Feasibility of postpartum placement of the levonorgestrel intrauterine system more than 6 h after vaginal birth

Stuart, Gretchen S.; Bryant, Amy G.; OʼNeill, Erica; Doherty, Irene A.

doi:10.1016/j.contraception.2011.08.005

Cited by 14 publications

(7 citation statements)

References 11 publications

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“…7,18,19 Twenty-two studies included only CuT380A IUDs, 8,16–18,20–37 13 included only LNG-IUS, 19,38–49 and nine included a mix of the two 7,9,10,14,50–54 ; the remaining four studies included CuT200 55–57 or Cu7 IUDs. 58 Twenty-eight studied women with IUDs placed only in the immediate postpartum period, 9,10,14,17,18,21,23,24,26–30,32–37,40–43,52–54,57,58 four studied only early postpartum placements, 44,47,55,56 and the remaining 16 studied more than one placement period. 7,8,16,19,20,22,25,31,38,39,45,46,48–50,51 Similar numbers of studies evaluated vaginal and cesarean deliveries, with 14 including only vaginal deliveries, 14,16,19,20,22,31,34,39,42,44,45,48,53,5816 including only cesarean deliveries, 7,8,17,18,27–30,35,37,38,40,41,43,46,54 16 including both delivery methods, 9,10,21,…”

Section: Resultsmentioning

confidence: 99%

Intrauterine Device Expulsion After Postpartum Placement

Jatlaoui

Whiteman

Jeng

et al. 2018

Obstetrics &Amp; Gynecology

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OBJECTIVE: To estimate expulsion rates among women with postpartum intrauterine device (IUD) placement by timing of insertion, IUD type, and delivery method. DATA SOURCES: We searched PubMed, Cochrane Library, and ClinicalTrials.gov from 1974 to May 2018. METHODS OF STUDY SELECTION: We searched databases for any published studies that examined post-partum placement of a copper IUD or levonorgestrel intrauterine system and reported counts of expulsions. We assessed study quality using the U.S. Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of IUD expulsion and estimated adjusted relative risks (RRs) for timing of postpartum placement, delivery method, and IUD type using log-binomial multivariable regression model. TABULATION, INTEGRATION, AND RESULTS: We identified 48 level I to II-3 studies of poor to good quality. Pooled rates of expulsion varied by timing of IUD placement, ranging from 1.9% with interval placements (4 weeks postpartum or greater), 10.0% for immediate placements (10 minutes or less after placental delivery), and 29.7% for early placements (greater than 10 minutes to less than 4 weeks postpartum). Immediate and early postpartum placements were associated with increased risk of expulsion compared with interval placement (adjusted RR 7.63, 95% CI 4.31–13.51; adjusted RR 6.17, 95% CI 3.19–11.93, respectively). Postpartum placement less than 4 weeks after vaginal delivery was associated with an increased risk of expulsion compared with cesarean delivery (adjusted RR 5.19, 95% CI 3.85–6.99). Analysis of expulsion rates at less than 4 weeks postpartum also indicated that the levonorgestrel intrauterine system was associated with a higher risk of expulsion (adjusted RR 1.91, 95% CI 1.50–2.43) compared with CuT380A. CONCLUSION: Postpartum IUD expulsion rates vary by timing of placement, delivery method, and IUD type. These results can aid in counseling women to make an informed choice about when to initiate their IUD and to help institutions implement postpartum contraception programs.

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Section: Resultsmentioning

confidence: 99%

Intrauterine Device Expulsion After Postpartum Placement

Jatlaoui

Whiteman

Jeng

et al. 2018

Obstetrics &Amp; Gynecology

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“…A systematic review of 18 comparative studies of IUD insertion at varying points in the postpartum period determined that both postplacental and early postpartum insertion result in higher expulsion rates than delayed or interval insertion, but that expulsion after postplacental insertion and early postpartum insertion at N10 min to 48 h are generally similar [26]. However, this review did not contain results from two studies conducted by Stuart et al that found expulsion rates of 38-41% in the early postpartum period (6-48 h after vaginal delivery) [50,51]. A planned RCT comparing postplacental and early postpartum insertion was terminated early because in the early postpartum arm, the combined rate of expulsion (7/17) and early removal (3/17) was over 50% [51].…”

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confidence: 93%

Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices

Whitaker

Chen

2018

Contraception

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Postplacental intrauterine device (IUD) placement, defined as IUD placement within 10 min after delivery of the placenta, is an appealing strategy for increasing access to postpartum IUDs because it does not require a separate postpartum visit. These guidelines present an evidence-based assessment of postplacental IUD placement after vaginal and cesarean delivery. Postplacental IUD insertion is safe and does not have higher risks of complications than interval insertion. Most studies find that the risk of IUD expulsion is higher after postplacental insertion than after interval insertion for both vaginal and cesarean deliveries. Most studies find higher rates of expulsion after vaginal delivery than after cesarean delivery. However, expulsion rates vary widely across studies, without clear evidence about the factors that may influence expulsion. In settings where replacement of expelled IUDs is available, patient populations with low rates of return for the postpartum visit are most likely to benefit from provision of postplacental IUD placement with appropriate counseling about risks and benefits.

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“…31,32 Although increasing in use, there are less data to date on the use of levonorgestrel-releasing IUDs immediately postpartum; however, these data demonstrate feasibility, acceptability, and effectiveness of this approach. 31,34,36,40,41 The main disadvantage to immediate postpartum provision is the higher expulsion rate, ranging from 8% to 51% in various studies, [33][34][35][36][37][38]41,42 which must be balanced against the advantages of immediate, highly effective, and long-acting contraceptive coverage. 12,39 An IUD may be safely placed after vaginal or cesarean delivery.…”

Section: Intrauterine Contraceptionmentioning

confidence: 99%

Postpartum Contraception

Sober

Schreiber

2014

Clinical Obstetrics &Amp; Gynecology

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As birth spacing has demonstrated health benefits for a woman and her children, contraception after childbirth is recognized as an important health issue. The potential risk of pregnancy soon after delivery underscores the importance of initiating postpartum contraception in a timely manner. The contraceptive method initiated in the postpartum period depends upon a number of factors including medical history, anatomic and hormonal factors, patient preference, and whether or not the woman is breastfeeding. When electing a contraceptive method, informed choice is paramount. The availability of long-acting reversible contraceptive methods immediately postpartum provides a strategy to achieve reductions in unintended pregnancy.

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Feasibility of postpartum placement of the levonorgestrel intrauterine system more than 6 h after vaginal birth

Cited by 14 publications

References 11 publications

Intrauterine Device Expulsion After Postpartum Placement

Intrauterine Device Expulsion After Postpartum Placement

Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices

Postpartum Contraception

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