Comparing the Complications of the Intrauterine Device Insertion in The Postpartum and Interval Periods at the Jos University Teaching Hospital

Abstract

Background: An unmet need for family planning exists among women, particularly in the postpartum period. This is however, an emerging form of contraception and concerns regarding its complications as opposed to the interval insertion may affect its uptake and acceptability. Objective:  This study aimed to assess the acceptability and complications of postpartum intrauterine device (IUD) insertion and compare them with interval insertion at the Jos University Teaching Hospital (JUTH).

Methodology: Conducted over one year (January to December 2021) at JUTH, this prospective parallel cohort study included 174 women who received CuT380A IUDs. Of these, 87 underwent postpartum insertion, and 87 received interval insertion. Follow-up occurred at 2, 6, and 26 weeks post-IUD insertion, focusing on outcomes like abnormal uterine bleeding (AUB), pelvic pain, expulsion, missing strings, abnormal vaginal discharge, discontinuation, and continuation rates.

Results: At the 2-week mark, complete expulsion (8.1%) and missing IUD strings (33.7%) were more common in the postpartum IUD (PPIUD) group, with statistically significant p-values of 0.002 and <0.001, respectively. Abnormal vaginal discharge (10.5%) was more frequent in the interval group, statistically significant (p=0.029). At 6 weeks, AUB (15.5%) and abnormal vaginal discharge (15.5%) were more common in the interval group, both statistically significant (p=0.041). However, at 26 weeks, there were no statistically significant differences in complications between the groups.

Conclusion: While both groups experienced early complications, long-term complications were comparable and not statistically significant. Thus, PPIUD insertion should be encouraged as a viable contraception option for women during the postpartum period, supporting the promotion of long-acting reversible contraception.

Keywords: Postpartum IUD, Contraception, Long-acting Reversible Contraception