A review of intrauterine device placement during caesarean section at level two facilities in the Metro West, Cape Town

Background: In the Western Cape there are many intrauterine contraceptive devices (IUDs) inserted during caesarean section (C/S). Little is known about long-term outcomes in the Metro West region of Cape Town. Objective: To assess placement of IUDs at C/S and describe follow-up, with a view to compile best practice guidelines for insertion and follow-up in our clinic setting. Methods: A retrospective descriptive audit of clinical records was performed of all women who received an IUD at C/S between January and June 2018 at Mowbray Maternity Hospital (MMH) and New Somerset Hospital (NSH) in Cape Town. Results: There were 2310 and 1376 C/Ss performed at MMH and NSH respectively. The IUD insertion rate was 17.4% (n=402) at MMH and 14.3% (n=197) at NSH. Almost two third of insertions were performed during emergency C/S (59.1%; n=276). The majority of women experienced no immediate complications (84.4%). Only 77 women attended follow-up. The continuation rate at follow-up was 71.6%. The overall expulsion rate in hospital and at follow-up was 3%. Strings were visible in 53.2 % of patients. An ultrasound was performed in 67.5 % of patients. The IUD removal rate at follow-up was 24.7%. Conclusion: The immediate postpartum period may be the only opportunity to provide long acting contraception to some women. In our study population follow-up rates are poor and therefore conclusions cannot be accurately gauged. Measures must be taken to improve follow-up.