India is the most populated country in world with 1.45 billion people .Family planning with adequate spacing between the pregnancies  can prevent about 32% of maternal death & 10 % child mortality .Pregnancies with less than recommended spacing  can lead to obstetric complication like anaemia , spontaneous abortion , preterm labour , post partum haemorrhage & maternal mortality also. Fetal complication like SGA & fetal deaths are more till  2 years after delivery ,because a women will not be ready physically to conceive & delivery. Hence practice of contraception is essential for women health . There is different types of contraception , but not all types appropriate for all situations . IUCDs are the top tier of contraceptives as they are  safe ,  long acting , cost effective  with no major side effects .

AIMS & OBJECTIVES

A clinical study of PPIUCD & Interval IUCD in terms of acceptability , safety & complications .  

MATERIAL & METHODS

This was  a hospital based prospective study conducted in    patients who delivered in RMC Ajmer  or  who came to family planning clinic or routine OPD & searching  for long acting reversible method of contraception .

 Study group :1500 women  in PPIUCD group & 150 in Interval IUCD group .

Inclusion criteria  - All women who  delivered at RMC Ajmer or who came for  long acting reversible method of contraception .

Exclusion criteria   ;  Women who did not provide informed consent , H/O  APH , PROM > 18 hrs , PPH ,  coagulation disorder , allergy to copper , genital tract infection or active STI  , Chorioamnionitis , fever during labour and delivery , anomalous uterus , known uterine fibroid , HIV positive mothers taking ART .

All women who accepted this method  of contraception , IUCDs were placed with proper technique under aseptic conditions  .These  cases are are followed up at 15^th day , 6^th week  6^th  month  .

RESULTS 

Total acceptability rate of PPIUCD was 26.60% & Interval IUCD was 20 % in  our study. Majority of cases  who accepted IUCD  belonges to 18- 30 years for both groups.( Table 1 & 2 ) .

Table No-  1 Distribution of patients according to Parameters .

This  study showed that acceptability  of IUCD was slightly higher in PPIUCD Group. Awareness  was also higher in PPIUCD group ( 58 % ) as compared to interval IUCD (53.33 %) . Minor side effects ( heavy menstrual bleeding , white discharge , pain etc .) was more in interval IUCD group ( 52 % v/s 73. 30 %) .

Table No- 2 Distribution of patients according to Age.

The maximum  age of users  of IUCD  was 18 -30  years in both groups . The age distribution showed that in the 18–30 years category, PPIUCD Group had 337 patients (84.25%) while Interval IUCD Group had 16 patients (53.33%). In the 31–40 years group, there were 57 patients (14.25%) in PPIUCD Group and 12 patients (40.00%) in Interval IUCD Group. Patients aged over 40 years accounted for 6 (1.5%) in PPIUCD Group and 2 (6.67%) in Interval IUCD Group. The total number of patients was 400 in PPIUCD Group and 30 in Interval IUCD Group. The mean age in PPIUCD Group was 26.007 ± 5.02 years, whereas in Interval IUCD Group it was 30.03 ± 5.37 years. This difference in mean age between the two groups was statistically significant, with a p-value of <0.0001.

Table No- 3 Distribution of patients according to Parity -

Most of women who accepted IUCD were multipara ( 53. 75 % v/s 86.67 % ) in both groups  .( Table 3 ) .

Table No- 4  Distribution of patients according to cause of Acceptance.

Regarding the cause of acceptability of  IUCD most common cause in PPIUCD was reversibility ( 64 %)  and for Interval IUCD were long term use and reversibility ( 40 % each ( Table 4)

Table  5 -Distribution of patients according to complications -

Regarding complications, pregnancy occurred in 1 patient (0.25%) in PPIUCD Group and none in Interval IUCD Group (p = 0.78). Expulsion was reported in 14 patients (3.5%) in PPIUCD Group and 3 patients (10%) in Interval IUCD Group (p = 0.07). Missing strings were significantly more common in Interval IUCD Group, with 6 patients (20%) affected compared to 15 patients (3.75%) in PPIUCD Group (p = 0.0001). Heavy menstrual bleeding (HMB) occurred in 35 patients (8.75%) in PPIUCD Group and 5 patients (16.67%) in Interval IUCD Group (p = 0.15). Abdominal cramps was reported by 91 patients (22.75%) in PPIUCD Group and 8 patients (26.67%) in Interval IUCD Group (p = 0.62). White discharge was present in 5.

