The Success of Post-Placental Intra-Uterine Device (IUD) at Simo Public Hospital

Makara Journal of Health Research
Manuscript 1538
The success of post-placental intra-uterine device (IUD) at Simo

Public Hospital
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The success of post-placental intra-uterine device (IUD)
at Simo Public Hospital
Alfi Marita Tristiarti1, Ratmi Pungkasari2, Soetrijatmini3
1,3
Obstetric and Gynecology Department, Simo Public Hospital, Boyolali
2
Director of Simo Public Hospital, Boyolali
ABSTRACT
Interval pregnancy of less than two years is associated with high maternal morbidity. The
family planning program in Indonesia is one solution to reduce maternal morbidity rates. The
use of an intrauterine device (IUD) is recommended because it has a failure rate of less than
1%. This study is an analytical study with a cross-sectional design. The research sample was
186 patients who gave birth at Simo Public Hospital from June to August 2023. The success of
post-placental IUD was related to the delivery method (p=0.00; 95% Cl=0.015-0.110) and
maternal age (p=0.01; 95% Cl=1.269–5.865). Delivery by cesarean section (62.4%) is more
common than vaginal delivery (37.6%). Post-placental IUD use is highest in mothers aged 25-
35 years. The use of a post-placental IUD can reduce pelvic pain and expulsion in various
delivery methods and at all maternal ages to reduce maternal morbidity.
Keywords: IUD, post-placental, delivery method
INTRODUCTION
The low use of contraception among couples of reproductive ages in Indonesia is
associated with maternal morbidity. Study shows that contraceptive attainment in Indonesia
is only 59.3% for couples aged 15-49 years1. A pregnancy interval of less than two years is
associated with higher maternal morbidity such as an increased prevalence of preeclampsia,
heart failure, and pulmonary edema compared to a pregnancy interval of more than 5 years.2.
The family planning program in Indonesia is one solution to reduce maternal morbidity
rates. The use of an IUD is recommended because it has a failure rate of less than 1% and can
be used for a long time3. The use of an IUD post-placental can reduce the occurrence of
dysmenorrhea, spotting, and expulsion compared to installing an IUD after the postpartum
period4. This study aims to analyze the success factors for post-placental IUD insertion at Simo
Public Hospital.
METHOD
This research is an analytical study with a cross-sectional design. The research sample
was 186 patients who gave birth at Simo Public Hospital from June to August 2023 and was
selected based on the inclusion and exclusion criteria. Data was collected using medical
records and interview methods.
The independent variable in this study is the method of delivery, while the dependent
variable is the use of a post-placental IUD. The external variables studied were maternal age,
parity, and gestational age. The data analysis used is bivariate analysis with statistical tests,
namely the chi-square test.
RESULTS AND DISCUSSION
A total of 186 patients gave birth at Simo Public Hospital from June to August 2023.
The method of delivery by cesarean section (62.4%) is more common than vaginal delivery
(37.6%). The highest age of mothers who gave birth was 25-35 years (61.3%). A total of 169
patients (90.9%) gave birth less than twice and 122 patients (65.5%) gave birth at term
gestational age.
Table 1. Patient characteristics
N %
Delivery method
Vaginal 70 37.6%
C-section 116 62.4%
Age
Less than 25 years old 45 24.2%
25-35 years old 114 61.3%
More than 35 years 27 14.5%
Parity
Less than equal 2 122 65.5%
More than 2 64 34.5%
Gestational age
Preterm 13 7.0%
Full-term 167 89.8%
Post-term 6 3.2%
The study showed that more patients with a cesarean section delivery used a post-
placental IUD (38.2%) compared to patients with a vaginal delivery (3.2%). Post-placental IUD
use was highest at maternal age 25-35 years and at term gestational age (36.0%). A total of
109 patients who did not use a post-placental IUD chose several contraceptive methods, such
as progesterone injection (38.5%), implants (26.7%), pills (22.9%), bilateral tubectomy (8.3%),
calendars (1.8%), and lactational amenorrhea (1.8 %).
Table 2. Bivariate test results
Post-placental IUD total OR 95% Cl p

