IJCRR - 6(14), July, 2014
FEASIBILITY OF POST PARTUM INSERTION OFINTRAUTERINE CONTRACEPTIVE DEVICE- EXPANDING THE USE OF INTRAUTERINE CONTRACEPTIVE DEVICE IN POST PARTUM PERIOD - A CROSS SECTIONAL STUDY IN DEVELOPING COUNTRY, INDIA
Author: Sudha T. R. Banapurmath, Girija B. S. Dotrad, Nirmala Doreswamy, Shyamala
Aim: Post partum contraception is the best evidence based intervention in prevention of pregnancy and abortion related maternal morbidity and mortality in the developing countries. The unmet need for contraception among women in the postpartum period can be effectively fulfilled by post partum insertion of IUCD, in a single visit under the Government scheme of providing free maternity services during institutional delivery. PPIUCD is an effective, safe, reversible method of long term contraception with high reported expulsion and low perforation rate, compared to interval insertion. Objective: To evaluate the acceptability, safety, efficacy and feasibility of PPIUCD as a method of post partum contraception. Study design: This is a prospective cross sectional study conducted between October 2011 to December 2013 at Sri Chamarajendra Government Hospital, Hassan, Karnataka, India. 26,123 pregnant women were counseled (clients) for Post partum IUCD insertion as a method of contraception in pregnancy, early in labor and in the immediate post partum period (<48 hours). Among the clients, 1832(7%) accepted and had PPIUCD inserted under asepsis by skilled Obstetricians. The timing of PPIUCD insertion were- 510(27.8 %) post placental, 427(23.3 %) in immediate post partum period<48hrs, and 895(49 %) Intra caesarian insertions. The side effects were minimal, Infection and perforation were 00%, pregnancy reported were 0%, Expulsion rate was 0.32 %( o6/1832), and Removal rate was 0.76% %( 14/1832). IUCD retention rate was 98.90% (1812/1832) at 14weeks post partum. Conclusion: PPIUCD is a feasible, safe and effective method of immediate postpartum contraception that may be practiced during a single visit for institutional delivery which may be continued as a long term reversible contraception.
Keywords: Post-partum intrauterine contraceptive Device (PPIUCD), Post placental, Client, Caesarian Delivery, Expulsion, Contraception, Counseling.
Sudha T. R. Banapurmath, Girija B. S. Dotrad, Nirmala Doreswamy, Shyamala. FEASIBILITY OF POST PARTUM INSERTION OFINTRAUTERINE CONTRACEPTIVE DEVICE- EXPANDING THE USE OF INTRAUTERINE CONTRACEPTIVE DEVICE IN POST PARTUM PERIOD - A CROSS SECTIONAL STUDY IN DEVELOPING COUNTRY, INDIA International Journal of Current Research and Review. 6(14), July, 38-48
1. National Rural Health Mission Ministry of Health and Family Welfare Government of India. JSY. Available at http://www.mohfw.nic.in/layout_09- 06;.pdf.Accessed;19September;2012
2. India Reproductive health surveyNFHS, 2003,2010- Family planning Fact sheets of India
3. A global hand book for providers and PPIUCD training materials, JPIEGO.
4. The Population Council and the Program for Appropriate Technology in Health (PATH). The Copper T 380A IUCD: A Manual for Clinicians. 2nd ed. Seattle, Washington: PATH, 1989. Consensus 2011, provisional population totals; office of the Registrar General and census commissioner, India Ministry of home affairs, 31st March2011
5. Post Partum IUCD Reference Manual,November 2010:Family planning division,ministry of Health and Family welfare.
6. Grimes.D,SchulzK,VlietH,Stanwood.N;,Imme diatepost partum insertion of IUCD;TheCochranesystemicdatabase of systemic Reviews;2003;1,Art no.CD003036, DOI:1002/14651858.CD003036. PMID: 11406064 [PubMed - indexed for MEDLINE]
7. Performance standards for immediate PPIUCD counseling and services,April,20113;(NRHM,GOI);The USAID/WHO manual family planning.
