scholarly journals Awareness of post partum intra uterine contraceptive device and reasons for its low acceptance in an urban Indian population

2020 ◽  
Vol 8 (2) ◽  
pp. 701
Author(s):  
Raina Chawla ◽  
Rashmi Ahuja ◽  
Priyanka Sharma
Keyword(s):  
Post Partum ◽  
Intrauterine Device ◽  
Unmet Need ◽  
Contraceptive Device ◽  
Urban Indian ◽  
History Of ◽  
Permanent Method ◽  
Antenatal Visits ◽  
Unmet Need For Contraception

Background: The safety and efficacy of the Post-Partum Intra Uterine Contraceptive Device (PPIUCD) has been documented worldwide. With increasing institutional deliveries and greater sensitization, the aim is to increase PPIUCD insertions. Many areas still report poor acceptance.  Objectives of this study to determine the proportion of antenatal women willing to accept PPIUCD insertion and the reasons behind refusal to accept this method.Methods: A prospective questionnaire study was done between January 2019 to June 2019 of 200 women. Inclusion criteria were antenatal women in the 2nd/3rd trimester. Exclusion criteria were those opting for a permanent method of contraception and those with a contra-indication.Results: Eighty-four women (42%) had never used any method of contraception. Earlier Intrauterine device (IUD) use (including both interval and PPIUCD) was in only 18.9% of all contraceptive users. Only 2 women in the group had ever used PPIUCD. 79% of women were aware of IUDs. Those unaware were mainly nulliparous. Amongst those aware of an IUD, 88 (56%) were aware it could be inserted postpartum. Only 18% were aware it could be inserted intra-cesarean. All women who participated were offered the option for a PPIUCD. Fifty-nine (29.5%) of all women expressed their willingness but on follow up till delivery only 18 of these women got a PPIUCD inserted.  Amongst those not willing for the PPIUCD insertion the commonest reason was general apprehension (39%) followed by partner refusal (33%) and fear of complications (31%). Six women (4.2%) gave history of complications following earlier use and were unwilling for its repeat use. Conclusion: The large unmet need for contraception in India can be solved through repeated counselling and discussions with the woman during her antenatal visits. Alleviating apprehension and addressing concerns of the couple will increase PPIUCD acceptance.

scholarly journals Immediate post placental insertion of intrauterine contraceptive device at caesarean delivery: a prospective study

2020 ◽  
Vol 9 (6) ◽  
pp. 2244
Author(s):  
Sravani Mukka ◽  
Madhavi Y.
Keyword(s):  
Family Planning ◽  
Prospective Study ◽  
Post Partum ◽  
Unmet Need ◽  
Intrauterine Contraceptive Device ◽  
Efficacy Rate ◽  
Contraceptive Device ◽  
Intrauterine Contraceptive ◽  
A Prospective Study

Background: In India almost 65% of the women have an unmet need for family planning in the first postpartum year. Increasing rates of institutional deliveries creates an opportunity for providing quality post-partum family planning services. Post-partum Intrauterine contraceptive device (PPIUCD), a form of long acting reversible contraception (LARC) is one of the most affective and safest method available. The present study aims at evaluating the safety, efficacy, rate of acceptance and rate of discontinuation of Intra caesarean inserted contraceptive device Copper T-380A.Methods: This was a prospective study conducted at ESIC Medical College, Sanathnagar in women delivered by caesarean section during the period between March 2018 to February 2019. Recruitment was done based on the WHO medical eligibility criteria (MEC) for PPIUCD and also their willingness to participate in the study. Follow-up visits were scheduled at 6 weeks, 3 months and 6 months.Results: Of the 265 women fulfilling the WHO MEC, 180 (67.92%) were willing to participate in the study. Total acceptance rate was 67.7%. Majority of them belonged to the age group 21-30 years (80%) and para 2 (53.88). 93.3% of the women were literates. 12 (6.66%) cases lost to follow up and the complications were studied in the rest 168 women. During follow up -38.69% had missing strings, 12.5% menstrual disturbances, 4.76% abdominal pain and spontaneous expulsion in 4.1%. No cases of perforation and pregnancy were reported. Total continuation rate was 84%.Conclusions: PPIUCD is a safe and convenient option of contraception with low expulsion rates and high continuation rates.

scholarly journals Study on post partum intrauterine contraceptive device practices and causes for discontinuation of PPIUCD at follow up in a tertiary hospital

