Comparative Outcomes of Postpartum Intrauterine Contraceptive Device (PPIUD) Insertion in Vaginal and Cesarean Deliveries: a Prospective Cohort Study
Keywords:
N/AAbstract
Background : The use of intrauterine devices (IUDs) is associated with several side effects, the most common of which include alterations in the menstrual cycle, dysmenorrhea, and device expulsion. However, comparative data on these outcomes based on mode of delivery vaginal versus cesarean section remain limited in Indonesia. This study aimed to compare clinical outcomes following postplacental IUD insertion in patients who underwent vaginal delivery versus cesarean section.
Methods : This analytical observational study employed a prospective cohort design. The sample included 184 IUD acceptors recruited from Wahidin Sudirohusodo Hospital, Sitti Khadijah 1 Hospital, Syekh Yusuf Gowa Hospital, Fatimah Hospital, and Lapalaloi Hospital Maros. Participants were equally divided into two groups based on delivery method: vaginal delivery (n = 92) and cesarean section (n = 92). Outcome measures included changes in menstrual cycle characteristics, dysmenorrhea, abnormal vaginal discharge, IUD expulsion, continuation rates, and hematological parameters. Statistical analysis was performed using the Chi-square and Wilcoxon tests, with significance set at P < 0.05.
Results : There were no statistically significant differences between the vaginal and cesarean delivery groups in terms of menstrual cycle length, number of pads used per day, duration of menstruation, menstrual pain, non-menstrual pelvic pain, abnormal vaginal discharge, spontaneous IUD expulsion, desire to continue IUD use, or hematological parameters at both 6 and 12 months post-insertion (P > 0.05).
Downloads
Metrics
References
Kementerian Kesehatan Republik Indonesia. Panduan Pelayanan Keluarga Berencana dan Kesehatan Reproduksi dalam Situasi Pandemi COVID-19. Jakarta: Kementerian Kesehatan RI; 2020
Mujiati. Pelayanan KB Pasca Persalinan dalam Upaya Mendukung Percepatan Penurunan Angka Kematian Ibu. Buletin Jendela Data Informasi dan Kesehatan. 2013;2(2):11–6.
Peipert JF, Zhao Q, Allsworth JE, Petrosky E, Madden T, Eisenberg D, et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol. 2011;117(5):1105–13.
Canning D, Shah IH, Pearson E, et al. Institutionalizing postpartum intrauterine device (IUD) services in Sri Lanka, Tanzania, and Nepal: study protocol for a cluster-randomized stepped-wedge trial. BMC Pregnancy Childbirth. 2016;16(1):362.
Apter D, Gemzell-Danielsson K, Hauck B, Rosen K, Zurth C. Pharmacokinetics of two low-dose levonorgestrel-releasing intrauterine systems and effects on ovulation rate and cervical function: pooled analyses of phase II and III studies. Fertil Steril. 2014;101(6):1656–62.e1–4.
Goldstuck ND, Cheung TS. The efficacy of intrauterine devices for emergency contraception and beyond: a systematic review update. Int J Womens Health. 2019;11:471–9.
Lanzola EL, Auber M, Ketvertis K. Intrauterine Device Placement and Removal. [Updated 2025 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557403/
Thiam O, Cissé ML, Ndiaye P, Thiam M, Tendeng JN, Gueye M, et al. The intra-uterine device (IUD) of the immediate postpartum: a comparative study between the caesarean IUD and the IUD inserted after a natural delivery. Clin Obstet Gynecol Reprod Med. 2015;1(3):87–92.
Diallo M, Daff H, Diouf A, Niass A, Toure Y, Fall K, et al. Intrauterine device in the immediate postpartum: study comparing insertion after cesarean section and vaginal delivery. Open J Obstet Gynecol. 2019;9:1510–8.
Gordon A, Benecke A. Postpartum hormonal and structural uterine changes after cesarean section. 2020. [Unpublished/Book – please verify source for proper citation].
Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009;79(5):356–62.
Diedrich JT, Desai S, Zhao Q, Secura G, Madden T, Peipert JF. Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction. Am J Obstet Gynecol. 2015;212(1):50.e1–8.
Kasdu D. Solusi Problem Wanita Dewasa. Jakarta: EGC; 2008.
Pudiastuti RD. Tiga Fase Penting Pada Wanita. Solo: PT Elex Media Komputindo; 2012.
Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception. 2007;75(6 Suppl):S16–30.
Chou CH, Chen SU, Shun CT, et al. Divergent endometrial inflammatory cytokine expression at peri-implantation period and after the stimulation by copper intrauterine device. Sci Rep. 2015;5:15157.
Tal MG, Reeves MF, Hathaway MJ, et al. A proposed classification for intrauterine device position: the Tal-Reeves classification. BMJ Sex Reprod Health. 2022;48:157–9.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
