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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