IUCD what we need to know??

The advantages of the IUD as a post coital method are its high efficacy and the fact that it can be used up to seven days after coital exposure. For certain parous woman it is the method of choice if the women desires to use the IUD as her an going method of contraception. At this time the women is highly motivation. It is particularly appropriate for the parous women with a single sexual partner who is at a high risk of pregnancy due to failure of a barrier method. It also is appropriate for a woman who has been sexually inactive for some time and suddenly finds herself in an unprotected and unplanned sexual relationship (source: OUTLOOK).

            The efficacy of copper-relapsing IUD as emergency contraception is very high. It can reduce the chance of pregnancy by more than 99% when inserted within 5 days after unprotected intercourse.

            This method may be particularly useful when the client is considering its use for long-term contraception and/or when the hormonal regimens are less effective because more than 72 hours have elapsed. When using on IUD for emergency contraception, the eligibility criteria are the same as those for regular use of these device. Making emergency contraception more widely available can be an important step in preventing unintended pregnancies.

A)In postpartum period –

                              i.            Insertion of IUD in immediate Postpartum period & after abortion (soon after vaginal delivery i.e. at Labor Room) IUD can be fitted Postpartum insertion within 48 hours of delivery is a recommended procedure with all safety. Though postpartum insertion is not popular in India but in some countries this procedure is being accepted by the women and community.

        How the programme can be made effective in India too? To be effective counseling of the couple should start in antenatal visits since a woman may have difficulty making a carefully considered decision about contraceptive use while she is in labor pain. Further, help of a HCP who is specially trained in postpartum IUD insertion must be available when a woman delivers which is not an easy proposition in India. The major disadvantage of postpartum insertion is the higher expulsion rate and increased probability of perforation of uterus. The IUD is more easily expelled after childbirth because the uterus (womb) is frequently contracting and the cervix (mouth of the womb) remains partly dilated. Surprisingly, expulsion rates following postpartum IUD insertion are lowest when the IUD is inserted within 10 minutes after the expulsion of the placenta. Placement of IUD correctly i.e. high in the fundus is mandatory to minimize expulsion. When a copper T IUD is inserted within 48 hours after delivery by an experienced provider, expulsion rates at six months ranges from 6 to 15 per 100 insertions and the health care provider’s skill and experience are probably very important to minimize of expulsion rate and other complications.

Technique of insertion of IUC soon after childbirth

        The process of introduction of IUD is technique a bit different at this stage. One can use a specially devised long insert for post partum insertion. Sounding the uterus should be avoided because of the risk of perforating the soft uterus. IUDs are usually inserted in immediate postpartum period by hand rather than with a standard inserter. Immediate postpartum insertion of the IUD can also be done by means of a sponge holding forceps. However if the inserter is used at all then the arms of T-shaped IUD should be released from the inserter once it has passed the cervical canal. Then the open IUD can be lifted up to the fundus. The uterus may be massaged to imitate a contraction so that wall of womb becomes relatively firm thus preventing perforation.

        The disadvantages of immediate postpartum insertion of the IUD is its higher expulsion rate and uterine perforation, Therefore most authorities advocate insertion after 4-6 weeks of delivery. Insertion between the time period 48 hours to six weeks after childbirth carries an increased risk of sepsis and perforation. Many therefore advise against inserting IUDs during this period.

During caesarean Section:

        Occasionally a woman can fitted with an IUD at the time of delivery by abdominal route. In these settings possibly it is the Obstetricians choice rather than acceptors decision, but when there has been prolonged labor or premature rupture of membranes, insertion during caesarean operation should be avoided because of the risk of infection.