Evaluation of Acceptability, Safety, Efficacy and Outcome of Postplacental IUCD Insertion in Women Undergoing both Vaginal Delivery and Caesarean Section- A Cohort Study

Introduction: Prevention of unplanned and unwanted pregnancies could help avert 20-35% of maternal deaths and as many as 20% of infant death. Despite many advantages of, mothers of India are reluctant for IUCD use. Aim: To determine the acceptability, safety, efficacy and outcome of Postpartum Intrauterine Contraceptive Device (PPIUCD) following both vaginal delivery and caesarean section. Materials and Methods: A descriptive prospective cohort study conducted in the Department of Obstetrics and Gynaecology in a tertiary care institute in Eastern India from August 2019 to July 2020. Among the women delivered almost all mothers were counseled about postplacental IUCD insertion and the first 100 mother who satisfy inclusion criteria were incorporated in the present study. Out of 100 mothers, six mother refused and 94 mothers accepted PPIUCD. Only three mothers were lost to follow-up. Ninety-one mothers were followed-up in postnatal clinic after 6 weeks, 12 weeks, 24 weeks and 48 weeks. Primary parameter was to assess acceptance rate and reason for acceptance. Secondary variables were refusal rate and reason for refusal, reason for removal, failure rate and complications. Collected data were then analysed by SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism version 5. Results: Majority of mothers were in the 21-25 years age group and completed secondary school education. A very high rate of acceptance of about 94% was found. The most common reason for acceptance was its long-term effect of contraception (40.4%) followed by reversible nature (27.7%). This study showed that refusal rate was 6%, majority due to fear of complications. Among 91 mothers followed-up for safety profile of PPIUCD, majority (81.3%) had no complication which was statistically significant (p<0.0001). Out of 91 women, 80 mothers (87.9%) continued PPIUCD, three mothers had abdominal discomfort, 10 had abnormal bleeding P/V, and 67 mothers (90.4%) had no complications and failure rate was 2.2%. Only two mothers conceived with PPIUCD in-situ. Expulsion rate was 4.4%. Out of 91 mothers followed-up, only four had expulsion. Conclusion: PPIUCD is widely accepted, efficacious, safe method of family planning, that can reduce maternal morbidity and mortality