (17%). In the same group of women, the post counselling choices were postpartum tubal ligation (32%) PPIUCD (12%), condom (8%).Conclusions: The study supports the usefulness of good quality counselling both with respect to the interpersonal relationship between the patient and the provider and quality of information that is provided during counselling. Postpartum intrauterine contraceptive device (PPIUCD), a long acting reversible contraceptive, will fulfil the felt need of postpartum contraception in near future.
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Background: The objective of this study was to study the acceptance rate, safety, demographic profile and complication of post placental intrauterine contraceptive device (PPIUCD).Methods: Study was prospective, interventional study, held in department of Obstetrics and Gynaecology at authors tertiary care centre. Number of participants was 280. Counselling about family planning was done in antenatal OPD and indoor ward. Total duration of study was 18 months. Selection of participants done based on selection criteria. Participants who accepted postplacental intrauterine contraceptive device as method of contraception followed up to 6 weeks postnatal for complication related to PPIUCD.Results: Authors noted that acceptance rate of PPIUCD was 13.6% and main reason for acceptance was its long acting reversible nature and main reason for denial was ‘do not want contraception immediately’. In present study there was statistically significant association between parity and birth order. However, literacy, urban locality and employment had positive influence over acceptance. If good technique of insertion will be used than expulsion rate will also reduce as seen in present study i.e. expulsion rate only 2.6 %.Conclusions: Post placental intrauterine contraceptive device is one of the best long acting reversible contraceptive methods. It does not affect breast milk production. Woman does not need extra visit to clinic for contraception and she is ensured that she has adequate contraception before getting discharge from hospital. PPIUCD provide adequate birth spacing between two children which reduces maternal and child morbidity.
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Background: To compare the effectiveness of postpartum intrauterine contraceptive device (PPIUCD) with interval IUCD in terms of effectiveness, expulsions, bleeding pain and other complications at Tertiary care Hospital.Methods: Current study was conducted among 224 women, at Gynaecology and Obstetrics of Reproductive Health Services-A (RHS-A) Centre of Jinnah Post Graduate Medical center, Karachi, for a period of Six months. Approval from Ethical committee and informed consent was taken from women and her husband before starting the study. The WHO medical eligibility criteria for contraceptive use (MEC) were followed and IUCD was inserted in 112 women in PPIUCD group and in 112 women in interval IUCD group. These cases were followed at 15 days, 6 weeks and 6 months. Results of PPIUCD group were compared with interval IUCDs group. Data was analyzed by using SPSS version 18.0. Continuous variables like age, parity, hemoglobin level were analyzed as mean±standard deviation. Frequencies and percentages were calculated for infection, expulsion, bleeding per vagina and effectiveness. Chi-square was applied to assess the difference between the categories. p value <0.05 was taken as significant.Results: The two groups were identical in mean ± SD age, parity, residence and baseline hemoglobin level. PPIUCD (Group-A) was more effective i.e., 87.5% as compared to interval IUCD (Group-B) i.e., 83.9%. Pain, PID, bleeding and expulsion of IUCD were more prevalent with interval IUCD (Group-B) than PPIUCD (Group-A) patients. Stratified analysis showed that age, parity & mean baseline hemoglobin were non-significant effect modifiers on the effectiveness among the two groups.Conclusions: Postpartum IUCD use was found to be a safe, simple, inexpensive and reversible procedure with higher chances of retention for a longer period. Additionally, there is decreased risk of complications and lower expulsion rates when compared with interval IUCD.
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Background: The objective of the study was to evaluate clinical outcome of insertion of post placental Cu T 380 A in women undergoing caesarean delivery.Methods: A prospective observational study was carried out in the department of obstetrics and gynecology, Dr RPGMC Kangra at Tanda (Rural Medical College) to evaluate the clinical outcome of post placental Cu T 380 A insertion in women undergoing caesarean section after taking approval of protocol review and institutional ethics committee of the institution. A total of 104 women delivering by caesarean section and wanting post-placental intra-caesarean Cu T 380 A insertion and who were meeting WHO standard medical criteria for PPIUCD insertion and were willing to comply with the study protocol was recruited for the study.Results: The present study showed that there were no major complications and only minor side effects were like pain, fever, discharge and irregular bleeding which were observed in only 5-15% of women during hospital stay and during follow up visit up to 6 months. String became visible in 72.12% of women at the 6 weeks follow up visit. The string visibility increased with time and at 6 months follow up stings became visible in 90.81% of the cases. Continuation rate was 100% at 6 weeks post-partum follow up. After that spontaneous expulsion occurred in 4 cases (3.84%) and another 4 women (3.84%) requested removal for various reasons leading to continuation rate of 92.3% at six months post-partum follow up. There was no case of pregnancy with Cu T in situ with no failure at the end of study at six months post-partum.Conclusions: Intra caesarean insertion of PPIUCD is practical, convenient, safe, effective and acceptable contraceptive method for spacing of the birth in this rural setting.
