Journal
CONTRACEPTION
Volume 97, Issue 1, Pages 2-13Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.contraception.2017.09.014
Keywords
Postpartum contraception; Intrauterine device; Intrauterine system; Contraception; Levonorgestrel; Postplacental IUD; Postpartum IUD; IUD expulsion
Categories
Funding
- Medicines 360
- Bayer Pharmaceuticals
- Merck
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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. (C) 2017 Elsevier Inc. All rights reserved.
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