COMPARISON OF INTRAUTERINE CONTRACEPTIVE DEVICE INSERTION AFTER NORMAL VAGINAL DELIVERY VERSUS INTRA CESAREAN
Abstract
INTRODUCTION: The intrauterine contraceptive device (IUCD) and contraceptive implant are safe and highly effective for most females, including adolescents. The success of IUCD in reducing unintended pregnancy could be extended if initiated immediately postpartum, with additional effect on reduction of unintended and short-interval pregnancy. Immediate post-partum insertion of IUDs appeared safe and effective, though direct comparisons with other insertion times were lacking.
OBJECTIVE: To determine the frequency of mode of delivery (vaginal/c-section) in women consenting for PPIUCD during antenatal period and to compare the frequency of expulsion of intrauterine contraceptive device (Copper T 380A) insertion after normal vaginal delivery versus intra cesarean
STUDY SETTING: The study was conducted at Unit-V, Department of Obstetrics & Gynecology, Lady Aitchison Hospital, Lahore.
DURATION OF STUDY: August 20, 2022 to February 20, 2023
STUDY DESIGN: Cross-sectional study
SUBJECTS & METHODS: Total 162 women who fulfilled the inclusion criteria were enrolled. Mode of delivery was recorded. After vaginal delivery, IUD was inserted by Kelly’s forceps, while intra caesarean Cu T 380A was placed at fundus manually and the IUCD thread was left in the lower uterine segment without trimming it. Strict asepsis was maintained during insertion in groups. All participants were called for follow-up for 3 months. Complication like expulsion was noted as per operational definition after 3 months. The collected information was entered and analyzed through SPSS v25.0. Data were stratified for age, education, socio-economic status, parity and gestational age to address the effect modifiers. Post-stratification, both groups were compared by using chi-square test for expulsion for each strata. A p-value ≤0.05 was considered as significant.
RESULTS: In this study, 162 patients desirous of CuT 380A insertion after delivery were enrolled. Age range in this study was from 20 to 40 years with mean age of 28.0±6.41 years. According to mode of delivery distribution, 78(48.1%) had had vaginal delivery, while 84(51.9%) had c-section. Among 162 patients, overall 27(16.7%) had expulsion, while according to comparison of expulsion with mode of delivery, 18(23.1%) patients with vaginal delivery and 9(10.7%) with c-section had expulsion rate.
CONCLUSION: The insertion of IUCD post-caesarean had an acceptable expulsion rate and there was no increase in the side effects rate compared to the IUCD in natural vaginal delivery. Therefore one can deduce that the post-caesarean IUCD is as effective as the IUCD immediate postpartum.
KEY WORDS: Intrauterine Contraceptive Device, C-section, Vaginal Delivery, Expulsion.
