Immediate post-placental insertion of IUDs at time of cesarean delivery: A randomized clinical trial
Awarded 2012
Complex Family Planning Fellowship Research
Erika Levi, MD
University of North Carolina at Chapel Hill

Background: Delaying the initiation of effective contraception until the postpartum visit puts some women at risk for rapid, repeat, and unintended pregnancy. Women who intend to use an intrauterine device (IUD) for postpartum contraception are often unable to return for a postpartum visit, and never receive an IUD. These women are more likely to be socially and financially disadvantaged and face barriers such as lack of transportation, lack of stable housing, and difficulty communicating with their healthcare providers. IUD placement in the immediate postpartum period has the potential to increase overall IUD use and decrease rates of unintended pregnancy in the US. Immediate postplacental IUD insertion (within ten minutes of placental delivery) is an alternative to interval insertion (insertion 6 or more weeks postpartum); however, little data are available regarding IUDs specifically placed at cesarean delivery.
Statement of Purpose: The purpose of this study was to compare IUD use at six months postpartum among women who underwent intracesarean IUD placement versus women who planned for interval IUD placement six or more weeks after delivery. We hypothesized that women who receive an IUD at the time of cesarean will be more likely to use an IUD 6 months later than women who plan on receiving an IUD 6-8 weeks after delivery.
Methodology: From March 2012 to June 2014, 112 women were enrolled 112 women into the trial. The women were randomly assigned to either receive an IUD during their cesarean delivery, or to have an IUD placed at their postpartum visit 6-8 weeks postpartum.
Results: A larger proportion of the women in the intracesarean group were using an IUD at six months postpartum ((40/48), 83%) compared to those in the interval group ((32/50) 64%, relative risk [RR]=1.3, 95% confidence interval [CI]: 1.02, 1.66). Among the 56 women randomized to interval IUD insertion, 22(39%) of them never received an IUD; 14 (25%) never returned for IUD placement, five (9%) women declined an IUD, and three (5%) had a failed IUD placement.
Conclusion: IUD placement at the time of cesarean delivery leads to increased IUD use 6 months postpartum. Immediate postpartum IUD placement at the time of cesarean allows women greater access to effective contraception during the postpartum period.

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