Post-Partum Contraception: Evaluating Effectiveness of Depot Medroxyprogesterone Acetate (DMPA) Administered within 48 Hours of Elective Caesarean Section

Shagufta  Parveen; Javeria  Nosheen; Roomana  Anwar; Faiza  Khanum; Zaib-un-Nisa .; Maleha Nawal  Butt

doi:10.51253/pafmj.v75i6.11686

Authors

Shagufta Parveen Department of Obstetrics & Gynae, Combined Military Hospital, Sialkot/National University of Medical Sciences (NUMS) Pakistan
Javeria Nosheen Department of Obstetrics & Gynae, Combined Military Hospital, Sialkot/National University of Medical Sciences (NUMS) Pakistan
Roomana Anwar Department of Biochemistry, Islam Medical and Dental College Sialkot, Pakistan
Faiza Khanum Department of Obstetrics & Gynae, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Zaib-un-Nisa . Department of Obstetrics & Gynae, Wah Medical College, Rawalpindi Pakistan
Maleha Nawal Butt Department of Obstetrics & Gynae, Combined Military Hospital, Kharian/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i6.11686

Keywords:

Contraceptive Agents, Contraceptive Effectiveness, Depot Medroxyprogesterone Acetate, Family Planning Practice, Unplanned Pregnancy

Abstract

Objective: To evaluate the feasibility of intramuscular (IM) Depot Medroxyprogesterone Acetate (DMPA) as post-partum contraception after elective caesarean section.

Study Design: Quasi experimental study

Place and Duration Study: Combined Military Hospital Kharian Cantt Pakistan, from Jun 2022 to Jul 2023.

Methodology: Women who chose to participate in the study were then given three monthly doses of DMPA. They were followed up at 3, 6, 9, and 12 months. The primary outcome measures were side effects and satisfaction with the contraceptive injection at 3, 6, 9, and 12 months and the secondary outcomes were frequency of unplanned pregnancy and continuation with DMPA at 12 months.

Results: Out of 197 women only 68(34.4%) were willing for postpartum contraception, received DMPA 48 hours after caesarean section. Age of the enrolled women range between 22-39 years and 70.0% have parity of 3 or more. At 12 months half (49.0%) of the enrolled women were satisfied. The continuation rates with the contraceptive injection were 95.0%, 93.1%, 85%,84.8% at 3, 6, 9 and 12 months. There was no unplanned pregnancy during 12 months of study period.

Conclusion: The study provides evidence that routinely offering women, undergoing elective caesarean section, DMPA single injection every 3 months, provides a promising post-partum contraceptive method with good patient’s satisfaction and continuity rates. Administration of DMPA postnatally can effectively prevent unintended pregnancies in the first year postpartum.

Downloads

Download data is not yet available.

References

1. Betran AP, Ye J, Moller AB, Souza JP, Zhang J, Torloni MR. The increasing trends in caesarean section rates: global and regional estimates: Regional and National Estimates: 1990-2014. PLoS One 2016; 11(2): e0148343.

http://doi.org/10.1371/journal.pone.0148343

2. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021; 6(6): e005671.

http://doi.org/10.1136/bmjgh-2021-005671

3. World Health Organization (WHO); U.S. Agency for International Development (USAID); Maternal and Child Health Integrated Program (MCHIP). Programming strategies for postpartum family planning. Geneva: WHO; 2013. [Internet]. Available at:

http://www.who.int/reproductivehealth/publications/family_planning/ppfp_strategies/en [Accessed on November 20, 2022]

4. Asif MF, Ishtiaq S, Abbasi NI, Tahir I, Abid G. The Interaction Effect of Birth Spacing and Maternal Healthcare Services on Child Mortality in Pakistan. Children 2023; 10(4): 710.

http://doi.org/10.3390/children10040710

5. Asif MF, Pervaiz Z, Afridi JR, Abid G, Lassi ZS. Role of husband's attitude towards the usage of contraceptives for unmet need of family planning among married women of reproductive age in Pakistan. BMC Women Health 2021; 21(1): 163. http://doi.org/10.1186/s12905-021-01314-4

6. Tibo M, Adem A, Dache A. Time to initiate postpartum modern contraceptive use and predictors among women of reproductive age group in Dilla Town, Southern Ethiopia: a retrospective cohort study. Contraception and Reproductive Medicine 2022; 7(20): 1186. https://doi.org/10.1186/s40834-022-00189-6