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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.
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The trends in the acceptability of contraceptives is globally shifting from permanent sterilisation to long acting reversible contraceptive (LARC). With the increasing use of IUCD, the knowledge of its common and rare complications has become pertinent. One of them is cervical perforation in which strings are mostly visible and hence it can be easily missed. Here we present a rare case of cervical perforation which was timely detected before it could have caused more damage. A patient complaining of IUCD associated pain should undergo thorough examination and a probability of perforation should be kept in differential diagnosis despite string visibility. A clinician has to be more vigilant about this rare complication to prevent damage to cervix and avoid unwanted pregnancy.
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Post-partum intrauterine contraceptive device inserted during caesarean section provides long acting reversible contraception to women soon after birth. It is now well accepted for its safety and efficacy. Uterine perforation, which is one of the most serious complication of PPIUCD has rarely been reported following intracaesarean insertion. The thick uterine wall and placement under direct vision helps prevent perforation. However, migration of IUCD to peritoneal cavity, causing perforation of several adjacent organs can occur due to improper closure of the uterine incision. Migration to sigmoid colon is an extremely rare complication. Authors present the case of a 29-year-old woman who had a Cu T 380 A insertion during Caesarean section. After 12 months of insertion, the patient suffered abdominal pain gradually increasing in intensity and frequent episodes of bleeding per rectum. Laparoscopic exploration revealed IUCD perforating the sigmoid colon completely and adhesions of bowel loops to the sigmoid colon. Extraction using laparoscopic method by gently pulling the threads was unsuccessful and the patient was managed by laparotomy.
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Background: Postpartum intrauterine contraceptive device (PPIUCD) is a safe, highly effective postpartum contraceptive, yet to be popularized at the community level in a diversified developing country like India where still the unmet need for spacing remains high. This study aimed to assess the knowledge regarding PPIUCD among users and the predictors of its retention.Methods: A case-control study had been conducted using multi-stage sampling technique in Nadia district of West Bengal. Face to face interviews of the cases and the controls had been done with the help of a predesigned pretested semi-structured schedule. Data were entered in MS Excel and analysed in SPSS 20.0 version.Results: Majority of the acceptors (55.2%) had poor knowledge regarding PPIUCD. Most of the participants (62.2%) retained their PPIUCD at least for 6 months. Acceptors who belonged to Hindu religion, higher socio-economic class (I and II), nuclear family, educated up to or above secondary level, ever counselled on PPIUCD, satisfied using that in day to day life, undergone follow-up visits and had correct knowledge regarding different aspects of PPIUCD had higher odds of retention of PPIUCD.Conclusions: Regular awareness campaigns, counselling at household level, advocacy are the utmost needs of the hour to motivate the eligible couple for its acceptance and retention.
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Background: The unmet need for contraception remains high in the postpartum period. Postpartum intrauterine contraceptive device (PPIUCD), despite being an effective and well-suited contraceptive method for this period, many women discontinue its use due to various reasons just after a few days or weeks. The study aimed to identify the factors associated with the removal of the same.Methods: A community-based case-control study had been conducted in Nadia district of West Bengal. A multi-stage sampling technique had been applied to identify and interview the cases and controls with the help of a predesigned pretested semi-structured schedule.Results: The overall removal and expulsion rates were found to be quite high (21.5% and 16.3% respectively). Multivariate analysis revealed that acceptors belonging to joint family, educated only up to middle level, if place of delivery and insertion of PPIUCD was BPHC, the same had been inserted by nursing staff, experienced pain after insertion, not given consent before insertion, not counselled ever on PPIUCD, not decided to accept PPIUCD before delivery, not satisfied with its use and undergone no follow up visit after its insertion, were having higher odds of removal of the same.Conclusions: Rigorous counselling during the antenatal period should be focused to achieve a declining trend regarding PPIUCD removal.
