Acceptability, Safety and Compliance of Copper T 380A as a Postpartum Intrauterine Contraceptive Device Inserted via Vaginal or Intracaesarean Route: A Cohort Study

Abstract

Introduction: Considering the high unmet need for family planning in India, especially in postpartum mothers, there is a necessity for reliable, long-term, highly efficacious, safe and reversible contraception like Intrauterine Device (IUD) in these women. Copper T 380A (CuT 380A) as a Postpartum Intrauterine Contraceptive Device (PPIUCD) can reduce maternal and perinatal mortality by decreasing unintended and closely spaced pregnancies in the postpartum period. Despite many advantages, the acceptability and utilisation of PPIUCD still remain very low due to lack of information about it. Aim: To determine the acceptance, safety, and efficacy of Copper T 380A; its association with socio-demographic factors and to compare the clinical outcomes between vaginal and intracaesarean insertions of this device. Materials and Methods: A hospital-based prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, India, from February 2021 to July 2021 among the cohort of 210 consecutive eligible postpartum mothers delivered either vaginally or by caesarean section. Primarily, acceptance rate was assessed. Postinsertion follow-up was done till six months after delivery to note various clinical outcomes and complications measuring safety of the device in terms of cramping pain abdomen, irregular vaginal bleeding, abnormal vaginal discharge, string problems, and perforation; compliance in terms of pregnancy and expulsion; and continuation of the device. All the follow-up results were compared between two modes of insertions. Comparison between categorical variables was done by Chi-square test. Results: Out of 210 counselled mothers, Copper T 380A insertions were done in 178 (84.8%) postpartum mothers. The acceptance rate was slightly higher in intracaesarean group (n=87, 85.3%). The mean±Standard Deviation (SD) age of acceptance of IUCD in partcipants was 25.59±4.06 years with the highest rate observed in the age group of 21-25 years (n=82, 46.1%). Acceptance of the device was significantly associated with multipara and the clients completed primary education (p-value <0.05). On follow-up, overall complications are low. No case of perforation was reported. Significantly higher incidences of abnormal vaginal bleeding, foul smelling vaginal discharge, string problems, and expulsions were observed in the vaginal group (p-value <0.05). Pregnancy was recorded in five (5.5%) clients and all of them were in the vaginal group. Out of 178 acceptors, compliance-continuation of the device was shown by 151 (84.8%), with significantly higher in the caesarean group (p-value <0.000051). A significantly higher continuation rate was observed among the clients of low socio-economic status (p-value <0.000207). Abdominal pain (33.33%) was reported to be the most common reason for discontinuation of Copper T 380A. Conclusion: Regardless of the mode of delivery, Copper T 380A is quite an acceptable, safe, effective, and convenient contraceptive method with a good continuation rate in the immediate postpartum period.

Keywords

• descended strings
• expulsion
• intrauterine device
• perforation
• vaginal insertion