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      Impact of immediate postpartum insertion of TCu380A on the quantity and duration of lochia discharges in Tanzania

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          Abstract

          Background

          The insertion of Intrauterine Contraceptive Device (PPIUD) for the purpose of contraception immediately after delivery is becoming popular in countries where the use of IUD for contraception has been extremely low. Since 2015, Tanzania implemented the initiative by the International Federation of Gynecology and Obstetrics (FIGO) to institutionalize PPIUD. As a result of capacity building and information delivery under the initiative, there have been increased uptake of the method. Working in this context, the focus of the study was to generate evidence on the effect of TCu380A IUD on amount and duration of lochia and equip service providers with evidence-based knowledge which can help them in counselling their PPIUD clients.

          Objective

          Establish impact of postpartum TCu380A on amount and duration of lochia.

          Methods

          A prospective cohort study of delivered women in two teaching hospitals in Tanzania with immediate insertion of TCu380A or without use of postpartum contraception in 2018. TCu380A models; Optima (Injeflex Co. Brazil) and Pregna (Pregna International, Chakan, India) were used. Follow-up was done by weekly calls and examination at 6th week. Lochia was estimated by Likert Scale 0–4 relative to the amount of lochia on the delivery day. An estimated 250 women sample (125 each group) would give 80% power to detect a desired 20% difference in the proportion of women with prolonged lochia discharges among the Exposed and Unexposed groups. Data analysis was by SPSS.

          Results

          Two hundred sixty women were analysed, 127 Exposed and 133 Unexposed. Medical complaints were reported by 41 (28.9%) Exposed and 37 Unexposed (27.8%), p = 0.655. Lack of dryness by end of 6th week was to 31 (23.3%) Exposed and 9 (7.1%) Unexposed, p < 0.001. Exposed had higher weekly mean lochia scores throughout with the difference most marked in 5th week (3.556 Versus 2.039, p < 0.001) and 6th week (1.44 Versus 0.449, p<0.001).

          Conclusion

          PPIUD is associated with increased amount of lochia and slows progression to dryness within 6 weeks of delivery. The implications of PPIUD clients’ needs to be informed about the possibility of delayed dryness of lochia at time of counseling are discussed.

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          Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial.

          Beatrice A. Chen, Matthew F Reeves, Jennifer L Hayes … (2010)
          To estimate whether 6-month use of the levonorgestrel-releasing intrauterine device (IUD) would be higher when insertion occurred within 10 minutes of placental delivery compared with 6-8 weeks postpartum.
          Article 0 comments Cited 30 times – based on 0 reviews     Review now
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            Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up.

            Gulcihan Akkuzu, G Vural, Ali Haberal … (2006)
            This study aimed to compare immediate postplacental (IPP) and early postpartum (EP) intrauterine device (IUD) insertions with interval (INT) IUD insertions with respect to efficacy and complications. The study group consisted of 268 women in whom the following TCu 380A IUD insertions were performed: 84 IPP (less than 10 min), 46 EP (10 min to 72 h) and 138 INT (more than 6 weeks). The women were followed up 8 weeks, 6 months and 12 months after insertion. Complications and pregnancies encountered at the end of 1 year following IPP, EP and INT insertions were compared. The chi-square test and Fisher's Exact Test were used for the evaluation of the data. Complications developed in 40.4% of the women in the IPP group, in 74.4% of the women in the EP group and in 19.2% of the women in the INT group (p .001), there was a statistically significant difference between the groups in the incidence of complete and partial expulsion according to the time of IUD insertion. The overall cumulative pregnancy rate and frequency of pregnancy were found to be higher (p>.05 for both), which are both insignificant for the EP group (2 of 43 women), as compared with the INT (4 of 130 women) and IPP groups (2 of 84 women), and pregnancy rates at 1 year for all groups was 3.1% (8 of 257 women). IPP and EP insertion of the TCu 380A IUD is an effective and convenient procedure, and expulsion rates in these groups are higher than in the INT group. Further studies are necessary to determine the cause of the higher expulsion rates and to find ways to reduce such rates.
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              Women’s experience with postpartum intrauterine contraceptive device use in India

              Somesh Kumar, Reena Sethi, Sudharsanam Balasubramaniam … (2014)
              Background Postpartum intrauterine contraceptive devices (PPIUCD) are increasingly included in many national postpartum family planning (PPFP) programs, but satisfaction of women who have adopted PPIUCD and complication rates need further characterization. Our specific aims were to describe women who accepted PPIUCD, their experience and satisfaction with their choice, and complication of expulsion or infection. Methods We studied 2,733 married women, aged 15–49 years, who received PPIUCD in sixteen health facilities, located in eight states and the national capital territory of India, at the time of IUCD insertion and six weeks later. The satisfaction of women who received IUCD during the postpartum period and problems and complications following insertion were assessed using standardized questionnaires. Results Mean (SD) age of women accepting PPIUCD was 24 (4) years. Over half of women had parity of one, and nearly one-quarter had no formal schooling. Nearly all women (99.6%) reported that they were satisfied with IUCD at the time of insertion and 92% reported satisfaction at the six-week follow-up visit. The rate of expulsion of IUCD was 3.6% by six weeks of follow-up. There were large variations in rates of problems and complications that were largely attributable to the individual hospitals implementing the study. Conclusions Women who receive PPIUCD show a high level of satisfaction with this choice of contraception, and the rates of expulsion were low enough such that the benefits of contraceptive protection outweigh the potential inconvenience of needing to return for care for that subset of women.
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Projestine Selestine Muganyizi: promuga@yahoo.com
                Grasiana Festus Kimario: kimariograce@yahoo.com
                France John Rwegoshora: rwegoshorafrance@gmail.com
                Ponsian Patrick Paul: ponsian29@gmail.com
                Anita Makins: anita@figo.org
                Journal
                Journal ID (nlm-ta): Contracept Reprod Med
                Journal ID (iso-abbrev): Contracept Reprod Med
                Title: Contraception and Reproductive Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2055-7426
                Publication date (Electronic): 5 January 2021
                Publication date PMC-release: 5 January 2021
                Publication date Collection: 2021
                Volume: 6
                Electronic Location Identifier: 1
                Affiliations
                [1 ]GRID grid.25867.3e, ISNI 0000 0001 1481 7466, Department of Obstetrics & Gynecology, , Muhimbili University of Health and Allied Sciences (MUHAS), ; P.O.Box 7623, Dar es Salaam, Tanzania
                [2 ]FIGO-TAMA PPIUD project, P.O.Box 65222, Dar es Salaam, Tanzania
                [3 ]Obstetrician & Gynecologist, Mbeya Zonal Referral Hospital, P.O.Box 419, Mbeya, Tanzania
                [4 ]GRID grid.475220.6, ISNI 0000 0001 1940 8979, FIGO House Suite 3, Waterloo Court, ; 10 Theed Street, London, SE1 8ST UK
                Article
                Publisher ID: 145
                DOI: 10.1186/s40834-020-00145-2
                PMC ID: 7783969
                PubMed ID: 33397504
                SO-VID: 9431fe4a-e5f3-42c5-83b2-9a18443b12ae
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 24 February 2020
                Date accepted : 8 December 2020
                Funding
                Funded by: International Federation of Gynecology and Obstetrics (FIGO)
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                Keywords: postpartum contraception,tcu380a,pregna,optima,lochia discharges,tanzania
                Data availability:
                Keywords: postpartum contraception, tcu380a, pregna, optima, lochia discharges, tanzania

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