Postplacental IUD placement has 20%-37% expulsion rate by day 90

  • Contraception

  • Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Levonorgestrel (LNG) 52 mg intrauterine system (IUS) has lower expulsion rate after postplacental insertion.

Why this matters

  • Traditionally, no contraception is initiated in the immediate postpartum period, an underused window of opportunity to access health care.

Key results

  • Cumulative partial or complete expulsion rate at 90 days was 36.7% for TCu380A intrauterine device (IUD) and 20% for LNG IUS.
  • Most expulsions occurred by 42-day visit:
    • TCu380A IUD: 17/39 vaginal deliveries and 4/31 cesarean deliveries (CDs).
    • LNG IUS: 8/35 vaginal deliveries and 4/35 CDs.
  • Expulsion rates were higher in women with vaginal delivery compared with CD and in women with 1 or ≥3 deliveries compared with 2 deliveries.

Study design

  • Open-label, parallel-group, randomized trial.
  • Women in prodromal labor or scheduled for elective CD were invited to participate.
  • Women were randomly assigned to receive TCu380A IUD (n=70) vs LNG IUS (n=70).
  • Data were collected at 42 and 90 days after IUD/IUS placement.
  • Expulsion rates were compared.
  • Funding: Fundação de Apoio à Pesquisa do Estado de São Paulo and Brazilian National Research Council. The TCu380A IUDs were donated by Pregna, Mumbai, India, and LNG-IUSs by the International Contraceptive Access Foundation, Turku, Finland.

Limitations

  • Parity was unbalanced.
  • Small numbers in study.