8. Lara Ricalde R, Menocal Tobías G, Ramos Pérez C, Velázquez Ramírez N;-Random comparative study between intrauterine device Multiload Cu375 and TCu 380a inserted in the postpartum period,Departamento de planificación familiar del InstitutoNaciónal de Perinatología. Lomas Virreyes, México. email@example.com pub med.
9. Morrison C, Waszak C, Katz K, Diabate F, Mate EM; Clinical out-comes of two early postpartum IUCD insertion programs in Africa. Contraception 1996;53:17-21.
10. Mohamed SA, Kamel MA, Shaaban OM, Salem HT;Acceptability for the use of postpartum intrauterine contraceptive devices: Assiutexperience.,Medprinc pract.2003,julsep;12(3):170-5
11. Celen S, Möröy P, Sucak A, Aktulay A, Dani?man N; Clinical outcomes of early postplacental insertion of intrauterine contraceptive devices.;Contraception,2004 Apr:69(4):279-82.
12. Xu J, Yang X, Gu X, Xu S, Zhou X, Chen Y, Xiao Z, Zhuang L Comparison between two techniques used in immediate postplacental insertion of TCu 380A intrauterine device: 36- month follow-up.; ReproductiveContraception.1999; 10(3):156- 62
13. Ero?lu K, Akkuzu G, Vural G, Dilbaz B, Akin A, Ta?kin L, HaberalAComparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up.; Cochrane Database Syst Rev. 2001;(2):CD003036. Update in: Cochrane Database Syst Rev. 2003;(1):CD003036.
14. Cole LP, Edelman DA, Potts DM, Wheeler RG, Laufe LE. Postpartum insertion of modified intrauterine devices;J Reprod Med. 1984 Sep;29(9):677-82
15. O'Hanley K, Huber DH;Postpartum IUDS: keys for success;.;Contraception. 1992 Apr;45(4):351-61.
16. Erika Levi, Evelyn Cantillo,Veronica Ades, Erika Banks, AmitasrigowriMurthy; Immediate postplacental IUD insertion at cesarean delivery: a prospective cohort study;Contraception;VVolume 86, Issue 2 , August ,Pages 102-105,
17. B.Sood et. al.,Jhpiego/India, New Delhi, IndiaR. Asif, E. Charurat, S. Das, S. Kumar, C.McKaig,,M.Rath,,S.Saha,R.Sethi,V. Srivastava,V.Yadav ;Revitalization of postpartum IUCD (PPIUCD) services: experience from India, http://dx.doi.org/10.1016/j. Contraception;Volume 86, Issue 2, August 2012, Pages 184–185,
18. Thiery M, Van Kets H, Van Der Pas H. Immediate postplacental IUD insertion: the expulsion problems. Contraception 1985;31;331-349
19. Hayes JL, Cwiak C, Goedken P, Zieman M;A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device. Department of Gynecology and Obstetrics, Grady Memorial Hospital, Emory University, Atlanta, GA 30303, USA. firstname.lastname@example.org
20. Global Health Observatory; Unmet need for family planning. Geneva: World Health Organization:www.who.int/entity/gho/mdg/m aternal_health/situation_trends_family_planni ng/en.
21. Muthal-Rathore A. Immediate postpartum insertion for intrauterine devices: RHL commentary (last revised: 1 September 2010). The WHO Reproductive Health Library; Geneva: World Health Organization
22. Sahaja Kittur, Y. M. Kabadi; Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy, and expulsion;. Int J Reprod Contracept Obstet Gynecol. 2012; 1(1): 26-32
23. Xu JX, Reusche C, Burdan A. Immediate postplacental insertion of the intrauterine device: a review of Chinese and the world's experiences. Adv Contracept 1994; 10:71-82.