2018 ◽  
Vol 7 (6) ◽  
pp. 2299 ◽  
Author(s):  
Radhika Chethan ◽  
Anitha G. S. ◽  
Savitha C.
Keyword(s):  
Family Planning ◽  
Post Partum ◽  
Unmet Need ◽  
Tertiary Hospital ◽  
Contraceptive Device ◽  
Eligibility Criteria ◽  
Reversible Method ◽  
Planning Methods ◽  
The Government

Background: 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. Despite optimal efforts by family planning program, very few couples are opting for spacing methods and lack of awareness has resulted in discontinuation of family planning methods particularly PPIUCD. This study is designed to study the practices of PPIUCD and causes for discontinuation at follow up in our hospital. The objectives of the study were study PPIUCD practices at Vanivilas hospital; causes for discontinuation of PPIUCD.Methods: Prospective study done at Vanivilas hospital attached to Bangalore Medical College and Research Institute from January 2014 to December 2014. Women admitted and delivered at VVH, were counselled. CuT 380A was inserted in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications for PPIUCD. They were followed up till June 2016.Results: There were 2072 PPIUCD insertions in one year, out of which 1244 were post placental, 139 were in immediate postpartum and 689 were intra caesarean insertions. Fifty four (54) women discontinued PPIUCD during follow up .Main causes for removal were menstrual abnormalities (19), pain abdomen (13), wanting sterilisation procedure (12) and marital disharmony.Conclusions: PPIUCD is an effective, safe, reversible method of long term contraception with high reported expulsion and low perforation rate, compared to interval insertion. More research is needed in the field of PPIUCD to enhance awareness and acceptance in the community. Awareness and counselling the eligible couples during ante natal care can improve acceptance and compliance of PPIUCD continuation rates.

scholarly journals A novel approach to meet the unmet need for family planning

2018 ◽  
Vol 8 (1) ◽  
pp. 169
Author(s):  
Subrata Samanta ◽  
Sujoy Dutta ◽  
Sudipta Samanta ◽  
Agrima Mullick
Keyword(s):  
Family Planning ◽  
Post Partum ◽  
Tertiary Care ◽  
Unmet Need ◽  
Contraceptive Device ◽  
Care Hospital ◽  
Expulsion Rate ◽  
Satisfaction Rate ◽  
Novel Approach

Background: Post-partum intra-uterine contraceptive device is one of the important methods of spacing to meet up the unmet need of family planning. The low complication rate, ease and certainty of insertion and one-time adoption advantages made it an option of family planning by Government of India. In the background of recent trends in family planning, the study aims to establish the efficacy and draw-backs of PP-IUCD among the clients in a tertiary care hospital of West Bengal.Methods: Prospective observational study on 1680 women during January 2016 to December 2016, where the PP-IUCD was given to the patients after vaginal delivery or Cesarean section and were followed up to 3 months.Results: During the study 1.37% patients did not turnup in either follow-up. The most common complication encountered was missing thread (4.64% at 6th week follow-up and 6.67% at 3rd month follow-up). Expulsion rate was much lower (2.02% at 6th week and 2.5% at 3rd month). Heavy bleeding per-vagina was in 1.55% at 6th week and 2.08% at 3rd month. Pain abdomen was .83% at 6th week and 1.67% at 3rd month. Incidence of perforation and failure was both nil at either follow-up. Dysmenorrhea was complained 2.44% at 6th week and 3.33% at 3rd month. Overall satisfaction rate at 6th week (86.05%) was higher than non-satisfaction (13.95%). This was also true for 3rd month where satisfaction rate (77.85%) was higher than non-satisfaction rate (22.15%).Conclusions: PP-IUCD appears to be a safe, efficacious, acceptable and accessible method of contraception.

