Muhumuza Joy, Migisha Richard, Ngonzi Joseph, Kayondo Musa, Mugyenyi Godfrey
Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Obstetrics and Gynecology, Kampala International University, Kampala, Uganda.
Contracept Reprod Med. 2021 Mar 2;6(1):7. doi: 10.1186/s40834-021-00153-w.
Postpartum intrauterine device (PPIUD) use refers to intrauterine device (IUD) insertion after delivery but within 48 h of birth. In Uganda, the general use of modern methods of contraception is low with < 1% of the women adopting the IUD as a method of contraception. An important limiting factor to increased uptake of immediate postpartum IUD insertion may be its expulsion rates which vary widely. There is minimal documentation PPIUD expulsion rates and factors associated with PPIUD expulsion during puerperium in Uganda.
We aimed to determine the proportion of TCu380A (copper) intrauterine devices expelled by 6 weeks postpartum, and identify risk factors for expulsion among women delivering at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.
We conducted a prospective cohort study from September 1, 2014 to January 31, 2015 at MRRH. We administered a structured questionnaire to all participants, to capture data on their baseline demographic, clinical and obstetric characteristics. We followed up women who accepted the PPIUD insertions at 6 weeks post insertion for any IUD expulsion. We fit multivariable log binomial regression models to identify risk factors for IUD expulsion.
We enrolled 167 women who had PPIUDs inserted. Of the144 women who returned at 6 weeks for follow up, 13 (9%; 95%CI:4.9-15%) of them had the IUDs expelled. In the multivariable model, the significant risk factors for PPIUD expulsion were: IUD insertion more than 10 min post-delivery (aRR 8.1, 95%CI 1.26-51.98, p = 0.027) and bloody lochia flow of ≥15 days (aRR 8.5, 95%CI 1.47-48.47, p = 0.017).
The cumulative expulsion rate of postpartum IUDs among women delivering at MRRH was low and comparable to expulsion rates in interval insertions. Longer duration from delivery to IUD insertions and longer duration of bloody lochia flow were key risk factors for postpartum IUD expulsion. More emphasis should be put on prenatal counseling for postpartum family planning to allow for postplacental IUD insertions, which are associated with lower expulsion rates.
产后宫内节育器（PPIUD）的使用是指在分娩后但在出生后48小时内插入宫内节育器（IUD）。在乌干达，现代避孕方法的总体使用率较低，只有不到1%的女性采用宫内节育器作为避孕方法。产后即时插入宫内节育器使用率增加的一个重要限制因素可能是其排出率差异很大。关于乌干达产褥期PPIUD排出率及与PPIUD排出相关因素的文献记载极少。
我们旨在确定产后6周时排出的TCu380A（铜）宫内节育器的比例，并确定乌干达西南部姆巴拉拉地区转诊医院（MRRH）分娩的妇女中排出的危险因素。
我们于2014年9月1日至2015年1月31日在MRRH进行了一项前瞻性队列研究。我们向所有参与者发放了一份结构化问卷，以收集他们的基线人口统计学、临床和产科特征数据。我们对接受PPIUD插入的妇女在插入后6周进行随访，观察是否有宫内节育器排出。我们拟合多变量对数二项回归模型以确定宫内节育器排出的危险因素。
我们纳入了167名插入PPIUD的妇女。在144名6周后返回进行随访的妇女中，有13名（9%；95%CI：4.9 - 15%）的宫内节育器被排出。在多变量模型中，PPIUD排出的显著危险因素为：分娩后10分钟以上插入宫内节育器（aRR 8.1，95%CI 1.2
