番茄社区

Inserting an intrauterine device (IUD) at 2 to 4 weeks postpartum matched the standard interval when it came to complete expulsions, a randomized trial found.

At 6-month follow-up, 2% of patients in the early placement group had a complete expulsion compared with none in the group where placement was at the standard 6 to 8 weeks postpartum, meeting criteria for noninferiority (P=0.04), reported Sarah Averbach, MD, of the University of California San Diego, and co-authors.

A higher absolute risk was seen with partial expulsions in the early placement group (9.4% vs 7.6%), which fell outside the bounds of noninferiority (P=0.22), though "the clinical significance of partial expulsion is less clear than that of complete expulsion," the group detailed in .

"This study will reassure a lot of clinicians that they can offer IUDs earlier in the postpartum time period," Averbach told 番茄社区. "And if patients are already at a postpartum visit and they're interested in initiating postpartum contraception -- particularly a postpartum IUD -- this data provide reassuring evidence that the risk of expulsion is low."

The that people who have given birth see a provider within the first 3 weeks postpartum, with some patients choosing to have an IUD placed at this visit rather than waiting until the 6-week visit.

"It's an ideal time to provide postpartum contraception because patients are already there," Averbach said. "We also know that they're not pregnant yet, because earlier in the postpartum period, we know that people have not yet returned to ovulation. And by the time people come back at 6 weeks postpartum, many have already begun to ovulate and initiated intercourse again, putting them at risk for short interval pregnancy and undesired pregnancy."

While it's possible to insert an IUD immediately postpartum, the expulsion rates are high, depending on the study, according to ACOG.

The results "might impact practice, and I find that encouraging," Pamela Berens, MD, of the McGovern Medical School at UTHealth Houston, told 番茄社区, noting that there hasn't been a large randomized study on this topic before. "We can safely offer IUD insertion earlier in the postpartum period, which is good information to have."

Berens, who was not involved in the research, noted that many patients don't show up to their postpartum visit, which covers far more than just birth control.

"We discuss postpartum depression, breast feeding, contraception, and address other things like weight loss," she said. "There has been a push to move that postpartum visit earlier. This study would be supportive of that."

From March 2018 to July 2021, Averbach's group recruited 404 postpartum participants from four U.S. health systems, a majority of whom had a vaginal delivery and were multiparous.

Patients were randomly assigned 1:1 to undergo early IUD placement at 2 to 4 weeks postpartum or interval IUD placement at 6 to 8 weeks postpartum. Most participants chose a 52-mg levonorgestrel IUD, and most of the remaining participants chose a copper IUD. Overall, 13% of patients never had an IUD placed and 14% were lost to follow-up. At the 6-month visit, clinicians (blinded to the study group) performed a bimanual pelvic and speculum examination and transvaginal ultrasonography to check for IUD placement.

The primary analysis included 294 patients who received an IUD and completed a 6-month follow-up visit. Among these, the mean patient age was about 30 years, more than half were white, 42% were Hispanic, and 11% were Black. The primary outcome was complete IUD expulsion by the 6-month postpartum visit, with a noninferiority margin of 6%.

Secondary outcomes included partial IUD expulsion, IUD removal (16.8% vs 11.7% for the early and standard groups, respectively), pelvic infection (2% vs none), uterine perforation (none in either group), and IUD use at the 6-month visit (69.5% and 67.2%), among others.

Berens said that more data are needed on rare adverse events that can happen with IUD placement, such as perforations or infections.

Participant satisfaction was also assessed, with 84.6% in the early group saying they would recommend an IUD insertion at the same time to a friend, as compared with 89.0% of the standard interval group.

Among the limitations, the study authors noted that because there were so few IUD expulsions across groups, it was difficult to assess associated risk factors. They also said the findings may not be generalizable to the community setting, as recruitment took place at academic centers.

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