Acceptability, Uptake and Safety of Intra-Operative IUCD Placement at KNH and Pumwani Maternity Hospital

Abstract

Increasing number of women undergo elective cesarean section due to repeat cesarean section, breech presentation, fetal or maternal conditions, these women need effective long term contraception to allow them recuperate from surgery and for reliable means of child spacing. Trials of IUCD placement intra-cesarean have proven to be safe, effective and feasible with even higher retention than other routes of PPIUCD. This is an innovative timing where the couples are highly motivated to use a long term method of contraception that is not offered routinely. The timing will also eliminate the need of other procedure for family planning later. It is also cost effective since same infrastructure and staff is involved. IUCD does not affect breastfeeding practice. There were limited local studies describing the uptake and safety of IUCD placement at elective cesarean section hence information generated by the study provided a solution on how to cater for the unmet need of contraception. Objective: To determine the acceptability, uptake, and safety of intra-operative placement of IUCD in women undergoing elective cesarean section at KNH and Pumwani Maternity Hospital. Study Methodology Study Design: Descriptive cohort study. Study Site: Kenyatta National Hospital and Pumwani Maternity Hospital. Study Population: Antenatal mothers between 36weeks and term, who were booked for elective cesarean section. Study Procedure: Women who were scheduled for elective cesarean section were offered intra-operative IUCD placement service after counseling during the period of study. Those who accepted were followed up intrapartum and had the IUCD insertion intra-operative. They were then observed for immediate postoperative outcome at 3rd postoperative day, 2 weeks and at 6 weeks. Results: Two hundred and thirty seven women booked for elective cesarean section were enrolled. Out of these 86 (36.3%) accepted intra-operative placement, 151 declined (63.7%). Uptake of the IUCD was 80(33%). Post insertion adverse events observed included heavy bleeding 1 (1.4%), sepsis 1(1.4%), expulsion rate 1(1.4%) by the end of 6 weeks. The proportion of discontinuation was at 4 (5.6%) at the end of the puerperium. Nine (9) patients were lost to follow up by the study period. Conclusion: Intra-operative IUCD insertion was an acceptable method among women undergoing elective cesarean section, and safety demonstrated through the minimal complication evidenced, with highest retention rates compared to other routes and timing of insertion. Low rates of discontinuation also reflect woman’s satisfaction with their choice. Recommendation: Intra-operative IUCD placement services should be routinely offered to women undergoing elective cesarean section. Antenatal counseling should create awareness of the existence of IUCD and its safety on intra-operative insertion.