Clinical Outcome of Postplacental Copper T 380A Insertion in Women Delivering by Caesarean Section.
BACKGROUND
Short interconception period after caesarean section and its associated risk of increased morbidity, mortality and surgical interventions could be avoided by postplacental IUCD insertion during the procedure. Despite the safety reports on intracaesarean IUCD insertion, obstetricians are still hesitant to extend the benefit of this long acting reversible contraception to women undergoing operative delivery.


OBJECTIVE
To study the clinical outcome (safety, efficacy, expulsion and continuation rates) of postplacental Copper T 380A insertion in primiparous women undergoing caesarean section.


METHODS
This study was a prospective observational study, carried out in the Department of Obstetrics and Gynaecology, Safdarjung hospital, which is a tertiary care hospital of Northern India. Primiparous women who delivered by caesarean section over a period of six months (July 2012 to December 2012), willing for postplacental intracaesarean IUCD insertion, and willing to comply with the study protocol, were recruited for the study. All these subjects fulfilled the WHO Standard Medical Criteria for PPIUCD insertion; follow up visits were scheduled at 1, 3, 6 and 12 months.


RESULTS
A total of 300 primiparous women underwent postpartum intracaesarean insertion of Copper T 380A. The mean age of women included in the study was 23.12 ± 2.42 years. Most common postinsertion complication observed in the immediate postoperative period was febrile morbidity (2%). Majority of women (94.33%) had hospital stay of less than 4 days. The common adverse events observed during follow-up of 12 months were menstrual complaints, excessive vaginal discharge and persistent pelvic pain. At the end of one year, there were 16 expulsions, 21 removals, and 2 pregnancies with gross cumulative expulsion, removal, failure and continuation rates of 5.33%, 7%, 0.67% and 91%, respectively.


CONCLUSIONS
Postplacental intracaesarean Copper T 380A insertion in primiparous women is a safe and effective method of reversible contraception, with low expulsion and high continuation rates.
Ex Chief Medical Officer (SAG), Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital , New Delhi, India .
Sunita
S
Singal
Assistant Professor, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital New Delhi, India .
Rekha
R
Bharti
Consultant & Professor, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital New Delhi, India .
Rupali
R
Dewan
Postgraduate Student, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital New Delhi, India .
Divya
Chief Medical Officer (SAG), Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital New Delhi, India .
Anjali
A
Dabral
Consultant & Associate Professor, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital New Delhi, India .
Achla
A
Batra
Consultant & Professor, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital New Delhi, India .
Manjula
M
Sharma
Head of Department, Consultant & Professor, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital New Delhi, India .
Pratima
P
Mittal
Intracaesarean insertion; Intrauterine device; Postplacental insertion