Increasing postpartum IUCD coverage through a QI initiative: a step towards reducing the unmet need of postpartum contraception

A Prospective Multi-centric Study of Acceptance, Insertion and Follow-Up of Postpartum Insertions of IUCD

Purpose of the Study

The unmet need for contraception in the postpartum period is a major challenge in our country. Unintended pregnancies are highest in the first year after birth, and postpartum IUCD insertion is an effective way to counter this problem. This study was planned to build up data for acceptance and follow-up of postpartum IUCD insertions.

Methods

The present study has included data of PPIUCD insertions and follow-up from seven institutions over a period of 6 months. The case recruitment lasted for 3 months, including only those who had PPIUCD insertions in this period, and they were followed up for a period of 6 months. The follow-up of patients was at 6 weeks and 6 months. All issues were addressed including side effects, expulsions, myths surrounding the device, etc., along with routine postnatal care.

Results and Conclusion

There were 5227 deliveries and 1895 insertions. The acceptance rate was 36%, and a follow-up at 6 weeks and 6 months showed up an expulsion rate of approximately 4% and a removal rate of 5%. Overall, at the end of 6 months we have a continuation rate of 90%. This shows that a dedicated approach to postpartum contraception will definitely bring down incidence of unintended pregnancies.

Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review

BACKGROUND

Intrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden.

METHODS

This systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type. English language articles indexed in MEDLINE, Embase, and Cochrane from January 2010-October 2021 were included.

RESULTS

133 articles met the inclusion criteria (46% interventional studies; 54% observational; n=87 from lower-income countries; n=46 from higher-income countries). PPIUD use was low in higher-income countries (6/10 000 US deliveries in 2013-2016) and varied widely in lower-income countries (2%-46%). Across both higher- and lower-income countries, in most studies (79%), >80% of women with PPIUDs had an IUD in place by 3 months; at 6 and 12 months, 76% and 54% of included studies reported that >80% of women had an IUD in place; reason for discontinuation was infrequently reported. Pregnancies were rare (96 pregnancies across 12 191 women from 37 studies reporting data) and were generally unrelated to device failure, but rather occurred in women no longer using a PPIUD. Expulsions occurred mainly in the early outpatient period and ranged widely (within 3 months: 0-41%). Abnormal bleeding, infections, or perforations were rare.

CONCLUSIONS

PPIUDs are safe and effective. Long-term follow-up data are limited. Future research elucidating reasons underlying lack of PPIUD use is warranted.