Expulsion of Immediate Postplacental Copper IUDs at Six Weeks: A Prospective Cohort Study [5A

Abstract

INTRODUCTION: Postplacental intrauterine device (IUD) placement could improve contraceptive access and child spacing. We sought to report a precise point estimate of the proportion of TCu380A IUDs expelled 6 weeks after immediate postplacental placement, and to assess risk factors for expulsion. METHODS: We enrolled women who received a TCu380A IUD after vaginal delivery beyond 33 weeks gestation from April 2015-August 2016. A sample size of 195 enabled us to detect a 15% expulsion proportion with a 95% confidence interval of ±6%. Follow-up to determine IUD status occurred 6 weeks postpartum. RESULTS: 195 women enrolled. Six weeks postpartum, 155 of 171 (90.6%) telephone survey respondents believed their IUD was in place, and 136 (79.5%) reported high satisfaction. Of the 147 women who completed a pelvic exam, 104 had a correctly positioned IUD and continued its use (70.7% [95% CI 63.4-78.1%]). Mechanical IUD complications included: 10 complete expulsions (6.8%), 14 partial expulsions (IUD in cervix; 9.5%), 5 devices in the lower uterine segment (3.4%), and 8 rotated in the uterus (5.4%). IUD strings were visible on exam for 112 subjects (76.2%); of these, 90 (80.4%) had correctly positioned devices. There were no statistically significant associations between clinical covariates assessed and IUD continuation. CONCLUSION: In our cohort, continuation of a correctly positioned IUD was 71% at 6 weeks postpartum. Mechanical complications occurred in 25%, and visualization of IUD strings did not assure fundal placement. The significance of malpositioned IUDs requires further investigation. Participants were satisfied with postplacental IUD access.