Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : QC33 - QC36 Full Version

Evaluation of Expulsion and Continuation Rate of Immediate Postpartum Intrauterine Contraceptive Devices: A Prospective Hospital-based Study


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/59330.17373
Monika Yadav, Archana Bharti, Gagandeep Kour

1. Secondary DNB Resident, Department of Obstetrics and Gynaecology, Kalpana Chawla Government Medical College, Karnal, Haryana, India. 2. Associate Professor, Department of Obstetrics and Gynaecology, Kalpana Chawla Government Medical College, Karnal, Haryana, India. 3. Assistant Professor, Department of Obstetrics and Gynaecology, Kalpana Chawla Government Medical College, Karnal, Haryana, India.

Correspondence Address :
Dr. Archana Bharti,
House No. 15 B, Medical Enclave, Kunjpura Road, Karnal, Haryana, India.
E-mail: archanabharti1414@gmail.com

Abstract

Introduction: Family planning can avert nearly one-third of maternal deaths and 10% of child mortality, when couples space their pregnancies more than two years apart. With increased institutional deliveries, Postpartum Intrauterine Contraceptive Devices (PPIUCD) can play an important role in addressing the unmet needs of spacing methods in India. Moreover, in this digital age, generalised awareness of the female population about contraception has increased considerably, so the acceptance and continuation rate might be high.

Aim: To evaluate expulsion and continuation rate of immediate PPIUCDs at a tertiary care hospital in Haryana, India.

Materials and Methods: The prospective, hospital-based study was conducted from October 2020 to September 2021 in the Department of Obstetrics and Gynaecology at Kalpana Chawla Government Medical College, Karnal, Haryana, India. Ninety women, who underwent IUCD insertion within 10 minutes of delivery of the placenta were enrolled, irrespective of the mode of delivery. Patients were followed-up at six weeks, three months, and six months. The expulsion and continuation rate of immediate PPIUCD and reasons for removal were studied. Descriptive variables were expressed in percentages. The Chi-square test was used to determine the continuation rate and expulsion/removal rates in vaginal versus cesarean deliveries and a p-value less than 0.05 was taken as statistically significant.

Results: A continuation rate of 84.4% was observed at six months. A statistically significant difference was observed in the continuation rate of participants of vaginal delivery vs caesarean section (82.67% vs 93.33%, p-value <0.01). Overall, the expulsion rate was 6.66%.

Conclusion: Immediate PPIUCD insertion has high continuation rates and can play an important role in family planning.

Keywords

Caesarean section, Contraception, Family planning, Vaginal insertion

World Health Organisation (WHO) recommends spacing between pregnancies by atleast 24 months (1). An estimated 61% of births in India occur at intervals that are shorter than the recommended birth interval (2). Short birth intervals are associated with adverse pregnancy outcomes such as induced abortions, miscarriage, preterm births, neonatal and child mortalities, still births, and maternal depletion syndrome (3). A study shows that, if couples space their pregnancies more than two years apart by contraception, more than 30% of maternal mortalities and 10% of child deaths can be averted (4).

The postpartum period provides the most convenient opportunity to explain women about family planning methods, as they are strongly motivated during this period (5). Women stay in contact with healthcare providers for enough time to undergo counselling and this opportunity may be utilised to motivate her for opting one of the contraceptive methods. If this prospect is missed, women may never return to seek contraception advice (6).

Postpartum Intrauterine Contraceptive Devices (PPIUCD) is a non hormonal, long-acting, and highly effective contraception, that does not affect fertility. It is suitable for women of all reproductive ages and represents the most cost-effective contraceptive method for preventing unwanted pregnancies (7). Women, who undergo tubal ligation at a relatively younger age may regret it later on, especially in view of high perinatal and infant mortality rates in developing countries like India (8). Therefore, Intrauterine Contraceptive Devices (IUCD) insertion at caesarean section, offers an alternative to the common practice of tubal ligation.

The PPIUCD coverage rate varies widely among different states in India ranging from 1.2% to 40.2% with the national average being 16.3% (9),(10). Given the high unmet need for birth spacing and the rise in Institutional deliveries, the Government of India has been working to scale up the use of postpartum family planning, with a focused effort on expanding the capacity to provide PPIUD services (11),(12). Moreover, in this digital age, generalised awareness of the female population about contraception has increased considerably, so, the acceptance and continuation rate might be high as compared to older studies (13),(14). Hence, newer studies on PPIUCD insertion are vital to understand the impact of Government’s initiatives and changing scenarios on PPIUCD use. There are limited studies on PPIUCD insertions in North India (15),(16),(17), which encouraged us to conduct the present study. Findings from the current study, will help planners in designing strategies, so as to promote the use of postpartum IUCD by providing baseline information. The present study aims to evaluate the expulsion and continuation rate of immediate PPIUCDs and factors associated with its discontinuation at a tertiary care hospital in Haryana, India.

Material and Methods

This was a prospective, hospital-based study conducted from October 2020 to September 2021 in the Department of Obstetrics and Gynaecology, Kalpana Chawla Government Medical College, Karnal, Haryana, India. Approval from Institutional Ethical Committee was obtained (KCGMC/SRC/2020/128-133). Written informed consent was obtained from all the participants.

