Comparative Evaluation of Postpartum Versus Interval Intrauterine Contraceptive Device Insertion: Safety, Continuation and Clinical Outcomes

Abstract

Background: The postpartum period provides an important opportunity to initiate effective contraception, particularly in women who may have limited access to subsequent family-planning services. Intrauterine contraceptive devices (IUCDs) provide long-acting, reversible contraception; however, outcomes may vary according to the timing of insertion.

Objective: To compare the safety, continuation, complications, and acceptability of postpartum and interval IUCD insertion.

Methods: This prospective hospital-based comparative study included 968 women, with 484 each in the postpartum and interval IUCD groups. CuT380A and Multiload 375 devices were used. Participants were followed at approximately 6 weeks and 6 months. Complications, expulsion, removal, continuation, and satisfaction were assessed. Categorical variables were compared using chi-square or Fisher’s exact test, with p<0.05 considered statistically significant.

Results: At the first follow-up, continuation was significantly higher in the postpartum group than in the interval group (95.0% vs 86.8%; p<0.01). At the second follow-up, continuation remained significantly higher with postpartum insertion (91.7% vs 81.8%; p<0.01). At 6 months, irregular bleeding, vaginal discharge and lower abdominal pain were less frequent in the postpartum group, whereas spontaneous expulsion was higher.

Conclusion: Postpartum IUCD insertion was associated with high continuation and satisfaction rates and represents an effective and feasible contraceptive option, although appropriate counselling and follow-up for expulsion are important.