Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis

• Published in: American journal of obstetrics and gynecology 2017-07, Vol.217 (1), p.51.e1-51.e7
• Main Authors: Eggebroten, Jennifer L., MD, Sanders, Jessica N., PhD, MSPH, Turok, David K., MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; contraception; Contraception - methods; contraceptive implant; Delivery, Obstetric - methods; Female; Hospitals; Humans; immediate postpartum intrauterine device insertion; Intrauterine Device Expulsion; Intrauterine Devices - statistics & numerical data; Intrauterine Devices, Copper - statistics & numerical data; Intrauterine Devices, Medicated - statistics & numerical data; Levonorgestrel; Obstetrics and Gynecology; Postpartum Period; Pregnancy; Prenatal Care; Prospective Studies; removals; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2017.03.015

Background In-hospital placement of intrauterine devices and contraceptive implants following vaginal and cesarean delivery is increasingly popular and responds to maternal motivation for highly effective postpartum contraception. Immediate postpartum intrauterine device insertion is associated with higher expulsion than interval placement, but emerging evidence suggests that the levonorgestrel intrauterine device may have a higher expulsion rate than the copper intrauterine device. Objective This study evaluated in-hospital provision, expulsion, and 6-month continuation of immediate postpartum copper T380 intrauterine devices, levonorgestrel intrauterine devices, and contraceptive implants. Study Design We offered enrollment in this prospective observational trial to women presenting to the University of Utah labor and delivery unit from October 2013 through February 2016 who requested an intrauterine device or implant for postpartum contraception during prenatal care or hospitalization at the time of delivery. Following informed consent, participants completed questionnaires prior to hospital discharge and at 3 and 6 months postpartum. Data on expulsions at 6 months were validated by chart abstraction. Results During the study period, 639 patients requested a postpartum intrauterine device or implant and 350 patients enrolled in prospective follow-up prior to discharge from the hospital. Among enrollees, 325 (93%) received their preferred contraceptive device prior to hospital discharge: 88 (27%) copper intrauterine device users, 123 (38%) levonorgestrel intrauterine device users, and 114 (35%) implant users. Participants predominantly were Hispanic (90%), were multiparous (87%), reported a household income