Female’s Experience with Post-placental Intrauterine Contraceptive Device Use in a Tertiary Care Centre in Pakistan

Abstract

Background: Insertion of a post-placental intrauterine contraceptive device (PPIUCD) 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, females are highly driven and in need of an effective method for contraception so that child-rearing can be easy without unintended pregnancy. Objective: To assess the outcome of females accepting PPIUCD in terms of insertion, complications, and discontinuation rate at 6 weeks and 6 months. Methods: Retrospective, cross-sectional study conducted at the Department of Obstetrics and Gynecology, Lahore General Hospital, Pakistan, from May 2015 to August 2019. The data were collected and analysed after approval from the hospital ethical committee and were retrieved from the maternal and neonatal child health programme. Record of clinical visit and telephonic survey for miscellaneous complaints at 6 weeks and 6 months were evaluated from the medical records department and relevant data were extracted. The data were analysed using the IBM Statistical Package for the Social Sciences (SPSS® Statistics) V21.0 software (International Business Machines Corporation [IBM], New York, USA) and the results were expressed in descriptive statistics in frequencies and percentages. Results: Total live births during the study period were 43,065. PPIUCD was inserted in 5,275 females (12.24%). Only 13% presented for clinical follow-up; 87% had a telephonic conversation. Of these, 33% were advised to have a clinical visit; 83% reported no complaints. Reassurance was needed in 11% and threads were trimmed in 2%. Problems reported were displaced intrauterine contraceptive device (IUCD; 3.3%); spontaneous expulsion (24.0%); vaginal infections (4.7%); missing strings (3.0%); cramping (25.0%); dyspareunia (6.0%); spotting (52.0%); and vaginal discharge (16.0%). Ultrasound was advised (3.0%), as were symptomatic treatment (14.0%) and antibiotics and IUCD removal (0.7%). IUCD was discontinued by 6.7% of the females for various reasons: family pressure (0.3%); wanting a further child (0.7%); and opting for another method of family planning (14.0%). IUCD was removed and reinserted in 4.9%. Conclusion: PPIUCD has a low turnover rate of follow-up but has high compliance with devices and a low complication rate; however, complications can be reduced by improving patient selection and clinical follow-up. It provides an excellent window of opportunity for providing effective long-term contraception to the patients who need it the most.