Correlation of Medical Specialty With Malpositioned Intrauterine Devices [ID 2683518

Abstract

INTRODUCTION: Intrauterine devices (IUDs) are an effective method of long-acting reversible contraception (LARC) and essential for preventing unintended pregnancies, as well as controlling abnormal uterine bleeding (AUB). Intrauterine devices are placed by both obstetrician−gynecologists and primary care providers. As an academic institution, our objective was to determine if training specialty of inserting provider correlated with the rate of malpositioned IUDs. METHODS: All ultrasounds from 2017 to 2020 in which an IUD was documented at SIU School of Medicine Department of Obstetrics and Gynecology, an American Institute of Ultrasound Medicine-certified center, were reviewed (IRB# 21-834). Association between specialty of inserting provider and malposition rate was assessed using chi-squared test. RESULTS: A total of 602 ultrasound reports documenting an IUD were reviewed; 109 malpositioned IUDs were identified (18.1%). Body mass index, age, and gravidity/parity were not significantly different in participants with malpositioned IUDs from those with a properly placed IUD. Indications for ultrasound included pelvic pain, bleeding, and lost strings. Intrauterine devices placed by primary care providers were malpositioned at a significantly higher rate than those placed by obstetrician−gynecologists, 30.0% versus 17.3%, respectively (P=.043). Obstetrician−gynecologists placed 1,961 IUDs and primary care providers placed 276 IUDs between 2017 and 2020. CONCLUSION: Intrauterine devices are a safe and reliable choice for LARC to prevent unwanted pregnancies and to control AUB. Training providers on proper techniques for IUD insertion is imperative for good clinical practice and patient satisfaction. Primary care providers are often seen for contraception management; therefore, the significantly higher malpositioned rate indicates the need to implement an enhanced simulation/education curriculum for IUD insertion.