Gestational diabetes mellitus: are mothers being followed-up? A retrospective study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697469
Author(s):  
Rebecca Ward ◽  
Fahmy W Hanna ◽  
Ann Shelley-Hitchen ◽  
Ellen Hodgson ◽  
Adrian Heald ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Median Time ◽  
Post Partum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Tertiary Referral Centre ◽  
Alternative Approach ◽  
Nice Guidance ◽  
History Of

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

scholarly journals Factors influencing post-partum women’s choice of an implantable contraceptive device in a rural district hospital in South Africa

2018 ◽  
Vol 60 (6) ◽  
pp. 41
Author(s):  
Francois Potgieter ◽  
Paul Kapp ◽  
Francois Coetzee
Keyword(s):  
Side Effects ◽  
South African ◽  
Post Partum ◽  
Implantable Device ◽  
Team Approach ◽  
Contraceptive Device ◽  
Attitudes And Beliefs ◽  
The South ◽  
New Device ◽  
Antenatal Visits

Background: A single-rod subdermal contraceptive implant containing 68 mg of etonogestrel, ImplanonNXT®, was introduced to the South African healthcare system in 2014. Initially the new device was well received but later uptake tapered off. A need was identified to determine the factors that influence women’s choices with regard to the use of ImplanonNXT® in order to improve its uptake. The aim of this study was to explore the factors that influence women’s choice of ImplanonNXT®.Method: A qualitative study was performed, using semi-structured interviews to explore patients’ knowledge, attitudes and beliefs regarding ImplanonNXT®. Ten patients were interviewed at Knysna Hospital.Findings: There was confusion amongst women about the harms and benefits of using ImplanonNXT® and it became apparent contraceptive counselling during pregnancy greatly affects the choices they make. Other factors that influenced the participants’ choice with regard to contraception included social influences, preference for familiar methods and the side effect profile of the various options. Perceptions of the adverse side effects of the implantable device added to confusion and fear of this method, which influenced women’s ideas about the use of ImplanonNXT®. Poor communication and reluctance from clinic staff to discuss ImplanonNXT® during antenatal visits contributed to poor knowledge about the implantable device and its side effects.Conclusion: Clearer communication during antenatal visits with pregnant women may address some of the fears and beliefs that surround its side effects, workings and efficacy. The fear of possible side effects should be a focus for counselling and education, as it predominantly contributes to women’s confusion and fear of the device. Further research is needed to address this as well as evaluate if interventions such as better counselling and a dedicated team approach can change the attitudes and beliefs of post-partum women towards the ImplanonNXT® device in the South African district health system.

Prevalence of Complications after Interval Postpartum Intrauterine Device Insertion

2021 ◽  
Vol 15 (9) ◽  
pp. 2785-2788
Author(s):  
Saba Abbas ◽  
Sadia Anwar ◽  
Kalsoom Essa Bhattani ◽  
Zubaida Khanum Wazir ◽  
Rubina Babar
Keyword(s):  
Teaching Hospital ◽  
Intrauterine Device ◽  
Contraceptive Device ◽  
Expulsion Rate ◽  
Cross Sectional ◽  
Uterine Infection ◽  
Contraceptive Devices ◽  
Intrauterine Contraceptive ◽  
Intrauterine Contraceptive Devices

Background and Aim: Postpartum intrauterine device (PPIUD) is a reversible, long-term and effective technique of contraception. The intrauterine device (IUD) is inserted within 48 hours of delivery. The immediate insertion of an intrauterine device causes certain complications. The present study aimed to assess the prevalence of complications after Interval Postpartum Intrauterine Device Insertion. Materials and Methods: This cross-sectional study was carried out on 147 women who underwent postpartum IUD (PPIUD) insertions during from January 2021 to June 2021 at Gynecology department, Mufti Mehmood Memorial Teaching Hospital (MMMTH), Dera Ismail Khan and Muhammad Teaching Hospital Peshawar. All the women who delivered and showed willingness for PPIUCD insertion were enrolled and continuously follow-up for 4 to 6 weeks after delivery. Demographic, obstetric, and clinical parameters were recorded on pre-designed medical proforma. PPIUCD insertion after 6 weeks of delivery were followed-up for the evaluation of complications. Uterine infection, medical removal of IUD, IUD expulsion, perforation, and method discontinuation were the outcome variables. SPSS version 20 was used for data analysis. Results: Of the total deliveries, 147 women inserted the postpartum intrauterine contraceptive device (PPIUCD). Of the total, about 122 (83%) women returned for follow-up after 6 weeks. All the women underwent transvaginal insertion of intrauterine contraceptive devices. The PPIUCD insertion related complications with prevalence were uterine infection 26 (21.3%), overall method suspension 17 (13.9%), perforation 20 (16.4%), interceptive uterine device expulsions 25 (20.5%), and intrauterine device removal 32 (26.2%). The severe uterine infection was in 2 (1.7%) cases who were hospitalized. Conclusion: The postpartum intrauterine device cumulative expulsion rate was higher among women compared to the expulsion rate of insertions. The longer duration of bloody lochia flow and delivery intrauterine device insertions were the key risk factors for expulsion of PPIUCD. Women can safely utilize intrauterine contraceptive devices with low complications beyond four week. Keywords: Postpartum intrauterine device; Complications; Intrauterine device expulsion