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Background: Janani Suraksha Yojana (JSY) was launched on April 12, 2005, under the National Health Mission for the benefit of maternal and child health. JSY is a centrally sponsored scheme, which integrates cash assistance with delivery and post-delivery care. Just after delivery, women are more receptive to accept a contraceptive method. With increased institutional deliveries influenced by JSY, the health-care providers have an excellent opportunity to counsel and provide them with safe and appropriate contraceptive method. The Government of India launched postpartum intrauterine contraceptive device (PPIUCD) services in the year 2000; although acceptance of PPIUCD in JSY beneficiaries is a real concern. Objectives: The objectives of this study were as follows: (1) To study the acceptance of PPIUCD in JSY beneficiaries and (2) to study the sociodemographic factors in relation to PPIUCD acceptance. Materials and Methods: The retrospective study was conducted in Rural Government Hospital in Maharashtra during 2016–2017. We studied sociodemographic variables of JSY beneficiaries and their acceptance to PPIUCD. The sample size was 353 (n = 353). The sociodemographic factors studied included age, type of delivery, sex of newborn, and educational status of patient and her husband. Results: The total postpartum women included in the study were 353 who had taken JSY benefit, of which, 116 (32.6%) accepted for PPIUCD, whereas 237 (67.4%) rejected the same. Around 43% of primipara patients were accepted PPIUCD. Among multiparous women with three living children, only 6% accepted it. The educational status of both, the postpartum women and their husband, showed statistically significant association with the acceptance of PPIUCD (P < 0.05) in JSY beneficiaries. Conclusions: The acceptance PPIUCD was low (32.6%) in JSY beneficiaries. Primipara or young age patients are easy to counsel about PPIUCD, and hence, the acceptance is high. All efforts should be made to increase acceptance of PPIUCD among JSY beneficiaries.
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Background: Vulvovaginal candidiasis (VVC) is a common infection among reproductive age group females. The objective of present study is to determine the prevalence of vulvovaginal candidiasis, its distribution and association of risk factors among reproductive age group females, attending the outpatient department of obstetrics and gynaecology of our Prime Medical Centre, Sharjah attached with Prime Hospital, Dubai, United Arab Emirates (UAE).Methods: It was cross-sectional descriptive study over a period of six months. Patients who came to our outpatient department with complains of vaginal discharge and itching in reproductive age group were included in this study. Patients characteristics i.e. age, parity, risk factors like diabetes, pregnancy, use of oral contraceptive pills (OCPills) and intrauterine contraceptive device (IUCD) were noted. High vaginal swabs (HVS) were collected and sent for culture. Candida positive cases were noted, and results were analyzed.Results: A total of 224 high vaginal swabs were collected. Prevalence of vulvovaginal candidiasis was found to be 31.6%. It was found more in 26-30 years age group and multiparous women. Previous history of candidiasis and diabetes were the commonest risk factors. Frequency of C. albicans was more (76.05%) than non-albicans candida (23.94%).Conclusions: Present study concluded that vulvovaginal candidiasis is more prevalent in reproductive age group females, therefore a routine high vaginal swab culture must be performed in every woman presenting with vaginal discharge and itching for correct diagnosis. Women should be educated on clinical symptoms.
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Background: Pregnancy comes as a temporary complication in the disease process of a patient with a cardiac lesion. It is the 4th common cause of maternal mortality and one of the most important non-obstetrical causes of maternal death. Previously most women with diagnosed heart disease were advised to avoid pregnancy and labor and termination was advised. But in modern obstetrical practice, pregnancy in a patient with a heart disease is no longer an unacceptable hazard. The objective of this study is to find out incidence of cardiac diseases in pregnancy, to evaluate their management and to find out maternal and fetal outcome in pregnancy with cardiac disease.Methods: This study is a prospective cohort study in which an analysis of maternal and fetal outcome in 30 cases of cardiac diseases in pregnancy was carried out in the department of Obstetrics and Gynaecology in our institute at Civil hospital Ahmadabad from 01/01/2017 to 31/12/2017.The study included all known case of RHD, CHD, or newly diagnosed case or surgically corrected case with prosthetic heart valves during current pregnancy.Results: Majority of women having pregnancy with cardiac disease were in the age group of 20-30 years. Majority of them were primigravida and suffered from rheumatic heart diseases with grade 1 NYHA severity. Majority of women got delivered by normal vaginal delivery with healthy fetal outcome. Most of the babies born to cardiac mother had their baby weight ranging between 2.0-2.5kg.Conclusions: The results of present study indicate that heart disease forms a considerable proportion of medical illness complicating pregnancy. Cardiac disease presents problems both to the obstetrician and as well as to the physician, cardiologist and to the neonatologist. But the majority of pregnancies complicated by heart disease are uneventful with a favorably good outcome for both the mother and the fetus.
