Comparative evaluation of postpartum versus post MTP insertion of intrauterine contraceptive device
Keywords:Cu T-380 A, Safety, Acceptability, Continuation, Expulsion
Background: This study was planned to evaluate acceptability, safety and continuation rate of postpartum intrauterine contraceptive device (PPIUCD) and to compare it with well accepted post MTP IUCD in Indian population.
Methods: This was a prospective study conducted in VMMC and Safdarjang Hospital, New Delhi, India. Copper T 380-A was inserted in 100 woman in postpartum period and in 100 woman in post MTP period. Follow up done at 6 weeks, 3 months and 6 months. Safety was assessed in terms of expulsion, IUCD failure/pregnancy rate, perforation, removal of IUCD, visibility of strings and various complain at each visit. Continuation rate along with their level of satisfaction was compared at the end of 6 months. SPSS software, Chi-square test and student T test were used for analyzing the results. P value ≤0.05 considered as significant.
Results: Acceptance of post MTP IUCD was more than PPIUCD. There was statistically no significant difference in expulsion rate, removal of IUCD and various complaints. There was no case of perforation in either group. Non visibility of strings was major cause of concern and apprehension in PPIUCD group. Only one case of pregnancy was reported in PPIUCD group while no failure was reported in post MTP group. Continuation rate and level of satisfaction were comparable in both groups.
Conclusions: PPIUCD is equally safe and effective as post MTP IUCD.
Eroglu K, Akkuzu G, Vural G, Dilbaz B, Akin A, Taskin L, et al. Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow up. Contraception. 2006;74(5):376-81.
Celen S, Moroy P, Sucak A, Aktulay A, Danisman N. Clinical outcome of early post placental insertion of intrauterine contraceptive devices. Contraception. 2004;69(4):279-82.
Katheit G, Agarwal J. Evaluation of PPIUCD in terms of awareness, acceptance and expulsion in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2013;2:539-43.
Grimes D, Schulz K, Stanwood N. Immediate postabortal insertion of intrauterine devices. Cochrane Database Syst Rev. 2002;(3):CD001777.
Grimes DA, Lopez LM, Schulz KF, Van Vliet HA, Stanwood NL. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev. 2010 May;(5):CD003036.
EL-Tagy A, Sakr E, Sokal DC, Issa AH. Safety and acceptability of post-abortal IUD insertion and the importance of counseling. Contraception. 2003;67(3):229-34.
Gupta A, Verma A, Chauhan J. Evaluation of PPIUCD versus interval IUCD (380 A) insertion in a teaching hospital. Int J Reprod Contracept Obstet Gynecol. 2013;2:204-8.
Safwat A. Mohamed, Momen A. Kamel, Omar M. Shaaban, Hossam T. Salem. Acceptability for the use of postpartum intrauterine contraceptive devices: Assiut experience. Med Principal Pract. 2003;12(3):170-5.
Jenabi E, Alizade SM, Baga RI. Continuation rates and reasons for discontinuing TCu380A IUD use in Tabriz, Iran. Contraception. 2006;(7496):483-6.
Dahlke JD, Terpstra ER, Ramseyer AM, Busch JM, Rieg T, Magann EF. Postpartum insertion of levonorgestrel: intrauterine system at three time periods: a prospective randomized pilot study. Contraception. 2011 Sep;84(3):244-8.
Lara Ricalde R, Velázquez Ramírez N, Reyes Muñoz E, Baca Olivo Pdel R. Posplacenta intrauterine device. Guide wires not visible. Gynecol Obstet Mex. 2012 Mar;80(3):201-7.
Drey EA, Reeves MF, Ogawa DD, Sokoloff A, Darney PD, Steinauer JE. Insertion of intrauterine contraceptives immediately following first-and second-trimester abortions. Contraception. 2009;79(5):397-402
Cole LP, Edelman DA, Potts DM, Wheeler RG, Laufe LE. Postpartum insertion of modified intrauterine devices. J Reprod Med. 1984;29(9):677-82.
Xu JX, Rivera R, Dunson TR, Zhuang LQ, Yang XL, Ma GT, et al. A comparative study of two techniques used in immediate post placental insertion (IPPI) of the copper T-380A IUD in Shanghai, People’s Republic of China. Contraception. 1996 Jul;54(1):33-8.
Brenner PF. A clinical trial of the delta-T intrauterine device: immediate postpartum insertion. Contraception. 1983 Aug;28(2):135-47.
Bednarek PA, Creinin MD, Reeves MF, Cwiak CA, Espey E, Jensen JT. Immediate intrauterine device insertion following suction aspiration between 5-12 weeks of gestation increases rates of insertion and utilization compared to scheduled delayed insertion. Contraception. 2009;80(2):203.
Das CR, Pradhan G. Study of side effects of Cu-T as intra-uterine contraceptive device in post medical termination of pregnancy and interval Cases. J Indian Med Assoc. 1995 Oct;93(10):375-6.
Morrison C, Waszak C, Katz K, Diabate F, Mate EM. Clinical outcomes of two early postpartum IUD insertion programs in Africa. Contraception. 1996 Jan;53(1):17-21.
Xu JX, Reusche C, Burdan A. Immediate post placental insertion of the intrauterine device: a review of Chinese and the world’s experiences. Adv Contracept. 1994;10(1):71-82.