A Prospective Study on PPIUCD Insertion between Vaginal Delivery and Caesarean Section

Introduction: Postpartum Intrauterine Contraceptive Device (PPIUCD) has great potential of being the modern, reliable contraceptive that can serve the unmet need for a large number of women. The program of PPIUCD suffered a setback when it was introduced earlier due to lack of trained personnel and subsequently a poor result in terms of efficacy and side effects were observed. Aim: To find out the acceptability, expulsion rate and other complications of PPIUCD in both vaginal and caesarean delivery groups. Materials and Methods: A prospective study was conducted from 3rd September 2017 to 2nd December 2017 in which 2287 women were counselled during the antenatal visit, after admission to the Hospital and in the immediate post-partum period. Overall 1345 patients had PPIUCD insertion in the study period. Out of these patients first 127 mothers who delivered vaginally and the first 127 mothers who underwent caesarean section were regarded as study groups and were followed up for three months. The collected data was entered in MS Excel 2016, and was analysed by Student's t-test, Pearson's Chisquare test, on IBM SPSS (R) software, version 20.0. The p-value <= 0.05 was considered statistically significant. Results: In the caesarean group the mean age was 25.1 years and in vaginal delivery group it was 23.6 years and the difference was statistically insignificant (p=0.27). Expulsion rate at six weeks was 0.8% in caesarean section group and 3.9% in vaginal delivery group (p=0.09). At three month the expulsion rates in caesarean section group and vaginal delivery group were 3.1% and 4.7% respectively (p=0.51). At six weeks missing string was seen in 39.3% and 34.6% in caesarean section and vaginal delivery group respectively (p=0.51). At three months follow-up missing string was seen in 39.3% in caesarean section and 26.9% in vaginal delivery group which was statistically significant (p=0.04). At three months, 3.9% of women in caesarean section and 4.7% in vaginal deliveries had bleeding (0.74). At three months, 6.2% women in caesarean section group complained of pain whereas 7.1% in vaginal delivery group complained of pain (p=0.78). At three months, in caesarean section group 4.7% and in the vaginal delivery group 3.9% came with complaints of vaginal discharge (p=0.75). No case of perforation of uterus was found in either group. Client satisfaction was assessed at three months of PPIUCD use using Visual Analogue Scale WAS 1-5) and 61.4% in intracaesarean group and 62.7% in the vaginal group gave score 3 in the 1-5 scale. Conclusion: The benefits of PPIUCD outweigh the minor risks associated with it. This study suggests that PPIUCD in caesarean section as well as in vaginal delivery group is a convenient opportunity which should not be missed in countries like ours with high rates of unplanned and short interval pregnancies with limited access to health care providers.