Jatlaoui TC, et al. - Researchers assessed the expulsion rates in women with postpartum placement of an intrauterine device (IUD) by timing of insertion, IUD type, and delivery method. There were many differences in postpartum IUD expulsion rates by the timing of placement, delivery method, and IUD type. With the help of these findings, women can be counseled to make an informed choice about when to initiate their IUD and to help institutions implement postpartum contraception programs.

Methods

• From 1974 to May 2018, authors searched PubMed, Cochrane Library, and ClinicalTrials.gov for published studies that examined postpartum placement of a copper IUD or levonorgestrel intrauterine system and reported counts of expulsions were searched.
• They evaluated the study quality using the US Preventive Services Task Force evidence grading system.
• Experts calculated the pooled absolute rates of IUD expulsion and estimated adjusted relative risks (RRs) for timing of postpartum placement, delivery method, and IUD type using log-binomial multivariable regression model.

Results

• As per data, 48 level I to II-3 studies of poor to good quality were identified.
• Findings suggested a variation in the pooled rates of expulsion by timing of IUD placement, ranging from 1.9% with interval placements (4 weeks postpartum or greater), 10.0% for immediate placements (10 minutes or less after placental delivery), and 29.7% for early placements (greater than 10 minutes to less than 4 weeks postpartum).
• They noted an association of immediate and early postpartum placements with increased risk of expulsion vs interval placement (adjusted RR 7.63, 95% CI 4.31–13.51; adjusted RR 6.17, 95% CI 3.19–11.93, respectively).
• Results demonstrated a correlation of postpartum placement less than 4 weeks after vaginal delivery with an increased risk of expulsion vs cesarean delivery (adjusted RR 5.19, 95% CI 3.85–6.99).
• The levonorgestrel intrauterine system was associated with a higher risk of expulsion (adjusted RR 1.91, 95% CI 1.50–2.43) compared with CuT380A, as seen in analysis of expulsion rates at less than 4 weeks postpartum.