Clinical outcome of post placental IUD CuT380 insertion in terms of expulsion

Background: Insertion of an intrauterine contraceptive device (IUD) immediately after delivery has been recommended by the World Health Organization (WHO), as one of the safe and effective methods of temporary contraception. In the immediate post delivery period the women are highly motivated and need an effective method for contraception so that the child can be brought up with a relaxed mind without the worry of unintended pregnancy. This approach is more applicable to our country where delivery may be the only time when a healthy woman comes in contact with health care personnel. However, immediate post-partum IUD insertion may have disadvantages as well. The risk of spontaneous expulsion may be unacceptably high.Methods: After taking approval from hospital ethical committee, all women planning vaginal delivery desiring IUD, admitted through OPD and emergency were evaluated in detailed on design Performa Performa include patient’s identity, age, parity, gestational age, no of alive children, outcome and timings of insertion. Informed consent was obtained. With aseptic precautions IUD was inserted with kellys forceps in the uterine cavity up to the fundus, then cervix was examined for thread (that should not be visible at cervix if proper insertion done). The procedure was performed by myself. Patients were followed at 6week by examining the threat of IUD. All the information was recorded by myself. Follow up was done by taking patients contact number.Results: In our study, out of 300 cases, 63.67% (n=191) were between 18-30 years of age while 36.33% (n=109) were between 31-40 years of age, mean+sd was calculated as 29.49+4.62 years, mean gestational age was calculated as 38.53+0.94 weeks, mean parity was calculated as 3.49+1.06 paras. Frequency of expulsion in post placental intra uterine device cuT 380 insertions reveals in 8.67% (n=26).Conclusions: We concluded that the frequency of expulsion in post placental intra uterine device cuT 380 insertions is not significantly higher and appears to be safe and effective method of contraception.

THE DIFFERENCESS OF DISCONTINUITAS IUD IN POST PLACENTAL AND INTRA-CESAREAN IN MADIUN

Background: Intra Uterine Device (IUD) which is placed after delivery of the placenta is an attempt to reduce the rate of population growth. However, the achievement is still very low, especially in the post-placental IUD insertion. It is this high expulsion rate that continues to be a concern for service providers, so this method is acceptable. The purpose of this study is to compare the sustainability of IUD acceptors in post-placental and intra-cesareann placement. Methods: The design of this study was cross sectional with an observational analytic method. Location of this research in the family planning clinic of Dr. Soedono Madiun Hospital, Banjarejo Health Center, Tawangrejo Health Center, and PMB Ny. “P” Madiun City in 2019.The sample used consecutive sampling as many as 114 acceptors. The independent variable was the time of IUD insertion. The dependent variable is the discontinuity of the IUD acceptor. The instrument used was the 2019 IUD acceptor medical record. The Fisher Exact Test on SPSS was used to perform data analysis. Results: From 114 acceptors, there was no difference in the discontinuity of IUD acceptors in post-placental and intra-cesarean placement (p=0.1). The incidence of expulsion was found in post-placental insertion (p=0.02). In intra-cesarean IUD acceptors more confirmed using ultrasound examination (p = 0.03). There was no perforation in both. Conclusion: There is no difference in IUD acceptor discontinuity in post-placental and intra-cesarean placement.

DESCRIPTION OF KNOWLEDGE ABOUT THE POST PLACENTA IUD (INTRA UTERINE DEVICE) CONTRACEPTIVE METHOD FOR PREGNANT

Introduction: Post-placental IUD is a long-term contraceptive method with an effective pregnancy prevention 0.6-0.8 pregnancies / 100 women. Installation that is carried out when the mother gives birth has an impact on the coverage of contraceptive use from an early age. Post-placental IUD contraceptives are not only effective in the long term for up to 10 years but are also affordable contraceptives for people from low to high economies status. Currently, these contraceptives can be purchased or installed for free. Contraception does not interfere with milk production, does not require routine follow-up to the hospital, contraceptive examinations can be done independently. The purpose of this study was to describe the knowledge about the post-placenta IUD contraceptive method. Methods: This study used a descriptive design, with a population of 98 people and a sample of 54 people. The sampling used is purposive sampling. Collecting data with a closed questionnaire. Data processing and data analysis by editing, scoring, coding, tabulating and presented in narrative form then draw conclusions. Results: Based on the results of the study, it was found that most (78.1%) pregnant women had less knowledge about Post Placenta IUD contraception. Conclusion: The reference of this study is to increase knowledge about the Post Placenta IUD (Intra Uterine Device) contraceptive method in pregnant women. Periodic health education regarding this contraceptive method during pregnancy so that at delivery, post placenta IUD contraception can be immediately installed.

Clinical Outcomes of Trans-caesarean and Vaginal Post-placental CuT380A IUCD Insertions: A Comparative Study

Background: Immediate postpartum CuT380A intrauterine contraceptive device (PPIUCD) insertion provides a novel approach in reducing the unmet contraceptive needs of family planning. The insertion can be trans-caesarean or vaginal following delivery of the placenta. The clinical outcomes of the different routes of insertion have not been adequately studied. Aim: The study aimed at comparing the clinical outcomes following trans-caesarean and vaginal post-placental insertions of CuT380A IUCD. Methodology: The study was a prospective cohort study of 81 pregnant mothers managed at a tertiary health institution in southern Nigeria. They were recruited into two groups using a convenient sampling technique; 27 and 54 mothers in the caesarean and vaginal delivery groups respectively. The pregnant mothers were followed up till delivery and at the six weeks postnatal visit. Information on their socio-demographic characteristics, Obstetrics and Gynecology history were obtained with the aid of a proforma. The proforma was updated with the clinical outcomes of immediate PPIUCD insertions in the two groups, at the six weeks visit. Data obtained were analyzed using statistical package of social sciences version 21. Continuous variables were expressed as means and standard deviations. The Chi square test was used for dichotomous or categorical variables. A p-value of less than 0.05 was considered statistically significant. Results: The study showed that PPIUCD is a safe practice in both vaginal and caesarean deliveries with no significant differences in clinical outcomes. However, incidence of missing string was higher in the caesarean group compared to vaginal group (81.5% vs 51.9%; p value-0.01); and expulsion rate was also high in the vaginal group but not significant. (13.0% vs 7.4%; p value 0.45). Conclusion: Immediate postpartum CuT380A contraception, irrespective of route of insertion, is convenient, effective, and safe. Although there is a relatively higher incidence of missing strings, including expulsions after vaginal PPIUCD insertions, immediate post-partum contraception should be encouraged. This will help to reduce high unmet contraceptive needs in our environment and loss to follow up irrespective of route of delivery. Recommendation: Immediate PPIUCD, irrespective of the route, should be encouraged and integrated into the existing Maternal and Child Health Programme. Awareness should be created to promote acceptance in our environment.