Intrauterine device insertion in the postpartum period: A systematic review

Sonalkar, Sarita; Kapp, Nathalie

doi:10.3109/13625187.2014.971454

Cited by 91 publications

(76 citation statements)

References 12 publications

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“…As expulsions are infrequent after this period, frequent sonography is not recommended. Our findings are in keeping with other reports where a significant proportion of expulsions occurred in the first 3 months after IUD insertion 9 11. Marchi et al 12.…”

Section: Discussionsupporting

confidence: 93%

Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device

Dewan

Singal³

et al. 2016

J Fam Plann Reprod Health Care

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Section: Discussionsupporting

confidence: 93%

Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device

Dewan

Singal³

et al. 2016

J Fam Plann Reprod Health Care

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“…Attendance rates at the 6-week postpartum visit are variable, with as many as 33% of prenatal care recipients not returning for postpartum care (1). Postplacental IUD insertion, which refers to IUD insertion within 10 minutes of placental delivery is one potential way to decrease rapid repeat pregnancies (2). However, expulsion rates are as high as 27% at 6 months postpartum with postplacental IUD insertion, compared to 1–4% with interval insertion at four to 6 weeks after delivery (3–7).…”

Section: Introductionmentioning

confidence: 99%

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Chen

Hou

Hsia

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To evaluate whether a department policy changing the scheduling of the postpartum visit from 6 weeks to 2–3 weeks after delivery is associated with higher long-acting reversible contraception (LARC) initiation at the postpartum visit. Methods We conducted a quasi-experimental before–after study to evaluate LARC initiation, specifically an intrauterine device (IUD) or contraceptive implant, at the postpartum visit between women scheduled for follow-up at 6 weeks (before policy change) and 2–3 weeks after delivery (after policy change). Secondary outcomes included postpartum visit completion, overall contraception initiation at the postpartum visit, overall contraceptive use at 6 months after delivery, and repeat pregnancies by 6 months postpartum. We obtained delivery and postpartum information using the electronic medical record and contacted participants 3 and 6 months after delivery to assess contraception use and repeat pregnancies. Results We enrolled 586 participants between December 2014 and November 2015, of whom 512 women (256 in each cohort) continued to meet eligibility criteria after delivery. Long-acting reversible contraception initiation rates at the postpartum visit were lower in the 2–3 week (16.5%, 95%CI 12.2–21.8) compared to 6-week group (31.1%, 95%CI 25.2–37.7, p<0.01), primarily due to patient and health care provider preferences for delaying IUD insertion to a later visit. More women completed a scheduled 2–3 week postpartum visit (90.2%, 95%CI 86.0–93.3) compared to 6-week visit (81.6%, 95%CI 76.4–85.9, p<0.01). Deferral of any contraception initiation was higher in the 2–3 week group (27.3%, 95%CI: 21.9–33.4) compared to 6-week group (15.8%, 95%CI: 11.5–21.4, p<0.01), but there were no differences in overall contraceptive use patterns at 6 months postpartum. No IUD perforations or expulsions were observed in women who underwent insertion at 2–3 weeks postpartum. Five pregnancies were reported in each cohort by 6 months after delivery. Conclusions Scheduling a visit at 2–3 weeks after delivery was not associated with increased LARC initiation at this visit despite higher postpartum visit attendance.

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“…Despite the limitations of this small study, the high discontinuation and pregnancy rates among our cohort highlight the difficulties that postnatal women, particularly, have in sustaining contraception utilisation in country settings like South Africa. IUD expulsion occurred in one-third of users in this follow-up study, which might be explained by the study limitations; however, this does not appear to be extraordinarily high: a 2015 systematic review of postnatal IUD insertion found IUD expulsion rates ranging from 2.4% to 72% across a variety of study designs 4. This suggests that some high-quality research is needed to clarify the risk of IUD expulsion for postnatal IUD users.…”

mentioning

confidence: 74%

Postnatal contraception discontinuation: different methods, same problem

Singata‐Madliki

Dekile-Yonto

Hofmeyr

et al. 2017

BMJ Sex Reprod Health

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Intrauterine device insertion in the postpartum period: A systematic review

Abstract: This review supports the evidence that insertion of an intrauterine contraceptive within the first 48 hours of vaginal or caesarean delivery is safe. Expulsion rates should be further studied in larger randomised controlled trials.

Cited by 91 publications

References 12 publications

Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device

Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit

Postnatal contraception discontinuation: different methods, same problem

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