Clinical Outcomes of Incidental, Postplacental Intrauterine Device Placement in the Setting of Chorioamnionitis [A26

Abstract

INTRODUCTION: This case-control study reviews complications and contraceptive outcomes following incidental, immediate post-placental intrauterine device (IUD) placement in the setting of chorioamnionitis (CDC contraindication category 4), versus waiting to receive an interval IUD per standard guidelines. METHODS: We conducted an institutional review board (IRB)-compliant retrospective chart review of individuals delivering an infant and desiring an IUD for postpartum contraception in the setting of chorioamnionitis (2015-2020). We collected demographics, histopathologic confirmation of chorioamnionitis, timing of IUD placement, duration of use, short term outcomes/complications (e.g., worsening infection), and long-term outcomes/complications (e.g., IUD retention, IUD expulsion, pelvic inflammatory disease). Data were compared between individuals receiving post-placental IUDs and those waiting to receive outpatient, interval IUDs. We conducted phone interviews to validate and follow-up on medical record data. RESULTS: Fifty-five individuals with chorioamnionitis desired an IUD for postpartum contraception (mean age: 27 years, gestational age at delivery: 39 weeks); 25% provided phone interviews. Nearly half (45%) of clinician-diagnosed chorioamnionitis was confirmed on histopathology. Among IUD recipients (22 post-placental, 10 interval), four re-presented with five complaints (one vaginal discharge, three pelvic pain, one IUD malposition). Incidence of re-presentation did not differ by timing (P=.77) or presence (P=.91) of IUD. Individuals who received a post-placental IUD were significantly more likely (P<.01) to have their IUD in place at 12 months than those intending to receive a post-partum interval IUD. CONCLUSION: No severe complications occurred among individuals receiving a post-placental IUD in the setting of chorioamnionitis. Recipients of immediate versus interval IUDs were more likely to have an IUD at 1 year follow-up.