INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICE (MULTILOAD CU-375) AT CAESAREAN SECTION

ABSTRACT:

Introduction: Pakistan is a country with a high population density and low contraceptive prevalence. Family Planning largely remains responsibility of woman. By the time most women practice contraception, they already have had many children, usually in quick succession. Birth spacing is essential for improving maternal and new born health. Intrauterine contraceptive device (IUCD) is a method for birth spacing favoured by many women, but is not used commonly in those who have had a Caesarean section. This study was done to determine the safety and efficacy of IUCD (Multiload Cu 375) insertion at Caesarean section and compare it to IUCD inserted as an interval procedure, and to compare the postoperative period of women who have IUCD inserted at Caesarean section, to those with Caesarean section without IUCD insertion.

Subjects and Methods: The study was conducted at the Department of Obstetrics and Gynaecology Jinnah Postgraduate Medical Centre, Karachi. It was a case control study consisting of convenience sampling. One hundred and fifty subjects were recruited after informed consent. Group 1 (cases) were 50 women who had IUCD (Multiload Cu375) inserted at Caesarean section, elective and emergency. Groups 2 and 3 were controls, of which the former consisted of 50 matched women who had a Caesarean section, elective and emergency, without IUCD insertion and the latter, also controls, consisting of 50 women who had Multiload Cu 375 inserted as an interval procedure at the Reproductive Health Services, a Centre affiliated with JPMC, at least 3 months following a vaginal delivery or abortion. Information was gathered by interviews of patients, checking case notes and registers. A data base was developed using Microsoft Excel, which was later converted to SPSS version 10.

Results: There was no significant difference between the socioeconomic and educational background of women or their husband in all groups. Less than a third of all women in each group had ever used contraception before. There was no significant difference in the duration of their marriages or previous operative deliveries either. However women who had IUCD inserted at Caesarean section were younger and had a significantly lower parity as compared to those opting for interval IUCD insertion.

IUCD insertion at Caesarean section did not alter the immediate postoperative period as compared to those who had Caesarean section without intra-operative IUCD insertion. There was no significant difference between expulsions or uterine perforation rates between those who had intra-operative or interval insertion of IUCD. The menstrual pattern and willingness to continue using the IUCD for contraception was also not significantly different between the two groups.

Discussion: IUCD insertion at Caesarean section is effective and safe. It has no an adverse effect on the postoperative period. There is no significant difference in expulsion or complications rate, or willingness to continue use, between interval insertion and insertion at Caesarean section.  It offers a convenient birth spacing method of contraception to younger women undergoing Caesarean section.

Conclusion: Women undergoing Caesarean section, who are desirous of, and suitable for using this method, should be given the option of IUCD insertion at the same time.