Anita Makins1,2, Neda Taghinejadi2, Maya Sethi1, Kazuyo Machiyama3, Projestine Munganyizi4, Elly Odongo5, Hema Divakar6, Parveen Fatima7, Kusum Thapa8, Gamini Perera9, Sabaratnam Arulkumaran1,10. 1. International Federation Gynecology and Obstetrics, London, UK. 2. Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 3. London School of Hygiene and Tropical Medicine, London, UK. 4. Association of Gynaecologists and Obstetricians of Tanzania, Dar es Salaam, Tanzania. 5. Kenya Obstetrical and Gyanecological Society, Nairobi, Kenya. 6. Federation of Obstetric and Gynecological Societies of India, Mumbai, India. 7. Obstetrics and Gynecology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 8. Nepal Society of Obstetricians and Gynaecologists, Kathmandu, Nepal. 9. Sri Lanka College of Obstetricians and Gynaecologists, Colombo, Sri Lanka. 10. St George's, University of London, London, UK.
Abstract
OBJECTIVE: To record and analyze complication rates following postpartum intrauterine device (PPIUD) insertion in 48 hospitals in six countries: Sri Lanka, India, Nepal, Bangladesh, Tanzania, and Kenya. METHODS: Healthcare providers were trained in counselling and insertion of PPIUD via a training-the-trainer model. Data were collected on methodology, timing, cadre of staff providing care, and number of insertions. Data on complications were collected at 6-week follow-up. Statistical analysis was performed to elucidate factors associated with increased expulsion and absence of threads. RESULTS: From May 2014 to September 2017, 36 766 PPIUDs were inserted: 53% vaginal and 47% at cesarean delivery; 74% were inserted by doctors. Follow-up was attended by 52%. Expulsion and removal rates were 2.5% and 3.6%, respectively. Threads were not visible in 29%. Expulsion was less likely after cesarean insertion (aOR 0.33; 95% CI, 0.26-0.41), following vaginal insertion at between 10 minutes and 48 hours (aOR 0.59; 95% CI, 0.42-0.83), and when insertion was performed by a nurse (aOR 0.33; 95% CI, 0.22-0.50). CONCLUSION: PPIUD has low complication rates and can be safely inserted by a variety of trained health staff. Given the immediate benefit of the one-stop approach, governments should urgently consider adopting this model.
OBJECTIVE: To record and analyze complication rates following postpartum intrauterine device (PPIUD) insertion in 48 hospitals in six countries: Sri Lanka, India, Nepal, Bangladesh, Tanzania, and Kenya. METHODS: Healthcare providers were trained in counselling and insertion of PPIUD via a training-the-trainer model. Data were collected on methodology, timing, cadre of staff providing care, and number of insertions. Data on complications were collected at 6-week follow-up. Statistical analysis was performed to elucidate factors associated with increased expulsion and absence of threads. RESULTS: From May 2014 to September 2017, 36 766 PPIUDs were inserted: 53% vaginal and 47% at cesarean delivery; 74% were inserted by doctors. Follow-up was attended by 52%. Expulsion and removal rates were 2.5% and 3.6%, respectively. Threads were not visible in 29%. Expulsion was less likely after cesarean insertion (aOR 0.33; 95% CI, 0.26-0.41), following vaginal insertion at between 10 minutes and 48 hours (aOR 0.59; 95% CI, 0.42-0.83), and when insertion was performed by a nurse (aOR 0.33; 95% CI, 0.22-0.50). CONCLUSION: PPIUD has low complication rates and can be safely inserted by a variety of trained health staff. Given the immediate benefit of the one-stop approach, governments should urgently consider adopting this model.