Contracept Reprod Med. 2026 May 7. doi: 10.1186/s40834-026-00455-x. Online ahead of print.
ABSTRACT
BACKGROUND: India is the most populous country in the world, with over 1.4 billion people, facing significant challenges in maternal and reproductive health services. Family planning is a key strategy to prevent unintended pregnancies and optimize spacing between births. Post-placental intrauterine contraceptive device (PPIUCD) insertion is a safe, long-acting, reversible, and cost-effective method of immediate postpartum contraception. This study aimed to compare continuation rates, complications, and expulsion rates of PPIUCD insertion between preterm and term deliveries, and to explore factors influencing outcomes.
SETTINGS AND DESIGN: Hospital-based observational study conducted at VMMC & Safdarjung Hospital, New Delhi.
MATERIALS AND METHODS: Among 2000 antenatal women counseled for immediate postpartum IUCD insertion, 240 (12%) consented and were enrolled. Participants were divided equally into preterm (n = 120) and term (n = 120) groups. CuT 380 A devices were inserted immediately post-placentally. Follow-up was conducted at 3, 6, and 12 months to assess continuation, satisfaction, expulsion, and complications. Counseling was provided antenatally and postnatally using standardized IEC materials, models, and checklists.
STATISTICAL ANALYSIS: Categorical variables were presented as numbers and percentages. Chi-square tests and t-tests were applied where appropriate using SPSS 24.0, with p < 0.05 considered statistically significant.
RESULTS: The mean age of participants was 26.9 ± 3.2 years. Continuation rates at 6 and 12 months were significantly higher in term deliveries (96.6% and 85.0%) than in preterm deliveries (88.3% and 63.3%; p < 0.05). Spontaneous IUCD expulsion was higher in preterm women at 6 months (7.5% vs. 1.6%) and 12 months (15.3% vs. 6.4%; p < 0.05), potentially due to smaller uterine size, underdeveloped uterine cavity, and variations in uterine involution. Satisfaction rates were high and comparable between groups at 12 months (81% preterm vs. 85% term; p > 0.05). Acceptance rates were low overall (12%), highlighting the need for structured counseling, provider training, and peer education to improve uptake.
CONCLUSION: Post-placental IUCD insertion is safe, effective, and cost-efficient in both preterm and term deliveries. Higher expulsion rates in preterm deliveries warrant focused counseling and follow-up. Structured antenatal and postnatal counseling, combined with provider confidence and patient education, is essential to increase acceptance and continuation of PPIUCD, particularly in populations at higher risk of early postpartum fertility.
PMID:42098888 | DOI:10.1186/s40834-026-00455-x
