POSTPARTUM INTRAUTERINE CONTRACEPTIVE DEVICE INSERTION IN CARDIAC PATIENTS

Abstract

Objective: To assess the acceptability and safety of immediate postpartum intrauterine contraceptive device insertion among parturient having cardiac disease and to determine gynecological and cardiac complications at follow up at four to six weeks and at six months.

Study Design: Prospective interventional study.

Place and Duration of Study: This study was conducted at obstetrics and gynecology ward of Armed Forces Institute of Cardiology/national Institute of Heart Disease (AFIC/NIHD) from Jan 2016 to Dec 2016.

Methodology: All consecutive cardiac patients delivering were evaluated and enrolled after consent. Patients were followed up for six months after placing post partum intrauterine contraceptive device (PPIUCD). Primary outcome was acceptance. Safety was assessed by occurrence of cardiac and gynecologic complications including perforation, expulsion, lost strings and pelvic infection. Cardiac complications studied were, arrhythmias
,Ischemic episodes, thromboembolism and infective endocarditis at follow up between 4-6 weeks and at six months.

Results: A total of 170 patients delivered during the study period. Of these women 108 (63.5%) were eligible for PPIUCD insertion and 42 (38.8%) accepted PPIUCD. Mean age and parity was 28 ± 5 and P2 ± 1.5. Cardiac lesions amongst participants was Mitral valve disease in 58.8% followed by double valve replacement in 14.7%, dilated cardiomyopathy 11.76%, aortic valve involvement in 8.8% and supra ventricular tachycardia in 5.9% patients. Minor gynecological complications were reported in 11 (26.0%) and cardiac complications were 6 (14.0%). Long term safety at follow up was assessed at six months by continuation of method in 30 (85.7%). discontinuation in 4 (9.5%) due to bleeding, 2 (4.8%) were lost to follow up and there was 0 (%) pregnancy.

Conclusion: Postpartum intrauterine device insertion is a safe and valid option in selected cardiac patients who would benefit most from this long acting reversible contraceptive method. There is no increased risk in cardiac patients compared to general population.