Expulsion of immediate postplacental copper intrauterine devices at six months: A prospective cohort study
Awarded 2015
Complex Family Planning Fellowship Research
Elizabeth Gurney, MD
University of Pennsylvania

Offering immediate postpartum contraception is a potential solution to the problem of unintended rapid repeat pregnancies, by providing birth control before a woman resumes sexual activity after delivering a child. There has been increasing interest in this practice over the past decade in the United States. Today, nearly half of states have reformed state Medicaid policy to allow for reimbursement for long acting reversible contraceptives (LARC) placed at the time of hospitalization for delivery. Studies of immediate postpartum LARC have shown it to be convenient and highly acceptable to women, to remove barriers to contraceptive access in comparison to the routine practice of LARC initiation at or after a six-week postpartum visit, and to be fiscally advantageous to states.
Despite international data supporting the safety of immediate postplacental intrauterine device (IUD) insertion, which is performed within 10 minutes of placental delivery, and the advantages of immediate postpartum LARC described above, there are limited data describing complications that may occur after immediate postplacental IUD insertion.
This was a prospective, observation study of adult women experiencing a normal vaginal delivery at 34 or more weeks’ gestation, who received an immediate postplacental copper intrauterine device (IUD) at one academic, urban, tertiary care institution. The purpose of this study was to determine a precise point estimate of the proportion of women who experienced expulsion of the immediate postplacental IUD by 6 months postpartum. A sample size of 195 enabled us to detect a 15% expulsion proportion with a 95% confidence interval of ±6%. We also assessed other abnormalities in IUD position, women’s satisfaction with the immediate postpartum IUD, contraceptive use at 6 months postpartum, and risk factors for IUD problems. Follow up occurred at 6 weeks and 6 months postpartum.