IUD complete expulsion rates similar for placement at early, later postpartum visits

Key takeaways :

• For IUDs placed at 2 to 4 weeks postpartum and 6 to 8 weeks, complete expulsion occurred for 2% and 0%, respectively.
• Partial expulsion occurred for 9.4% and 7.6% with earlier or later placement, respectively.

Early IUD placement at 2 to 4 weeks postpartum was noninferior to placement at 6 to 8 weeks postpartum for expulsion, but not partial expulsion, according to a randomized noninferiority trial published in JAMA.

“The early postpartum period, 2 to 4 weeks postpartum, is an ideal time to receive contraception. People are known not to be pregnant, and the visit can be co-located with other health visits, such as well-baby visits,” Sarah Averbach, MD, associate professor of in the department of obstetrics, gynecology and reproductive sciences in the division of complex family planning and the Center on Gender Equity and Health at the University of California, San Diego, and colleagues wrote. “The American College of Obstetricians and Gynecologists recommends all postpartum people have contact with a clinician within the first 3 weeks postpartum, and early postpartum visits are becoming increasingly common.”

In this randomized noninferiority trial, researchers enrolled 404 participants (mean age, 29.9 years) from four U.S. medical centers who had a vaginal or cesarean birth between March 2018 to July 2021. All participants were randomly assigned to undergo early (2 to 4 weeks; n = 203) or interval (6 to 8 weeks; n = 201) postpartum IUD placement. Clinicians confirmed IUD presence and placement with transvaginal ultrasound at the 6-month postpartum follow-up visit.

The primary outcome was complete IUD expulsion by 6 months postpartum. Secondary outcomes included partial IUD expulsion, IUD removal, pelvic infection, patient satisfaction, uterine perforation, pregnancy and IUD use at 6 months postpartum. The prespecified margin for noninferiority was 6%.

At 6 months postpartum, 13% of participants never had their IUD placed, and 14% of participants were lost to follow-up, the researchers wrote. Among the remaining 294 participants who received an IUD and completed their follow-up, complete expulsion occurred among 2% of participants in the early IUD placement group and 0% in the interval IUD placement group.

Researchers observed partial expulsion among 9.4% of participants in the early IUD placement group and 7.6% of participants in the interval IUD placement group, which did not meet noninferiority. At 6 months, IUD use was similar between both groups (69.5%, early group vs. 67.2%, interval group).

“Understanding the risk of IUD expulsion across the postpartum period enables patients and clinicians to make informed choices about postpartum IUD placement timing based on the patient’s goals and preferences,” the researchers wrote.