7. Phiri M, Odimegwu C, Kalinda C. Unmet need for family planning among married women in sub-Saharan Africa: a meta-analysis of DHS data (1995 - 2020). Contracept Reprod Med 2023; 8(1): 3. http://doi.org/10.1186/s40834-022-00198-5

8. Kroelinger CD, Okoroh EM, Uesugi K, Romero L, Sappenfield OR, Howland JF, et al. Immediate Postpartum Long-Acting Reversible Contraception: Review of Insertion and Device Reimbursement Policies. Women Health Issues 2021; 31(6): 523-531. http://doi.org/10.1016/j.whi.2021.09.001

9. Senderowicz L, Sokol N, Pearson E, Francis J, Ulenga N, Bärnighausen T et al. The effect of a postpartum intrauterine device programme on choice of contraceptive method in Tanzania: a secondary analysis of a cluster-randomized trial. Health Policy Plan 2023; 38(1): 38-48.

http://doi.org/10.1093/heapol/czac094

10. Sori DA, Debelew GT, Degefa LS, Asefa Z. Continuous quality improvement strategy for increasing immediate postpartum long-acting reversible contraceptive use at Jimma University Medical Center, Jimma, Ethiopia. BMJ Open Qual 2023; 12(1): e002051. http://doi.org/10.1136/bmjoq-2022-002051

11. Faculty of Sexual and Reproductive Healthcare (FSRH). UK medical eligibility criteria for contraceptive use (UK MEC 2016). London: FSRH; 2016. [Internet]. Available at: https://www.fsrh.org/documents/ukmec-2016 [Accessed on November 30, 2022]

12. Higgins JA, Kramer RD, Everett B, Wright KQ, TurokDK, Sanders JN et al. Association between Patients’ Perceptions of the Sexual Acceptability of Contraceptive Methods and Continued Use Over Time. JAMA Intern Med 2021; 181(6): 874–876. http://doi.org/10.1001/jamainternmed.2021.1439

13. Goldthwaite LM, Shaw KA. Immediate postpartum provision of long-acting reversible contraception. Curr Opin Obstet Gynecol 2015; 27(6): 460-464.

http://doi.org/10.1097/GCO.0000000000000224

14. Olorunsaiye CZ, Brunner Huber LR, Degge HM, Yada FN, Yusuf KK. Assessing the Contraceptive Attitudes of US-Born and Foreign-Born Black Women Living in the USA: a Descriptive Cross-Sectional Study. J Racial Ethn Health Disparities 2024; 11(2): 874-884.

http://doi.org/10.1007/s40615-023-01569-7

15. Mruts KB, Tessema GA, Kassaw NA, Gebremedhin AT, Scott JA, Pereira G et al. Achieving reductions in the unmet need for contraception with postpartum family planning counselling in Ethiopia, 2019-2020: a national longitudinal study. Arch Public Health 2023; 81(1): 79.

http://doi.org/10.1186/s13690-023-01096-1

16. Samal S, Das L. Study of depot medroxyprogesterone acetate as an extended postpartum contraceptive at SCB medical college and hospital, Cuttack. International Journal of Reproduction, Contraception, Obstetrics and Gynaecology. Int J Reprod Contracept Obstet Gynecol 2021; 10(4): 1484-1490.

https://doi.org/10.18203/2320-1770.ijrcog20211125

17. Castleberry NM, Stark L, Schulkin J, Grossman D. Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynaecologists. Contraception 2019; 100(2): 123-127.

http://doi.org/10.1016/j.contraception.2019.03.053

18. Parker LA, Sullivan S, Cacho N, et al. Effect of postpartum Depo Medroxyprogesterone acetate on lactation in mothers of very low birth weight infants. Breastfeed Med 2021; 16: 835-842.

http://doi.org/10.1089/bfm.2020.0336

19. Jenny A. Higgins, Renee D. Kramer, Bethany Everett, Kelsey Q. Wright, David K Turok, Jessica N. Sanders. Association Between Patients’ Perceptions of the Sexual Acceptability of Contraceptive Methods and Continued Use Over Time. JAMA Intern Med 2021; 181(6): 874–876.

http://doi.org/10.1001/jamainternmed.2021.1439