Yes % No %
Delivery method 0.04 0.015-0.110 0.00
Vaginal 6 3.2% 64 34.4% 70
c-section 71 38.2 45 24.2% 116
%
Maternal age 2,729 1,269–5,865 0.01
<25 years 20 10.8 20 10.8% 40
%
25-35 years 52 28.0 69 37.1% 121
old %
>35 years 5 2.7% 20 10.8% 25
Parity 1,505 0.656-3.452 0.34
<=2 57 30.6 65 34.9% 122
%
>2 20 10.8 44 23.7% 64
%
Gestational age 0.551 0.244-2.121 0.55
Preterm 6 3.2% 6 3.2% 12
Full-term 67 36.0 101 54.3% 168
%
Post-term 4 2.2% 2 1.1% 6
CONCLUSION
This study shows that the success of the post-placental IUD is related to the method
of delivery (p=0.00; 95% Cl=0.015-0.110) and maternal age (p=0.01; 95% Cl=1.269–5.865).
Delivery by cesarean section more often uses an IUD compared to patients with vaginal births.
This is because in patients who undergo a cesarean section, a post-placental IUD is installed
while under narcotic conditions, thereby reducing pain. The use of an intra-cesarean IUD can
prevent IUD displacement and IUD expulsion5.
In other studies, it has been shown that intra-cesarean IUD placement reduces the
incidence of uterine perforation and IUD installation failure compared to installation during
the postpartum period6. The use of an IUD is highly recommended in patients with cesarean
delivery to prevent uterine rupture. In labor with a history of cesarean delivery for less than
12 months, the risk of uterine rupture doubles7.
Patients between the ages of 25-35 years are the largest number of patients using
post-placental IUDs. IUD use in reproductive age increased by 0.81% until 2017 8. IUD
acceptors reported that IUD use did not affect libido, body weight, and metabolic disorders
compared to hormonal contraception9. The use of an IUD during reproductive age is closely
related to the level of education and then husband's support10. So, to increase the use of IUDs,
the participation of health workers is needed in providing education about IUD contraception.
SUGGESTION
Other studies can be carried out with larger subjects with more types of contraception
studied.
BIBLIOGRAPHY
1. Gafar A, Suza DE, Efendi F, Pramono AP, Susanti IA. Indonesia [ version 1 ; peer review
: 2 approved ]. 2020;(September). doi:10.12688/f1000research.22482.1
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2021;225(3):331.e1-331.e8. doi:10.1016/j.ajog.2021.05.013
3. Adeyemi-fowode OA, Bercaw-pratt JL. Original Study Intrauterine Devices: Effective
Contraception with Noncontraceptive Benefits for Adolescents.J Pediatr Adolesc
Gynecol. 2019;32(5):S2-S6. doi:10.1016/j.jpag.2019.07.001
4. Khurshid N, Taing S, Qureshi A, Jan I. Post‑Placental Intrauterine Device Insertion
Versus Delayed Intrauterine Device Insertion: An Observational Study. J Obstet Gynecol
India. 2020;(0123456789). doi:10.1007/s13224-019-01299-z
5. Seleem M, Sedik MM, Megahed AMM, Nabil H. Conventional manual technique of post
placental IUD insertion versus intra-cesarean post placental introducer withdrawal IUD
insertion technique : a new standardized technique for IUD insertion during cesarean
section : a randomized controlled trial.BMC Pregnancy Childbirth. Published online
2023:1-8. doi:10.1186/s12884-023-05777-1
6. Ghany AA, Khalifa E, Zeen M, et al. Intrapartum versus postpartum insertion of
intrauterine device in women delivering by cesarean section.BMC Pregnancy
Childbirth. Published online 2022:4-9. doi:10.1186/s12884-022-04681-4
7. Cunningham S, Algeo CE, Defranco EA. Influence of interpregnancy interval on uterine
rupture.J Matern Neonatal Med. 2019;0(0):1-6. doi:10.1080/14767058.2019.1671343
8. King LA, Michels KA, Graubard BI, Trabert B. Trends in oral contraceptive and
intrauterine device use among reproductive‑aged women in the US from 1999 to 2017.
Cancer Causes Control. 2021;32(6):587-595. doi:10.1007/s10552-021-01410-8
9. Teddy N, Olwit C, Osingada C, Kiguli J. IUD Contraceptive Use Among Women of
Reproductive Age: Experiences, Motivators and barriers in a General Hospital, Uganda.
Published online 2020:1-12.
10. Wijaya VF, Rahardjo SS, Adriani RB. Religious Belief, Social Support, and the Acceptance
of Intrauterine Devices Among Women of Reproductive Age in Klaten, Central Java.
Published online 2016.

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Makara Journal of Health Research

The success of post-placental intra-uterine device (IUD) at Simo

Follow this and additional works at: https://scholarhub.ui.ac.id/mjhr

Part of the Medicine and Health Sciences Commons

Keywords: IUD, post-placental, delivery method

Table 1. Patient characteristics

Table 2. Bivariate test results

Post-placental IUD total OR 95% Cl p

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