Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications

• Published in: American journal of obstetrics and gynecology 2015-10, Vol.213 (4), p.515.e1-515.e5
• Main Authors: Teal, Stephanie B., MD, MPH, Romer, Sarah E., RN, ND, MSN, FNP-BC, Goldthwaite, Lisa M., MD, Peters, Marissa G., MPH, Kaplan, David W., MD, MPH, Sheeder, Jeanelle, MSPH, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; advanced practice clinician; Advanced Practice Nursing; Age Factors; Cohort Studies; contraception; Female; Gynecology; Humans; intrauterine device; Intrauterine Device Expulsion; Intrauterine Devices; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Obstetrics and Gynecology; Parity; Prosthesis Implantation - methods; Retrospective Studies; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2015.06.049

Objective The objective of the study was to evaluate success and safety of intrauterine device (IUD) placement in a large cohort of adolescents. Study Design We examined the medical records of patients aged 13–24 years at the Children’s Hospital Colorado Adolescent Family Planning Clinic with at least 1 attempt at IUD placement. We abstracted demographic, reproductive, and procedural variables. The primary outcome was successful placement at first IUD insertion visit. We compared nulliparous with parous adolescents and patients younger than 18 years with those 18 years of age and older. Results Between April 2009 and December 2011, 1177 adolescent women aged 13–24 years (mean age 20.8 ± 2.5 years) had an attempted IUD placement, 1012 (86%) of which were with an advanced practice clinician. The first attempt was successful for 1132 women (96.2%). The first-attempt success rate was 95.8% for nulliparous women and 96.7% for parous women ( P  = .45). The first-attempt success rate was 95.5% (n = 169) for women aged 13–17 years compared with 96.3% (n = 963) for women aged 18–24 years ( P  = .6). Only 1.8% (n = 21) of all first-attempt successful insertions required ancillary measures. Of the 45 patients with a failed first insertion attempt, 40% (n = 18) had a second attempt with a physician, of which 78% (n = 14) were successful. Within the first 6 months of IUD placement, no perforations were identified and 24 patients (3.0%) expelled the IUD. Insertion failures and IUD expulsions were not related to IUD type, age, or parity. Conclusion Intrauterine devices can be inserted in nulliparous adolescents of any age with similar success to parous adolescents, by both physicians and advanced practice clinicians. Inability to provide ancillary measures such as paracervical block or cervical dilation should not limit access to this first-line contraceptive method.