Importance of the delivery-to-insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis.

Abstract

OBJECTIVE: To evaluate the delivery-to-insertion interval for copper postpartum intrauterine devices (PPIUDs).METHODS: Secondary analysis of two related studies at five academic sites in India from March 2015 to July 2016. IUDs were inserted within 48hours of vaginal delivery. Women (n=560) were grouped by whether they underwent postplacental (=10minutes) or immediate (>10minutes) insertion. Outcomes were complete expulsion at the 6-8-week follow-up (primary), and IUD-to-fundus distance, as assessed by postinsertion ultrasound (secondary).RESULTS: Overall, 93 (16.6%) women received a postplacental PPIUD and 467 (83.4%) received an immediate PPIUD. Complete expulsion at follow-up was 3.2% (n=3) in the postplacental and 7.5% (n=35) in the immediate postpartum group (P=0.176; difference in proportions, 4.3%; 95% confidence interval, -2.0 to 8.1). Distance from the fundus did not differ between the two groups (P=0.107); high fundal placement (=10mm from the internal endometrial verge) was achieved for most women.CONCLUSION: The present data challenge previous guidance on the timing of PPIUD insertion. The 10-minute insertion window is a barrier to uptake and should be reassessed for inclusion in service delivery guidelines. A flexible interval would accommodate the multiple post-delivery tasks of providers and increase access to PPIUD.

View details for DOI 10.1002/ijgo.13115

View details for PubMedID 32037531