Objective: To investigate whether early interval placement of a postpartum intrauterine device (IUD) at 3 weeks after delivery, compared to the usual placement timing of 6 weeks, is associated with greater IUD uptake by 3 months after delivery. Uterine measurements via ultrasound and uterine sounding were compared. Pain with insertion, six month continuation, subject acceptability, bleeding patterns, and adverse outcomes were also examined.
Methods: This prospective randomized, controlled trial enrolled inpatient postpartum women up to 5 days after a vaginal or cesarean delivery at our academic tertiary care hospital in the United States. Participants were recruited from among women who delivered a live-born singleton infant at greater than 32 weeks gestation and who had indicated interest in obtaining intrauterine contraception. After scheduling an initial IUD insertion appointment at the ideal time, no further study interventions or reminders were made. Participants were followed for 6 months. Analysis was by intention to treat and by actual insertion timing.
Results: Between February 2012 and December 2013, 201 subjects were enrolled; 101 were randomized to 3 week and 100 to 6 week intrauterine device placement. Four subjects were enrolled despite exclusions (1 in 3 week group and 3 in 6 week group). IUD placement occurred in 75% of participants (75/100) in the 3 week group and in 80% (78/97) in the 6 week group (55/73, 75.3% at ideal timing for 3 week group, 58/70, 82.9% for 6 week group). By 3 months, there was no difference in uptake between the randomization groups (73% in each group, p = 0.91). There were no differences between groups for pain with insertion, satisfaction with timing, or 6 month continuation. When uterine measurements at actual placement timing were compared, they were slightly larger at 3 weeks compared to 6 weeks, with mean uterine sound length 8.2 cm compared to 7.5 cm (p = 0.002) and fundal thickness 2.3 cm versus 1.7 cm (p < 0.001). Seven women became pregnant prior to 6 months postpartum, 2 in the 3 week group and 5 in the 6 week group, only one of which had an IUD placed and then removed within 2 weeks. There were 6 cases of malposition at insertion, including myometrial embedment, 2 expulsions, and no complete perforations. Conclusion: Early interval postpartum IUD placement at 3 weeks appears acceptable to women and without increased discomfort or risk, compared to usual postpartum timing at 6 weeks. Early placement offers women more time to return to clinic before resuming intercourse or returning to work and should be offered as an option.