Clinical Outcomes of Intrauterine Devices Inserted After Peripartum Intrauterine Infection [06J

Abstract

INTRODUCTION: Postpartum intrauterine device (IUD) insertion is contraindicated after intrauterine infection such as chorioamnionitis or endometritis, as this theoretically increases risk of pelvic inflammatory disease (PID). We conducted a retrospective study to evaluate PID risk associated with IUD placement after delivery complicated by intrauterine infection. METHODS: A retrospective cohort receiving an IUD off-label within 3 months of a delivery complicated by intrauterine infection (INF+IUD) was identified and propensity matched to two control cohorts: patients with intrauterine infection but no IUD (INF Only), and patients without infection but receiving an IUD (IUD Only). PID and other complications within 9 months post-delivery were assessed by chart review. IRB approval was obtained. RESULTS: Eighty patients in each cohort had similar demographics with the exceptions of higher age, gravidity, and parity in the IUD Only group. Documented follow up occurred for 79 (99%), 44 (55%), and 77 (96%) in the INF+IUD, INF Only, and IUD Only groups, respectively (P<.0001). PID developed in one patient each in the INF+IUD and IUD Only cohorts, which was not statistically significant (P=1). The INF+IUD cohort experienced more abnormal bleeding (12.1% vs 0% vs 3.9% in INF+IUD, INF Only, and IUD Only groups, respectively, P=.048), which was not significant after controlling for IUD type. Three patients in the INF Only cohort were pregnant within 9 months, compared to 0 in both IUD groups (P=.024). CONCLUSION: This retrospective review does not show an increased risk of PID in patients receiving an IUD after peripartum intrauterine infection. Larger studies are needed to confirm these findings.