A 30% reduction in maternal deaths and 10% reduction in child deaths was observed in females who used family planning methods with the intention to create interval of at least 3 years apart between births . Short intervals among births are associated with greater mother and child morbidity as well as mortality. Despite of these facts, only 26% of postpartum women are using contraceptive methods and more than 60% of births follow a track with an interval of less than 3 years. The intrauterine contraceptive devices (IUCD) are one of the commonest methods for contraception. CuT 380A is a little coil, usually in the form of T- shape letter that is placed into a womb to prevent pregnancy . The IUCD is a highly effective, long acting, reversible, cost effective and easily accessible family planning method that is safe for used by most postpartum women including those who are breast feeding or any time during reproductive age. Awareness and removing the stigma about the use of IUCD especially in the postpartum period holds importance since it may help in reducing morbidity and mortality of mother and fetes, which is due to high India that is presently having population crisis.

This study aims to determine proportion of women accepting  PPIUCD & Inerval IUCD  Insertion.

Our study showed that Intra uterine contraceptive devise is a safe , effective and long acting reversible method contraceptive.Women are highly motivated during the postpartum period and receptive to family planning advise & no additional visits are required for contraception .

ADDITIONAL INFORMATIO

 Auther Contributions

All authers have reviewed the final version to be published and agreed to be accountable for all aspects of the work .

Concept and design – Navita kumawat , Renu meena

Acquistion , analysis or interpretation of data – Navita k , Sandhya choudhary , Suchitra Narayan

Drafting  of manuscript – Navita Kumawat , Arjun Singh

1. EL Beltagy NS Darwish EA , Kasem MS , Hefila NM . Comparison between CuT380A and Multiload 375 in early postpartum insertion – East fertility society J.2010 ;16:143-8. 2. Mohan H, Rmappa R , Sandesh M ,Akash BK. PPIUCD versus Interval IUCD insertion ;a comparative study in a referral hospital of Karnataka , India . Int J Reprod contracept Obstet Gynecol 2015 ;4:1730 -2. 3. Priya S, Tuteja A , Mittal P , Diwan R ,Suri j ,Kumar A .Exploring reasons behind low acceptance for PPIUCD in postnatal womwn.New Indian J surg.2011;2;246. 4. Saroj k,Neha G. Acceptibility for the use of PPIUCD ,znana hospital Jaipur .IntvJ Sci Res. 2016 ;5 401-9 . 5. .World Health Organization. Selected practice recommendations for contraceptive use.Geneva: WHO,2004b. 6. Eroglu K, Akkuzu G, Vural G, Dilbaz B, Akin A, Taskin L, et al. Comparison of efficacy and complications of IUD insertion in immediate postpartum/ early postpartum period with interval period: 1 year follow up. Contraception. 2006;74(5):376-81 7. Alvior GT, Jr Pregnancy outcome with removal of intrauterine device. Obstet Gynecol. 1973;41:894–896. 8. Kulier R, O’Brien PA, Helmerhorst FM, UsherPatel M, D’Arcangues C. Co pper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev 2007(4):CD005347. 9. Mohamed AI, Abd Elati IH, Ramadan EN. Assessment Effect of Post Puerperal and Immediate Post Placental Intrauterine Contraceptive Devices Insertion after Cesarean Delivery on Women's Health. IOSR Journal of Nursing and Health Science.2015;4(3):1-7.doi:10.9790/1959-04310107. 10. Kanhere AV, Pateriya P, Jain M. Acceptability and feasibility of immediate postpartum IUCD insertion in a tertiary care centre in Central India. Int J Reprod Contracept ObstetGynecol .2015; 4:179-84. doi: 10.5450- 1770.ijrcog20150232. 11. Kittur S, Kabadi YM. Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy, and expulsion. Int J Reprod Contracept Obstet Gynecol. 2012 Dec; 1(1):26-32.doi:10.5455/2320-1770.ijrcog001112 12. Singal S, Bharti R, Dewan R, Divya ,DabralA, Batra A et al. Clinical Outcome of Postplacental Copper T 380A Insertion in Women Delivering by Caesarean Section. Journal of clinical and diagnostic research.2014 Sep; 8(9):OCO1-OC04. Doi:10.7860/jcdr/ 2014/10274. 4786. 13. Jain N, Akhtar N. A Study to Compare the Efficacy, Safety &Outcome of Immediate Postpartum Intrauterine Contraceptive Device (PPIUCD) With That of Delayed Insertion. International Journal of Science and Research (IJSR).2015 Feb;4(2):1388-1391. 14. Katheit G, Agarwal J. Evaluation of post-placental intrauterine device (PPIUCD) in terms of awareness, acceptance, and expulsion in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2013 Dec; 2(4): 539- 543.doi:10.5455/2320-1770.ijrcog20131210 15. Sultana R, Jameel A, Amjad A. Immediate Postpartum Insertion of Intrauterine Device: An Ideal Method. JSOGP.2015;5(1):34-39.