Coeliac crisis mimicking nephrotic syndrome in a post-partum patient

2019 ◽  
Vol 64 (3) ◽  
pp. 116-118
Author(s):  
Özant Helvacı ◽  
Seyma Yıldız ◽  
Berfu Korucu ◽  
Ulver Derici ◽  
Turgay Arinsoy
Keyword(s):  
Nephrotic Syndrome ◽  
Coeliac Disease ◽  
Post Partum ◽  
Lower Extremity Weakness ◽  
Case Presentation ◽  
Multisystem Involvement ◽  
Life Threatening ◽  
History Of ◽  
Rare Occasion

Background Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. Case presentation A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months’ follow-up. Conclusion Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment.

scholarly journals Comparative study of post-partum intra uterine contraceptive device insertion and interval intra uterine contraceptive device insertion in a tertiary care hospital

2017 ◽  
Vol 6 (7) ◽  
pp. 2760
Author(s):  
Manimegalai R. ◽  
Suganthi R.
Keyword(s):  
Post Partum ◽  
Tertiary Care ◽  
Family Health ◽  
Common Reason ◽  
Contraceptive Device ◽  
Care Hospital ◽  
Medical College

Background: NFHS (National Family Health Survey) 2005-2006 in India revealed that the contraceptive prevalence rate is 53.5%. 10% of all pregnancies are mistimed and 11% of all pregnancies are unwanted in India. Objective of present study was to compare the benefits and complications of postpartum IUCD insertion (PPIUCD) over interval IUCD insertion in a tertiary care hospital.Methods: It is a retrospective study conducted in the Department of Obstetrics and Gynecology, Govt. Mohan Kumaramangalam Medical College, Salem from 2009-2014. The cases of interval IUCD for the year 2009-2014 and PPIUCD cases for the year 2012-2014 both vaginal insertion and intracaesarean insertion were taken for study. Complications, benefits and reasons for removal were compared between the two groups.Results: The total number of cases of IUCD insertion significantly increased after the introduction of PPIUCD programme in 2012. The acceptance of IUCD insertion was steadily increasing after the introduction of PPIUCD even though the follow up of PPIUCD cases was less (32%). The rate of removal in patients who came for follow up was less in PPIUCD group (18%) compared to interval IUCD cases (57%) when the reason was menorrhagia. The most common reason for removal was menorrhagia in interval IUCD patients. Abdominal pain was the most common reason for removal in PPIUCD patients. The rate of expulsion was higher in PPIUCD (6%) compared to interval IUCD patients (<1%). No cases of perforation and no cases of pregnancy in situ were reported in PPIUCD cases during the study period. Even though the rate of infection and missing strings were higher in PPIUCD patients when compared to interval IUCD patients who came for follow up the number of women with infection in PPIUCD patients is less and easily managed with appropriate antibiotics.Conclusions: In India PPIUCD insertion soon after delivery is a safe, effective, reversible and reliable method of long term contraception. Both vaginal and intracaesarean insertions are safe, efficacious and convenient even though there are few complications which are easily manageable. There are no incidences of perforations, pregnancy in situ, ectopic pregnancy and low rates of infection. Hence PPIUCD is a promising approach to decrease the fertility rate in the field of family planning.

scholarly journals Risk of puerperal and non-puerperal recurrence of illness following bipolar affective puerperal (post-partum) psychosis

2005 ◽  
Vol 186 (3) ◽  
pp. 258-259 ◽  
Author(s):  
Emma Robertson ◽  
Ian Jones ◽  
Sayeed Haque ◽  
Roger Holder ◽  
Nick Craddock
Keyword(s):  
Mental Illness ◽  
Value Of Information ◽  
Psychiatric Illness ◽  
Post Partum ◽  
Positive Family History ◽  
Psychotic Episode ◽  
Clinical Value ◽  
Puerperal Psychosis ◽  
History Of

