This document discusses postpartum intrauterine contraceptive devices (PPIUCDs) for healthy spacing of pregnancies. It covers optimal pregnancy spacing intervals, benefits of PPIUCDs, when counseling for PPIUCDs can take place, contraindications, misconceptions about PPIUCDs, advantages and disadvantages, warning signs, insertion techniques, side effects, complications, success rates of PPIUCDs in one hospital, and typical expulsion rates. The goal is to provide information to healthcare providers about counseling women on PPIUCDs during antenatal care and the postpartum period.

1. Is pregnant (known or suspected)
Has unexplained vaginal bleeding
Has current PID, gonorrhea, or chlamydia
Has acute purulent (pus-like) discharge
Has distorted uterine cavity
Has malignant trophoblast disease
Has known pelvic tuberculosis
Has genital tract cancer (cervical or endometrial
CHART or
PICTURE
Women in labor are not in the best situation to
understand and consider their family planning
options.
Counseling for PPFP should ideally occur during
antenatal care.
Counseling for PPIUCD can take place:
During ANC
During the early stages of labor
(latent phase)
During a hospitalization for an ANC
complication
While preparing for a scheduled
cesarean section
During the first 2 days postpartum
BACKGROUND
CONTRAINDICATED IF WOMEN
COUNCELLING
POST PARTUM IUCD FOR HEALTHY SPACING OF PREGNANCIES
Dr. SNEHA JADHAV JR I
Dr. Neelesh Risbud Prof & HOU Dept of OBGY
Shrimati Kashibai Navale Hospital & Medical College, Narhe
OPTIMAL PREGNANCY SPACING INTERVALS
In India, 65% of women in the first year postpartum
have an unmet need for family planning.
Only 26% of women are using any method of
family planning during the first year postpartumA
baby born after a short birth interval (<18
MONTHS) has increased chances of:
being born pre-term
being SGA
death during newborn period or childhood
A woman who becomes pregnant too quickly
following a previous birth or spontaneous or
induced abortion has higher risks of:
anaemia
abortion
premature rupture of membranes
maternal mortality
Recommendation for spacing after a live birth:
The recommended interval before
attempting the next pregnancy is at least
24 months in order to reduce the risk of
adverse maternal, perinatal and infant
outcomes
Recommendation for spacing after miscarriage or
induced abortion:
The recommended minimum interval to
next pregnancy should be at least six
months in order to reduce risks of adverse
maternal and perinatal outcomesPost
partum family planning and pregnancy
spacing programs help women to achieve
those longer intervals
MISCONCEPTIONS
IUCDs do not cause PID; insertion if there is undiagnosed
cervicitis may result in PID
Do not increase the risk of contracting STIs, including HIV
Do not make a woman infertile
Do not increase the risk of miscarriage when a woman
becomes pregnant after the IUCD is removed
Do not cause birth defects
Do not cause cancer
Do not move to the heart or brain
Do not cause pain or discomfort for the woman during sex
Substantially reduce the risk of ectopic pregnancy
ADVANTAGES AND DISADVANTAGES
Advantages:
Very effective, reversible, long-term method
Safe, convenient and no increased risk perforation or infection
Does not affect the quantity or quality of breastmilk
Greater coverage of population
Limitations:
Changes in monthly bleeding pattern
Slightly higher rate of expulsion 8 – 14%
with good technique: 4– 5%
Meaning 86-92% retention
Requires special training of providers
A woman should NOT be counseled for the
first time about immediate PPIUCD during
active labor as she may not be able to make
an informed choice due to stress of labor

2. WARNING SIGNS
1)Heavy vaginal bleeding
2)Severe lower abdominal discomfort
3)Fever and not feeling well
4)Unusual vaginal discharge
5)Suspected expulsion: can either feel IUCD
in the vagina or has seen it expelled from the
vagina.
6) Any other problems or questions she has
related to IUCD.
INSERTION TECHNIQUES
Immediate Postpartum:
Post placental: Insertion within 10 minutes
after expulsion of the placenta.
Intracesarean: Insertion that takes place during
a caesarean delivery, after removal of the
placenta & before closure of the uterine
incision.
Within 48 hours after delivery: Insertion within
48 hours of delivery and prior to discharge.
Post abortion: Insertion following an abortion,
if there is no infection, bleeding or any other
contraindication.
Extended Postpartum/Interval: Insertion any
time after 6 weeks postpartum.
SIDE EFFECTS
Heavy and Prolonged Bleeding
Changes in menstrual bleeding
Menstrual cramping and pain
COMPLICATIONS
Uterine perforation
Expulsion
Missing strings
Severe lower abdominal pain
Success of PPIUCD in SKNMC
Sept 2015
Total deliveries-410
Total contraception
after Delivery-132
PPIUCD-74(56.06% of total contraception)
LSCS with TL- 32 (24.24% of total
contraception)
PTL-26 (19.69% of total contraception)
STUDY IN SKNMC
A PROSPECTIVE STUDY TO ASSESS
COMPLIANCE,SAFETY AND EXPULSION RATE OF
Cu-T 380A IN IMMEDIATE POST PARTUM
PERIOD.
Total PPIUCD 458 out of which 344 were
followed,
Compliance or Retention rate of PPIUCD.
HAPPY WITH CUT?????
Expulsion rates vary from 3 – 37%.
In general, expulsion rates for PPIUCD
range between 10 – 14%
Good technique can reduce
expulsion to 4 – 5%
Postplacental expulsion rates are lower
than postpartum expulsion rates
EXPULSION RATES