All antenatal women, admitted to labour room of the Department of Obstetrics and Gynaecology, for their delivery were counseled for PPIUCD insertion as a part of the routine protocol.

Inclusion and Exclusion criteria: All women, who delivered vaginally or by caesarean section and underwent PPIUCD insertion within 10 minutes of delivery of placenta were enrolled in the study. Women belonging to Medical Eligibility Category 3 and 4 for PPIUCD and IUCD by WHO (18), haemoglobin <8 gm%, diagnosed with obstructed labour, more than 18 hours from rupture of membranes to delivery of the baby, suffering from Acquired Immunodeficiency Syndrome (AIDS) and neither clinically well nor on antiretroviral therapy, unresolved postpartum haemorrhage, women who underwent PPIUCD insertion after 10 minutes of delivery of placenta and women, who were lost to follow-up were excluded from the study.

Sample size calculation: The study by Lall J and Nagar O (19) observed a continuation rate of 84.5% for PPIUCD at three months of follow-up. Taking this value as a reference, the minimum required sample size, with a 7.5% margin of error and a 5% level of significance was 90 patients.

Study Procedure

For women who underwent vaginal delivery, Copper T380A (CuT380A) Intrauterine Device (IUD) was placed high up the fundus, immediately within 10 minutes of delivery of the placenta using long Kelley’s forceps, in the lithotomy position, and the strings were cut (6). For those undergoing caesarean section,CuT380A IUCD was placed high up at the fundus within 10 min of delivering the placenta, with the help of long ring forceps passed through the uterine incision. Strings were pointed toward the cervical canal but not pushed to the canal to avoid infection by vaginal flora, and displacement of the IUCD. Care was taken to avoid strings being included during suture. The uterus was repaired in two layers (Vicryl 1-0) as routine (6),(20).

Each participant was provided with a discharge card at the time of discharge showing the type of IUCD and date of insertion. The participant was informed about the IUCD side effects and normal postpartum symptoms. Participants were asked to come for follow-up in the Outpatient Department (OPD) of Obstetrics and Gynaecology, at six weeks, three months, and six months or they could visit OPD any time if they had foul-smelling vaginal discharge, lower abdominal pain, especially accompanied by not feeling well, fever or chills, feeling of being pregnant, suspicious of IUCD expulsion. Patients who did not turn up for follow-up were contacted telephonically. The study was discontinued, once the patient number who completed follow-up, was equal to the sample size achieved.

Details regarding socio-demographic factors such as age, parity, socio-economic status (21), and residence were recorded from case sheets. At each follow-up visit, complaints regarding PPIUCD were recorded, and per abdomen, per speculum, and per vaginum examination of each participant was done. Details regarding in-situ presence of IUCD, missing threads, spontaneous expulsion/removal of IUCD, along with reasons for removal were recorded. Details regarding adverse effects of PPIUCD such as pelvic pain, abnormal vaginal discharge, and excessive/irregular menstrual bleeding were recorded. The continuation rate of PPIUCD was the primary outcome. For continuation rate, participants with IUCD in-situ at six months, were counted. Factors leading to its discontinuation were also evaluated.

Statistical Analysis

All the data was analysed using various tests on Statistical Package for Social Sciences (SPSS) software version 21.0. Descriptive variables were expressed in percentages. The Chi-square test was used for categorical values. For all statistical tests, a p-value <0.05 was taken as statistically significant.

Results

The first 90 women, who completed six months of follow-up were included in the study. Seventy five (83.33%) participants got IUCD inserted following vaginal delivery and 15 (16.67%) had intracaesarean insertion.

During the study period, 44 (48.9%) participants were between 18 to 24 years of age group, 37 (41.1%) participants were between 25 to 30 years of age group, 8 (8.9%) participants were between 31 to 35 years of age group and 1 (1.1%) participant was above 35 years. In present study, 44 (48.88%) participants were parity-1, 24 (26.67%) participants were parity-2, 12 (13.33%) participants were parity-3 and 10 (11.11%) participants were parity-4 and above parity (Table/Fig 1).

Four (4.44%) participants had spontaneous expulsion of the device within six weeks and 2 (2.22%) more cases of spontaneous expulsion were observed at three months of follow-up. No additional cases were recorded at six months. One (1.11%) participants requested for removal of IUCD at six weeks, 2 (2.22%) at three months, and 5 (5.55%) at six months. (Table/Fig 3) shows that 5 (5.55%) PPIUCD removals were done due to menstrual/bleeding problems, 1 (1.11%) within three months and an additional 4 (4.44%) at six months. One (1.11%) removal was done due to pelvic pain at three months.

Thirteen (17.33%) participants of the vaginal delivery group and 1 (6.66%) from the intracaesarean group had IUCD expulsion/removal of PPIUCD. Vaginal delivery and intracaesarean groups had a continuation rate of 82.67% (n=62) and 93.33% (n=14), respectively (p-value <0.001) (Table/Fig 4).

