Title: Clinical Outcome of Intra caesarean Intrauterine Contraceptive (CuT380A) Insertion among Primiparous Parturients -An Experience at a Community Health Centre

Authors: Tanzeela Nazir, Waseem Mushtaq Syed, Sakina Akhter

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.246

Abstract

Worldwide around 115 million women have unmet needs of family planning. Launch of JSSKY by Government of India in 2011 to provide completely free and cashless services to pregnant women in institutional deliveries has led an opportunity for providing postpartum family planning services and an opportunity to overcome the unmet needs. Post partum intrauterine contraception device (PPIUCD) appears an ideal method for limiting and spacing births.

Objectives: The present study was taken to study the clinical outcome, acceptability and safety of PPIUCD in primiparous women who delivered by caesarean section at our health Centre – Maternity and Child Care Hospital (MCCH) Sherbagh Anantnag.

Method and Materials: This study was a prospective observational study carried out at Maternity and Child Care Hospital Anantnag – 200 primiparous women who delivered by caesarian section over a period of six months (June 2016- Dec. 2016) and had PPIUCD insertion and were willing to comply with the study protocol were involved in the study. All these subjects fulfilled the WHO standard Medical criteria for PPIUCD insertion. Follow up visits were scheduled at 1, 3, 6 and 12 months.

Results: A total of 200 women who underwent intra caesarean PPIUCD insertion were followed at 1, 3, 6 and 12 months. Majority of the women (88%) completed one year follow up. The most common complication observed in immediate postoperative period was fever (2.5%) followed by wound infection (1.5%) and UTI in (1%) women. The common adverse events noted during one-year follow up were menstrual complaints, excessive vaginal discharge and persistent pelvic pain. At the end of 1 year follow up there were a total of 10 expulsions, 18 removals leading to a gross cumulative expulsion, removal and continuation rates of 5%, 9% and 88% respectively.

Conclusion: Postplacental insertion of CuT380A is a safe and effective method of reversible contraception with low expulsion, high continuation and satisfaction rates.

References

  1. Family Planning Division, Ministry of health and family welfare, Government of India, available at nrhm.gov.in, 2010.
  2. Rutstein SO Effects of proceeding birth intervals on neonatal infant and under five year mortality and nutritional status in developing countries ; evidence from the demographic and health surveys. Int J Gynaecal Obstet. 2005; 89 Suppe 1:57-524.
  3. Conde-Agudelo A, Rosas-Bermudez A, Kafury-Geota AC. Effects of birth spacing on maternal health: a systematic review. Am J Obstet Gynecol 2007; 194 (4):297-308.
  4. National Rural Health Mission. “Guide lines for Janani-Shishu Suraksha Karyakram (JSSK)” new Delhi: Government of India, Ministry of Health and Family Welfare, Maternal Health Division 2011, 1-40.
  5. Long term safety and effectiveness of copper releasing intrauterine devices; HRP external evaluation . 2003-2007; 6, 7.
  6. Postpartum IUCD reference manual, New Delhi: Family Planning Division, Ministry of Health and Family Welfare, Government of India 2010.
  7. Thonneau PF, Almont T. Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol, 2008; 198(3):248-53.
  8. Kulier R, O Brien PA, Helmerhost FM, Usher Palel M, D Arcangues C, Copper containing, framed intrauterine devices for contraception. Cochrane Database System Rev. 2007; (4); CD 005347.
  9. Kapp N, Curtis KM. intrauterine device insertion during the postpartum period; a systematic review. Contraception 2009; 80(4):327-36.
  10. Eroghi K, AKKUZUG, Vural G, Dilbaz B, Akin A, Takin L, et al. comparison of efficacy and complication of IUD insertion in immediate postplacental/ early postpartum period with interval period: 1 year follow up. Contraception 2006; 74 (5); 376-81.
  11. Xu Jx, Reasche C, Burdan A. immediate postplacental insertion of the intrauterine device: a review of Chinese and the worlds experience. Adv. Contracept. 1994; 10 (1): 71-82.
  12. Celen S, Moroy P, Sucak A, Aktulay A, Daniman N. clinical outcome of early postplacental insertion of intrauterine contraceptive device. Contraception 2004; 69 (4) : 278-82.
  13. Long acting reversible contraception the effective and appropriate use of long acting reversible contraception. Regents Park, London: National Collaborating Centre for women’s and children Health commissioned by the National Institute for Health and Clinical Excellence ; 2005. October 2005.
  14. Singal S, Bharti R, Dewan R, Divya Dabral A, Batra A, Sharma M, Mittal P: Clinical outcome of postplacental copper + 380A insertion in women delivering by caesarean : J Clin Diagu Res. 2014; 8 (9): DC 01-4.
  15. Indian Council of Medical Research Task Force study on Psychosocial factors affecting continuation and discontinuation of intrauterine device and oral pill in urban India. New Delhi : Indian Council of Medical Research, 1986.
  16. EI Beltagy NS, Darwish EA, Kasem MS, Hefila NM. Comparison between copper +380IUD and Multiload 375 IUD in early postpartum insertion. Middle East Fertility Society J. 2010; 16: 143-8
  17. Hayes JL, Civiak C, Goedkan P, Zieman M. A pilot clinical Trial of Ultrasound guided postplacental insertion of a levonorgesterol intrauterine device. Contraception 2007; 76 (4) : 292-96.

Corresponding Author

Dr Waseem Mushtaq Syed
Department of Surgery, SKIMS, Jammu & Kashmir, India

House no. 02, sector J-2, Irm Lane, Natipora, Srinagar, Jammu and Kashmir

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