What are the advantages of immediate postpartum intrauterine device (IUD) insertion?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Postpartum Insertion

Reliable data exist to support the safety and effectiveness of immediate (within 10 minutes) postpartum insertion of both the levonorgestrel-intrauterine systems and the copper T380A IUD. [37, 13] Insertion has been proven to be safe and effective after both vaginal delivery and cesarean delivery. [38]

Choosing the immediate postpartum period for insertion is advantageous for several reasons. First, in the immediate postpartum period patients are motivated regarding contraception, and this occasion eliminates concern regarding insertion timing and pregnancy risk. [37] Further, postpartum IUD insertion is theoretically less painful secondary to cervical dilation and labor analgesia and is more convenient for the patient. [37] Although previously a concern, the literature supports that neither the levonorgestrel-releasing intrauterine system nor the copper T380A has a negative effect on breastfeeding volume/duration or infant growth. [39]

Expulsion rates in patients who undergo postpartum insertion are higher than in women who delay insertion for postpartum follow-up appointments (23.5% versus 4.4%). However, delaying insertion to postpartum follow up visit is associated with a significantly decreased number of patients that follow through with IUD insertion. [13]

Given the higher expulsion rate, close follow-up is indicated following postpartum insertion to identify unrecognized spontaneous expulsions. IUDs should not be placed in the immediate postpartum period in women who have been diagnosed with chorioamnionitis or endometritis.


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