Discussion

A total of 90 women who completed follow-up were enrolled in the study, out of which 83.33%of women underwent post placental IUCD insertion, within 10 minutes of placental delivery following vaginal birth, whereas 16.67% of women had device insertion during caesarean section. Present study showed that women following vaginal delivery were more inclined for PPIUCD insertion. This could be due to the fact that pain of normal labour inclines a woman more toward birth spacing. Moreover, women may be afraid of complications of an operative procedure and therefore, do not choose any further procedure along with caesarean section. Garg N et al., also observed that women following vaginal delivery were more inclined to PPIUCD insertion (22).

In the present study, acceptance of PPIUCD was more among parity1 (48.88%) and parity 2 (26.67%). Mothers having more than two living children had lower acceptance, as they prefer permanent sterilisation. The same observation was seen in the study by Halder A et al., primipara mothers accepted PPIUCD more than the others (44 and 52% in vaginal and intracaesarean group, respectively) (6). Sharma A et al., and Kanhere AV et al., also found the highest acceptance in the parity 1 group (44.24% and 48% respectively) (8),(13).

The present study showed that maternal age is an important factor in accepting contraceptives. Results showed that the majority (48.9%) of acceptors belonged to the 18-24 years of age group. It could be due to the fact that women in the high age group belong to higher parity also, and therefore, are more inclined towards permanent sterilisation. Halder A et al., found the highest acceptors in the age group 21-25 years (40% and 44% in vaginal and intracaesarean group) (6). Sharma A et al., (8), Garg N et al., (22) and Shanavas A et al., (23) also observed almost similar age group in their study (45%, 61.8% and 50% in age-group 20-25 years respectively). The middle socio-economic group constituted the majority in this study (86.67%). Shanavas A et al., found the middle socio-economic group as a major constituent of their study, which was almost 70.7% (23). Whereas, Goswamy G et al., in their study found 62% of acceptors from the lower socio-economic group (14).

In the present study 59 (65.56%) participants were from rural areas and 31 (34.44%) participants were from urban areas. This shows the role of antenatal contraceptive counselling done by ASHA workers and ANM in rural areas because the frequency of contact of pregnant women with ANM or ASHA worker and their influence in the rural area is more as compared to urban areas. Garg N et al., also observed that 71.13% of participants were from a rural background in their study (22). In the present study, 6 (6.66%) cases had spontaneous expulsion of the device, 4 (4.44%) at six weeks, and the remaining 2 (2.22%) at three months. The expulsion rate of the device might be reduced by improving the skills in PPIUCD insertion by conducting more training for healthcare workers. Moreover, confirmation of the position of the IUCD postinsertion with ultrasonography might also lead to better results (12).

Variations in rates of IUD expulsions, mainly depend upon the timing of placement and mode of delivery (24). A statistically significant difference was observed in the continuation rate of participants of vaginal delivery vs caesarean section (82.66% vs 93.33%, p-value <0.01). Intracaesarean PPIUCD insertion is attempted through the uterine incision and is under direct vision. It leads to better placement of IUCD and hence, lesser expulsions and an improved continuation rate. Sharma A et al., observed an expulsion rate of 5.20%, and IUCD removal was done in 13.54% of women (8). The continuation rate at six months was 81.25%, which is comparable to the present study.

Bayoumi YA et al., observed a total expulsions rate of 13.9% in the postplacental group at six months and the continuation rate of IUCD use was 87.0% at 6 months (25). In a similar study by Agarwal M et al., the expulsion rate was high in vaginal delivery than intracaesarean group (26). The overall expulsion rate was 6% and the continuation rate was 78% after 3 months. This may be due to better visualisation, fundal placement and expertise of the provider in case of caesarean section. Hooda R et al., found that the expulsions were significantly higher in postplacental IUCD insertions after vaginal deliveries as compared to caesarean insertions (p-value=0.042) (27).

The PPIUCD insertion is a single-time decision as compared to the barrier and hormonal contraceptives. Moreover, it is available free of cost in government health facilities and is long-acting and reversible. Further, healthcare providers can also be easily trained for PPIUCD insertion as the technique is quite simple. Trained providers and proper technique of PPIUCD insertion result in a lesser expulsion rate as seen in the present study. For women, undergoing multiple caesarean sections, it is an alternative to tubal ligation. With the rapidly growing population and high unmet needs for family planning, especially during the first two-three years following delivery, immediate PPIUCD can play a significant role.

Limitation(s)

The short duration of follow-up and the study was conducted in a single-centre, hence, the findings cannot be generalised.

Conclusion

With the rise in Institutional births in our country, opportunities to provide postpartum contraception have further increased. Immediate PPIUCD insertion has high continuation rates and can play an important role in family planning. Although there is a relatively higher incidence of expulsions after vaginal PPIUCD insertions, they should be encouraged considering the advantages that come along. Improvement in follow-up services, can further enhance continuation rates.

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DOI and Others

DOI: 10.7860/JCDR/2022/59330.17373

Date of Submission: Jul 27, 2022
Date of Peer Review: Aug 30, 2022
Date of Acceptance: Oct 22, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 28, 2022
• Manual Googling: Oct 17, 2022
• iThenticate Software: Oct 20, 2022 (22%)

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