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Background: Post-partum intra-uterine contraceptive device is one of the important methods of spacing to meet up the unmet need of family planning. The low complication rate, ease and certainty of insertion and one-time adoption advantages made it an option of family planning by Government of India. In the background of recent trends in family planning, the study aims to establish the efficacy and draw-backs of PP-IUCD among the clients in a tertiary care hospital of West Bengal.Methods: Prospective observational study on 1680 women during January 2016 to December 2016, where the PP-IUCD was given to the patients after vaginal delivery or Cesarean section and were followed up to 3 months.Results: During the study 1.37% patients did not turnup in either follow-up. The most common complication encountered was missing thread (4.64% at 6th week follow-up and 6.67% at 3rd month follow-up). Expulsion rate was much lower (2.02% at 6th week and 2.5% at 3rd month). Heavy bleeding per-vagina was in 1.55% at 6th week and 2.08% at 3rd month. Pain abdomen was .83% at 6th week and 1.67% at 3rd month. Incidence of perforation and failure was both nil at either follow-up. Dysmenorrhea was complained 2.44% at 6th week and 3.33% at 3rd month. Overall satisfaction rate at 6th week (86.05%) was higher than non-satisfaction (13.95%). This was also true for 3rd month where satisfaction rate (77.85%) was higher than non-satisfaction rate (22.15%).Conclusions: PP-IUCD appears to be a safe, efficacious, acceptable and accessible method of contraception.
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Intrauterine contraceptive device (IUCD) is common choice for contraception. Migration of IUCD is one of the complications that are encountered. Here we report a case of IUCD migration to the sigmoid colon. A 39-year-old Malay lady carrying a copper T type of IUCD presented with missing thread then underwent examination under anaesthesia, proceeded to hysteroscopy but failed removal. Abdominal ultrasound detected it in the left lower quadrant of abdomen. She then underwent diagnostic laparoscopy where the device was found to be embedded in the sigmoid colon. Technical difficulty necessitated conversion to mini laparotomy and sigmoidotomy to remove the IUCD and the bowel closed primarily. IUCD is a relatively simple and safe contraceptive procedure but possible complications are bleeding and pain that usually co-exist, pelvic infection, expulsion and perforation. Investigations should be based on clinical suspicion and migrated IUCD in symptomatic patients should be surgically removed whereas, asymptomatic patients can be managed conservatively under certain circumstances. However in the presence of a concurrent pathology that requires exploration then retrieval of the migrated IUCD should be undertaken.
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Dispositivos IntrauterinosRESUMO
Objective To observe the therapeutic effect of Wenyang Huayu Sanjie Decoction ( WHSD) for the treatment of adenomyosis with the syndrome of blood deficiency and cold stagnation. Methods Seventy qualified patients were evenly randomized into observation group and control group. The control group was treated with Mirena intrauterine contraceptive device, and the observation group was treated with WHSD ( composed of Danggui Sini San, Wuzhuyu Shengjiang Tang, Shixiao San and Rhizoma Sparganii, Rhizoma Curcumae). The clinical outcomes included the menstrual blood volume, menstrual cycle, menstruation, degrees of dysmenorrhea, uterine volume, and serum CA125 level in the two groups before treatment and 3, 6 months after treatment. Results ( 1) After treatment for 6 months, the total effective rate of the observation group was 94.29%, significantly higher than 85.71% in the control group ( P<0.05). ( 2) After treatment, dysmenorrheal degrees, menstrual blood volume, menstrual cycle, menstruation, uterine volume, and serum CA125 level were improved in both groups ( P<0.05) , and the observation group had better effect on relieving dysmenorrhea, improving menstruation, and decreasing CA125 level than the control group ( P<0.05). ( 3) No obvious adverse reaction was found in the observation group, but most of the cases in the control group had menstrual disorder such as vaginal irregular bleeding and prolongation of menstruation. Conclusion WHSD has certain therapeutic effect on adenomyosis with the syndrome of blood deficiency and cold stagnation, and can also obviously improve the quality of life of the patients.
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Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.
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Humanos , Dor Abdominal , Abscesso , Colo Descendente , Colonoscopia , Corpos Estranhos , Trato Gastrointestinal , Hemorragia , Dispositivos IntrauterinosRESUMO
A 47-year-old Chinese lady presented at our clinic with an intermittent pelvic discomfort for years. Pelvic examination was unremarkable. Transvaginal scan revealed an anteflexed uterus containing a dense echogenic circular device, 3 centimeters in diameter. The heavy sonographic reverberation pattern suggested its metallic composition. Examination with three-dimensional sonographies (3D US) in a reconstructed coronal plane (C plane) with soft tissue subtraction showed a perfectly round intrauterine device (IUD). This device was centrally located and positioned along the axis of the upper part of the uterine cavity. No evidence of myometrial migration was found. To the best of our knowledge, this article presents the first 3D image of this rare device. It also suggested the application of 3D sonographies in determining the contraceptive efficacies and management plans. 3D US images that are related to the intrauterine device were also shown and discussed.