POSTPARTUM INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICES: A STUDY ON EXPULSION RATES, ADVERSE EVENTS, AND PATIENT COMPLIANCE.

Abstract

Background: Postpartum intrauterine contraceptive device (PPIUCD) insertion is an effective strategy to address the unmet need for contraception and to reduce the risk of closely spaced pregnancies, which are associated with adverse maternal and neonatal outcomes. This study was conducted to evaluate the safety, efficacy, side effects, and complications of PPIUCD insertions in a tertiary care center.

Method: This prospective observational study was conducted at a tertiary care center and included 250 postpartum women who accepted PPIUCD insertion within 48 hours of delivery after counseling and consent. Women with contraindications as per WHO category 3 and 4 were excluded. CuT 380A was inserted either post-placental following vaginal delivery or during cesarean section by trained doctors using aseptic techniques. Participants were followed at 6 weeks and 3 months to assess complications, side effects, expulsions, removals, and continuation. Data were analyzed using SPSS with descriptive statistics and chi-square test, considering p<0.05 as significant.

Results: A total of 250 women underwent PPIUCD insertion, with a mean age of 24.1 ± 3.9 years. Follow-up was achieved in 85.6%. The most common complaints were bleeding (32.7%) and pain (18.6%). Expulsion occurred in 9.8%, mostly after vaginal delivery. Removal was done in 13.5%, mainly for side effects or preference. The 3-month continuation rate was 76.6%, significantly higher after cesarean than vaginal delivery (p<0.001).

Conclusion: PPIUCD is a safe and effective postpartum contraceptive with high continuation and minimal complications. Counseling, skilled insertion, and follow-up are key, and efforts should focus on reducing expulsions, especially after vaginal delivery.