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Freelance writer for Contemporary OB/GYN
A prospective interventional hospital-based study from India has found that a postpartum intrauterine copper device (PPIUCD) is an efficacious method to reduce the unmet need of contraception.
The study in the journal Cureus also concluded that most of the women were satisfied with the intracesarean insertion of an IUCD.
“The postpartum period is one of the critical times when ovulation is highly unpredictable and couples often underestimate the likelihood of pregnancy,” wrote the investigators.
According to the World Health Organization (WHO), an IUCD can be inserted within 48 hours postpartum.
The study, which sought to determine the safety and expulsion of an intracesarean PPIUCD, including complications, was conducted at Uttar Pradesh University of Medical Sciences in Uttar Pradesh, India, from November 2016 to October 2019.
In total, 1,586 patients with planned emergency or elective cesarean section were inserted with an intracesarean PPIUCD; however, only 1,029 cases followed up at 6 weeks and 6 months, thus the sample size for analysis was reduced to 1,029.
The majority of patients were between 20 and 25 years old (66.4%) and resided in rural areas (70.7%). In addition, roughly half of the patients were having parity 2 (49.9%) and 90% were of the Hindu religion.
Following contraceptive insertion, the most common complaint at 6 weeks follow-up was an undescended/missed thread (22.2% of women), followed by bleeding (11.9%), expulsion (2.2%), pain (2%) and local infection (1.3%).
At 6 months, the most frequent complaint was a missed thread (8.6% of women), followed by bleeding (6.0%), pain (1.6%), expulsion (1.2%) and local infection (0.7%).
The investigators noted that many patients with a complaint of bleeding at 6 weeks responded well to hemostasis.
Additionally, there were no cases of perforation.
Although 19.05% women desired the removal of their PPIUCD, by the end of the 6-month study period the device had been removed in only 11.27% of cases, due to various reasons including dissatisfaction with a missing thread, bleeding, family pressure and change over to another contraceptive method.
Visibility and/or feeling of the IUCD thread is paramount to ensure that the IUCD is in situ, according to the authors. Sometimes a woman cannot feel the thread, even when the IUCD is inside the uterine cavity.
At 6 weeks, the complaint of an undescended IUCD thread in 22.2% of women was detected in only 5% of cases via a speculum examination and the IUCD expelled in 0.4% of cases, thus the missed thread was absolutely missed in 16.8% of cases.
The study found an IUCD continuation rate of 88.8%.
“The patients were willing to continue with the device, indicating a high level of satisfaction, and were willing to recommend this method to others,” the authors wrote.
The study underscores the importance of offering a PPIUCD as an option for postpartum family planning.
Counseling is most beneficial when a woman is either pregnant or in early labor or experiencing the milestones and minor ailments of pregnancy or early labor, “which is also the simplest time to motivate her for the role of birth spacing, especially in case of cesarean delivery,” the authors wrote.