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Clinical outcomes of postpartum intrauterine devices inserted by midwives in Tanzania
Author(s) -
Muganyizi Projestine S.,
Kimario Grasiana,
Ponsian Patrick,
Howard Kate,
Sethi Maya,
Makins Anita
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12603
Subject(s) - medicine , discontinuation , tanzania , intrauterine device , obstetrics , cohort study , retrospective cohort study , gynecology , family planning , population , surgery , research methodology , environmental science , environmental health , environmental planning , pathology
Objective To assess the rate of complications following immediate postpartum insertion of intrauterine devices ( IUD s) by trained midwives in Tanzania. Methods A prospective cohort study of women who underwent immediate postpartum IUD ( PPIUD ) insertions provided by midwives between December 31, 2016 and October 15, 2017. Midwives received standardized training via the FIGO initiative. Women who returned 6 weeks after delivery were evaluated for complications. Outcomes of interest were uterine infection, IUD expulsion, medical removal of IUD , and method discontinuation. Results There were 40 470 deliveries, 2347 (5.8%) PPIUD insertions, and 1013 (43.2%) women with a PPIUD who returned for a follow‐up visit in the program‐affiliated clinics. Midwives were providers in 596 (58.8%) of these follow‐up cases and clinicians in 417 (41.2%) cases. All PPIUD insertions by midwives were transvaginal and among them 43 (7.2%) had PPIUD ‐related complications by the end of sixth week. These complications included 16 (2.7%) cases of uterine infection, 14 (2.3%) IUD expulsions, 26 (4.4%) IUD removals, and 33 (5.5%) with overall method discontinuation. Only one case had uterine infection severe enough to warrant hospitalization. Conclusion PPIUD insertion by trained midwives in Tanzania compares favorably with results reported from other settings.