SummaryThe clinical value of information on the risk of future psychiatric illness in women who have experienced puerperal (post-partum) psychosis has been limited by inconsistencies in terminology and nosology. Here we report rates of subsequent puerperal and non-puerperal episodes, in a well-characterised sample of women diagnosed with clearly defined bipolar affective puerperal psychosis (n=103). Out of 54 women having further children, 31 (57%; 95% Cl 44–69) experienced an additional puerperal psychotic episode, and 64 of 103 women (62%; 95%Cl 52–71) experienced a non-puerperal affective episode during the follow-up period (mean duration 9 years). A history of bipolar episodes prior to the puerperal psychosis did not predict risk following subsequent pregnancies, but positive family history of mental illness predicted shorter time to non-puerperal relapse.

scholarly journals 772 Incidence of stroke in patients with hypertrophic cardiomyopathy implanted with a cardiac implantable electronic device

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Carlo Fumagalli ◽  
Chiara Zocchi ◽  
Francesca Bonanni ◽  
Luigi Tassetti ◽  
Matteo Beltrami ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
De Novo ◽  
Multivariable Analysis ◽  
Unmet Need ◽  
Prior History ◽  
Advanced Stage ◽  
History Of

Abstract Aims Incidence of stroke in patients with an advanced stage hypertrophic cardiomyopathy (HCM) is associated with adverse outcome, impaired quality of life and loss of productivity. Still today, however, the real burden of stroke in both patients with and without atrial fibrillation (AF) is unresolved. To assess the prevalence and incidence of AF and stroke in patients with an advanced stage HCM implanted with cardiac implantable electronic devices (CIEDs) at our institution, a long-standing high flow referral centre for cardiomyopathies. Methods and results Clinical and instrumental data of HCM patients implanted with CIEDs [either pacemakers (PM) or implantable cardioverter defibrillator (ICD)] from 1998 to 2019 were retrospectively reviewed. Inclusion criteria were site-designated diagnosis of HCM, age at diagnosis &gt;18 years, Follow-up &gt;1 year. HCM phenocopies (e.g. Fabry disease) were carefully excluded. Patients were divided into three categories according to presence of AF (‘AF prior to CIED implantation’ vs. ‘AF after CIED implantation’ vs. ‘sinus rhythm’). Outcome was measured against incidence of thromboembolic events [stroke or transient ischaemic attack (TIA)] at Follow-up. Patients were also stratified by left atrial diameter (LAD) in two groups (&lt;47 vs.  &gt; 48mm). Of 1861 patients followed at our Unit, a total of 185 (9.9%) patients implanted with a CIED were included (57% men, mean age at implantation 54 ± 17 years). At baseline, AF was present in 72 (36%) patients. Mean CHA2DS2VASc was 1.7 + 1.3 with no differences among patients with or without AF. Patients with AF at baseline had a more pronounced LAD dilation (51 ± 7 vs. 44 ± 8, P &lt; 0.001) and a lower ejection fraction (55 ± 11 vs. 64 ± 12, P &lt; 0.001). After 5.0 ± 3.8 years from CIED implantation, de novo AF was detected in 24 (21%) individuals, resulting in an annual incidence rate of 4.1%/year. Overall, 89 (48%) of patients remained is sinus rhythm. Stroke/TIAs were reported in 19 (10.3%) patients: seven (37%, 1.1%/year) occurred in patients with prior history of AF, three (16%, 2.2%/year) in patients with de novo AF, and nine (63%, 2.3%/year) in patients with no history of arrhythmias documented at CIED interrogation. Among patients in sinus rhythm, those with a LAD &gt; 48 mm had the greatest risk of stroke (4.8%/year vs. 0.5%/year, P &lt; 0.01, for LAD &gt; 48 vs. LAD &lt; 47, respectively). At multivariable analysis, after adjustment for CHA2DS2VASc, AF, and obstructive physiology, only LAD was associated with a higher risk for stroke (HR: 1.09, 95% CI: 1.03–1.11, P &lt; 0.001). Conclusions In a large cohort of consecutive high risk HCM patients referred to CIED implantation, the incidence of stroke was high, with 1-in-10 patients experiencing at least one event. Among patients in sinus rhythm, those with a marked left atrial dilatation were at highest risk of ischaemic stroke, suggesting the existence of an unmet need to stratify risk of stroke even in patients with no detected arrhythmias.

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