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Continuation rates of postpartum intrauterine contraceptive device (IUCD) insertion: randomised trial of post placental versus immediate postpartum insertion
Ahuja R, Rahtore A. Continuation rates of postpartum intrauterine contraceptive device (IUCD) insertion: randomised trial of post placental versus immediate postpartum insertion (conference abstract). BJOG: An. International Journal of Obstetrics and Gynaecology 2014;121. (Suppl s2):1–2.
Introduction The postpartum period is a critical period with special needs for both mother and neonate. The unmet need of long acting contraception to space pregnancy in the postpartum period can be fulfilled by postpartum intrauterine contraceptive device (IUCD) insertion. This study was undertaken to compare the continuation and complication rates of postpartum CuT 380 A insertion in postplacental and immediate (<48 hours) postpartum period after vaginal delivery. Methods This randomised controlled trial with ethical clearance from institutional ethics committee was done in the Obstetrics and Gynecology Department, Lok Nayak Jaiprakash Hospital, New Delhi where 263 vaginally delivered women meeting the eligibility criteria as laid by Ministry of Health and Family Welfare, Government of India, willing for postpartum IUCD insertion were randomised to two groups- Group A (postplacental i.e. within 10 min of placental expulsion n = 131) and Group B (immediate postpartum i.e. 10 min-48 hours postdelivery n = 132) and followed-up upto 6 months. IUCD inserted was CuT 380 A using Kelly Placental Forceps curved or Sponge holder by trained health personal. Sample size calculation was done based on the mean incidence of expulsion in the two groups 11% in postplacental group versus 28% in immediate postpartum group with power of study 80% and confidence interval 95% was found to be 172 and with attrition rate of 25% the total size was calculated to be 215 with 108 in each group. The difference between means for quantitative data was calculated by Student ‘t’ test and for qualitative data was computed using c-square/Fischer’s exact test was used. P < 0.05 was the cut off point for statistical significance. Expulsion rates, continuation rates at 6 months, complications rate, removal rates for pain and bleeding, patients acceptability were compared in two groups. Results Continuation rates were 88.9% in postplacental group compared to 74.10% in immediate postpartum group (P = 0.0054). Expulsion rates were 24.11% in immediate postpartum group compared to 9.11 in postplacental group (P = 0.0037). Overall incidence of complications of PPIUCD was 6.7% including PID (1.3%) menorrhagia (3.1%) pain abdomen (0.83%) and prolonged lochia (1.3%) and the rates being similar in two groups however requiring removal in 2.17% women similar in each group. Conclusions Postpartum IUCD insertion is acceptable means of contraception and for women who accept postpartum IUCD insertion, postplacental insertion should be preferred over immediate postpartum insertion.