Comparative analysis of postpartum IUDC versus interval IUCD insertion: a study conducted in a tertiary care hospital in Karachi, Pakistan

Zakia Bano, Sanober Memon, Fiza Ali Khan, Mala Jitendra Shahani, Urooj Naz, Syed Naqeeb Ali


Background: To compare the effectiveness of postpartum intrauterine contraceptive device (PPIUCD) with interval IUCD in terms of effectiveness, expulsions, bleeding pain and other complications at Tertiary care Hospital.

Methods: Current study was conducted among 224 women, at Gynaecology and Obstetrics of Reproductive Health Services-A (RHS-A) Centre of Jinnah Post Graduate Medical center, Karachi, for a period of Six months. Approval from Ethical committee and informed consent was taken from women and her husband before starting the study. The WHO medical eligibility criteria for contraceptive use (MEC) were followed and IUCD was inserted in 112 women in PPIUCD group and in 112 women in interval IUCD group. These cases were followed at 15 days, 6 weeks and 6 months. Results of PPIUCD group were compared with interval IUCDs group. Data was analyzed by using SPSS version 18.0. Continuous variables like age, parity, hemoglobin level were analyzed as mean±standard deviation. Frequencies and percentages were calculated for infection, expulsion, bleeding per vagina and effectiveness. Chi-square was applied to assess the difference between the categories. p value <0.05 was taken as significant.

Results: The two groups were identical in mean ± SD age, parity, residence and baseline hemoglobin level. PPIUCD (Group-A) was more effective i.e., 87.5% as compared to interval IUCD (Group-B) i.e., 83.9%. Pain, PID, bleeding and expulsion of IUCD were more prevalent with interval IUCD (Group-B) than PPIUCD (Group-A) patients. Stratified analysis showed that age, parity & mean baseline hemoglobin were non-significant effect modifiers on the effectiveness among the two groups.

Conclusions: Postpartum IUCD use was found to be a safe, simple, inexpensive and reversible procedure with higher chances of retention for a longer period. Additionally, there is decreased risk of complications and lower expulsion rates when compared with interval IUCD.


Effectiveness, Interval, Intrauterine contraceptive device, Postpartum

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Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012;380(9837):111-25.


National Institute of Population Studies (NIPS) [Pakistan] and ICF. 2019. 2017-18 Pakistan Demographic and Health Survey Key Findings. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF. Available at: Accessed 12 February 2020.

National Institute of Population Studies (NIPS) [Pakistan] and Ministry of Population Welfare, Govt of Pakistan. 2007. 2006-07 Pakistan Demographic and Health Survey. Islamabad, Pakistan.

National Institute of Population Studies (NIPS). ICF International. Pakistan Demographic and Health Survey 2012–13. Islamabad: NIPS; 2013.

World Health Organization (WHO), United States Agency for International Development (USAID), Maternal and Child Health Integrated Program (MCHIP). Programming strategies for postpartum family planning. Geneva: World Health Organization; 2013.

Moniz MH, Roosevelt L, Crissman HP. Immediate postpartum contraception: a survey needs assessment of a national sample of midwives. J Midwifery Womens Health. 2017;62(5):538-44.

Gautam R, Arya KN, Kharakwal S, Singh S, Trivedi M. Overview of immediate PPIUCD application in Bundelkhand Region. J Evol Med Dental Sci. 2014;3(36):9518-26.

World Health Organization. Sexual and reproductive health: unmet need for family planning. Geneva: World Health Organization; 2015.

Bhutta SZ, Butt IJ, Bano K. Insertion of intrauterine contraceptive device at caesarean section. J Coll Physicians Surg Pak. 2011;21(9):527-30.

Sonalkar S, Gaffield ME. Introducing the World Health Organization postpartum family planning compendium. Inter J Gynecol Obstetr. 2017 Jan 1;136(1):2-5.

Pfitzer A, Mackenzie D, Blanchard H, Hyjazi Y, Kumar S, Lisanework Kassa S, et al. A facility birth can be the time to start family planning: postpartum intrauterine device experiences from six countries. Int J Gynaecol Obstet. 2015;130 Suppl. 2:S54-61.

Pradhan MR, Patel SK, Saraf AA. Informed choice in modern contraceptive method use: pattern and predictors among young women in India. J Biosocial Sci. 2019 Dec 19:1-4.

Ezugwu EC, Achara JI, Ezugwu OC, Ezegwui HU. Acceptance of postpartum intrauterine contraceptive device among women attending antenatal care in a low‐resource setting in Nigeria. Inter J Gynecol Obstetr. 2020 Feb;148(2):181-6.

Mazza D, Black K, Taft A, Lucke J, McGeechan K, Haas M, et al. Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive Choice Project (ACCORD) cluster randomized controlled trial protocol. BMJ open. 2016 Oct 1;6(10):e012491.

Washington CI, Jamshidi R, Thung SF, Nayeri UA, Caughey AB, Werner EF. Timing of postpartum intrauterine device placement: a cost-effectiveness analysis. Fertility Sterility. 2015;103(1):131-7.

JHPIEGO corporation. Postpartum intrauterine contraceptive device services: learner’s handbook. Baltimore, Maryland. 2010.

Altshuler AL, Gaffield ME, Kiarie JN. The WHO’s medical eligibility criteria for contraceptive use: 20 years of global guidance. Current Opin Obstetr Gynecol. 2015 Dec;27(6):451.

Chen BA, Reeves MF, Hayes JL, Hohmann HL, Perriera LK, Creinin MD. Post-placental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery:a randomized controlled trial. Obs Gynecol. Nov 2010;116 (5):1079-87.

Katheit G, Agarwal J. Evaluation of post-placental intrauterine device (PPIUCD) in terms of awareness, acceptance, and expulsion in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2013;2(4):539-43.

Kittur S, Kabadi YM. Enhancing contraceptive usage by post-placental intrauterine contraceptive devices (PPIUCD) insertion with evaluation of safety, efficacy, and expulsion. Int J Reprod Contracept Obstet Gynecol. 2012;1(1):26-32.

Sucak A, Ozcan S, Çelen Ş, Çağlar T, Göksu G, Danışman N. Immediate postplacental insertion of a copper intrauterine device: a pilot study to evaluate expulsion rate by mode of delivery. BMC Pregnancy Childbirth. 2015 Dec 1;15(1):202.

Fernandes JAH, Lippi UG. A clinical and ultrasound study on the use of postplacental intrauterine device. Einstein. 2004;2(2):110-4.

Tyagi S, Aditya V, Srivastava R, Gupta G. Changing trends in intrauterine contraceptive device: From interval intrauterine contraceptive device to postpartum intrauterine contraceptive device: A prospective observational study in a tertiary care hospital in Eastern Uttar Pradesh. Inter J Reprod, Contracep, Obstetr Gynecol. 2016; 5(7):2105.

El-Beltagy NS, Darwish EA, Kasem MS, Hefila NM. Comparison between Copper T380 IUD and multiload 375 IUD in early post-partum insertion. Middle East Fertil Soc J. 2010;16(2):143-8.