Safety, efficacy and complications of intracaesarean cut 380a

Background: Copper Intrauterine Contraceptive Device is a form of long acting reversible contraceptive device and is considered to be one of the most effective forms of birth control available. Copper T 380A has lowest pregnancy rate among all copper IUDs and can be used for a lifespan of 10 years The advantages of post placental insertion include the assurance that the women is not pregnant, high motivation, convenience and eliminates the 6 week post partum wait. This study examines the factors associated with acceptability of post partum IUCD insertion according to their socio-demographic and obstetrics characteristics and the rates of perforation, expulsion, pelvic infection, lost strings and displacement following insertion among acceptors till 12 months. Objective: To assess the safety, efficacy and complications of post placental Copper T 380A insertion following caesarean section. Study Design: This was a prospective study conducted on 500 women who underwent LSCS and were willing for CuT 380 A insertion after proper counselling in a tertiary care hospital. After placental delivery CuT was inserted into the endometrial cavity through the incision. The study participants were then followed up after discharge at 6 weeks, 6 month and one year postpartum. Any complaints if present were noted and pelvic examination and Ultrasonography were performed to verify the presence of IUCD and to check for any signs of infection or bleeding. Results: Of the 500 patients studied, 487(97.4%) patients came for follow up at 6 weeks, 454(90.8%) at 6 months and 411(82.2%) at 12 months. 15(3%) patients had expulsion of Cu T, of which 3(0.6%) expelled within 6 months, 10(2%) expelled in between 6-12 months and 2(0.4%) expelled at 12 months follow up. A total of 37(7.4%) patients removed the IUCD, 12(2.4%) due to increased bleeding per vaginum, 8(1.6%) due to displacement, 4(0.8%) due to abdominal pain, 1(0.2%) due to leucorrhoea and 12(2.4%) patients removed due to their misperceptions like discomfort, fear of displacement into the abdomen and social pressure. Complications were seen in 162(32.4%) patients such as bleeding in 20(4%), strings not visible in 105(21%), pain abdomen in 5(1%), leucorrhoea in 4(0.8%) and 15 (3%) expelled the IUCD. Pregnancy occurred in 3(0.6%) patients out of which 2(0.4) patients had intrauterine pregnancy and 1(0.2%) ectopic pregnancy. Conclusion: Post placental Copper T 380 A insertion following caesarean section is a safe, effective. low cost and convenient method of long term reversible contraception with a low incidence of expulsion and high continuation rates.