Postcesarean Intrauterine Contraception

Allison Bryant, MD, MPH


Journal Watch 

In This Article

Abstract and Introduction


IUD placement immediately after cesarean delivery was well tolerated, with low likelihood of expulsion.


Immediate postpartum placement of an intrauterine device (IUD) is safe and highly effective, but placement <6 weeks after vaginal delivery generally has been discouraged because of high expulsion rates (JW Womens Health Dec 2 2010). But what about tolerability and expulsion rates of IUDs inserted after cesarean delivery? Investigators sought to determine feasibility of postcesarean IUDs in 90 women (median age, 30; 96% multiparous; 85% black or Latina) who planned to use contraception with copper-T IUDs and who had cesarean deliveries at ≥35 weeks' gestation in two New York City medical centers.

Most cesarean deliveries occurred before onset of labor. Participants underwent IUD placement just before hysterotomy closure. In the 43 women who returned for their 6-week postpartum visit, no confirmed expulsions had occurred: 74% received confirmation that IUDs remained in place, and the remainder did not return for a scheduled ultrasound. At 6 months, just fewer than half of the participants were reached for follow-up. Of these, 80% said they were "happy" or "very happy," and none said they were "unhappy" with the IUDs, despite 55% reporting some cramping or heavy bleeding during menses. No expulsions were reported among any of the women contacted at 6 months.