Post-placental expulsion risk based on IUD type: A prospective cohort study
Awarded 2016
Complex Family Planning Fellowship Research
Erica Hinz, MD
New York University

Objectives: To compare the expulsion rate at 6 months after postplacental insertion by intrauterine device (IUD) type.
Study design: This prospective cohort included participants with a postplacental IUD inserted after vaginal or cesarean delivery, aged 18–45 and ≥24weeks’ gestation. Study enrollment took place after IUD selection and insertion. Participants returned for a postpartum visit and received a short message service survey regarding IUD expulsion, removal, vaginal bleeding and breastfeeding weekly from weeks 0 to 5 and on weeks 12 and 24 postpartum. Multivariable logistic regression examined 6-month expulsion rate by IUD type adjusting for variables
that differed between the groups at baseline and in the bivariate analyses.
Results: Of 114 participants, 75 (65.8%) chose a levonorgestrel 52-mg IUD and 39 (34.2%) chose a copper IUD; 58 (50.9%) had a vaginal delivery, and 56 (49.1%) had a cesarean delivery. Groups were similar except that copper IUD users had a higher median parity (3 vs. 2, p=.03) and a higher proportion of senior residents compared to junior residents had performed insertion (46.2% vs. 22.7%, p=.02). The expulsion rate at 6 months was similar between the levonorgestrel and copper groups (26.7% and 20.5%, respectively; p=.38).Multivariable logistic regression also demonstrated that the odds of expulsion did not differ by IUD type (adjusted odds ratio 0.98, 95% confidence interval 0.22–4.48).
Conclusion: The expulsion rate at 6months after postplacental insertion did not differ between the levonorgestrel and copper IUD type.
Implications: Prior studies demonstrate a wide range of expulsion after postplacental insertion, and recent data suggest a higher expulsion rate for the levonorgestrel compared to the copper intrauterine device. However, many studies did not control for patient-level factors or delivery route. We found that when controlling for these confounding variables, the expulsion rate at 6 months postpartum did not differ by intrauterine device type.