Timing of postpartum IUD placement: it's complicated

  • Jatlaoui TC & al.
  • Obstet Gynecol
  • 1 Oct 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Immediate postpartum intrauterine device (IUD) placement for contraception is associated with an increased risk for expulsion.

Why this matters

  • Despite higher risk for expulsion, immediate IUD placement may still be beneficial to women with limited access to care or follow-up.

Key results

  • Crude pooled expulsion rates ranged from 0% to 46.7%.
  • On multivariate analysis, immediate and early IUD placement had more than a 6-fold higher risk for expulsion (adjusted relative risk [RR], 7.63; 95% CI, 4.31-13.51).
  • Expulsion rates were lower with immediate insertion (≤10 minutes after placental delivery, 10.0%; 95% CI, 0.0%-26.7%) compared with early insertion (>10 minutes but
  • Immediate IUD placement after vaginal delivery involved a higher rate of expulsion compared with placement during cesarean delivery (RR, 5.19; 95% CI, 3.85-6.99).
  • The levonorgestrel intrauterine system had a higher rate of expulsion compared with a copper IUD (adjusted RR, 1.91; 95% CI, 1.50-2.43).

Study design

  • Systematic review and meta-analysis examining postpartum IUD placement (48 publications included).
  • Pooled absolute rates of IUD expulsion compared.
  • Funding: None.

Limitations

  • Expulsions were not always clearly reported and were ascertained through various methods.

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