Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review

Abstract

BackgroundIntrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden.MethodsThis systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type. English language articles indexed in MEDLINE, Embase, and Cochrane from January 2010–October 2021 were included.Results133 articles met the inclusion criteria (46% interventional studies; 54% observational; n=87 from lower-income countries; n=46 from higher-income countries). PPIUD use was low in higher-income countries (6/10 000 US deliveries in 2013–2016) and varied widely in lower-income countries (2%-46%). Across both higher- and lower-income countries, in most studies (79%), >80% of women with PPIUDs had an IUD in place by 3 months; at 6 and 12 months, 76% and 54% of included studies reported that >80% of women had an IUD in place; reason for discontinuation was infrequently reported. Pregnancies were rare (96 pregnancies across 12 191 women from 37 studies reporting data) and were generally unrelated to device failure, but rather occurred in women no longer using a PPIUD. Expulsions occurred mainly in the early outpatient period and ranged widely (within 3 months: 0–41%). Abnormal bleeding, infections, or perforations were rare.ConclusionsPPIUDs are safe and effective. Long-term follow-up data are limited. Future research elucidating reasons underlying lack of PPIUD use is warranted.

Comparison of Frequency of Menorrhagia after Immediate Versus Delayed Intrauterine Contraception Device Insertion

“…IUCD is the method of choice in post partum period. 16 Birth spacing of a minimum of two years has improved fetal and maternal health. [17][18][19] and thus a method should be used after delivery that is effective and has lesser failure rates to achieve adequate birth spacing.…”

“…14,15 Post-partum IUCD insertion is effective and safe but underutilized method of contraception. 16 A study has showed lesser menorrhagia in post-partum IUCD insertion 14 and in another study 15 it was 4% i.e. equal in both groups.…”

Barriers and Challenges in the Acceptance and Continuation of Postpartum Intrauterine Contraceptive Device

“…It is also cost-effective and readily available, with a short learning curve for service providers to learn its insertion technique [16][17][18][19] Despite the promising results elicited by the FIGO endeavor and government enthusiasm and support in the participating six countries, PPIUCD remains an under-utilized contraceptive option and falls short of expectations in lowering fertility rates in those populations, where it is most needed. A recent systemic review on the utilization of PPIUCD globally comes to the conclusion that despite its safety and efficacy it remains an underused contraceptive option [20]. It concludes with the observation that future research is warranted and vital to explore the reasons behind these discouraging trends and the low acceptance and provision of PPIUCDs currently.…”

Words matter: perforation… or transmural migration?

“…The intrauterine device (IUD) is a safe and highly effective form of reversible contraception, and IUD use is increasing globally 1. The paper published in this edition is a credible and comprehensive review of early postpartum IUD (PPIUD) experiences 2. In summary, the authors show that PPIUDs decrease unintended pregnancy rates and short-interval pregnancies, lessen economic burden, and are safe for most people seeking contraception.…”