Insertion of intrauterine contraceptive device at caesarean section

To determine the safety (infection, conception rate and perforation) of intrauterine contraceptive device (IUCD, Multiload Cu 375) insertion at caesarean section and compare their postoperative period (in term of pain, amount of bleeding and expulsion rate) of women who had caesarean section without IUCD insertion and to women who had IUCD inserted as an interval procedure.

A case control study.

Jinnah Postgraduate Medical Centre, Karachi, from November 2006 to October 2007.

Group 1 (cases) were 50 women who had IUCD inserted at caesarean section. Groups 2 and 3 were controls, group 2 consisted of 50 matched women who had a caesarean section without IUCD insertion and group 3 consisting of 50 women who had IUCD inserted as an interval procedure. Degree of pain was assessed by doses of analgesics needed and amount of bleeding by the soaked pads, which were observed by doctor. Infection and expulsion was observed in immediate postoperative period during admission and at follow-up visits at 6 weeks and 6 months and conception was also checked. Analysis of variance was undertaken to compare characteristics at baseline on SPSS version 13. Data were analyzed using univariate methods, two-tailed t-test for continuous variables and chi-square test or Fisher's exact test as appropriate for dichotomous variables.

Hospital stay of group 1 was 3.48 days as compared to 3.46 in group 2 (p=0.93). Wound was infected in 10% women in group 1 and 2% in group 2 (F-test = 0.10); lochia was heavy in 4% in group 1 and 0% in group 2 (F-test = 0.25). Thread was visible in 92% in group 1 and 96% in group 3 (p=0.50). Eighty two percent women were willing to continue with IUCD in group 1 and 86% in group 3 after 6 months.

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.