Immediate Post Placental IUDs: Are Removal Complications Increased? [13J

Abstract

INTRODUCTION: Post-placental intrauterine device (IUD) insertion is associated with increased risk for expulsion and missing strings at follow up. We evaluated the proportion of non-visualized strings and complicated IUD removals in patients who had post-placental IUDs placed at the time of vaginal delivery or cesarean section. METHODS: We performed a single site retrospective cohort study of women who had an IUD placed at either the time of cesarean section or vaginal delivery from January 2016-January 2019. The primary outcome was identification of the IUD strings at a postpartum or emergency department visit. IRB approval was obtained. Demographic, obstetric and clinical characteristics were summarized through descriptive statistics, and 95% confidence intervals summarized variability. Fisher’s exact test was utilized to provide unadjusted comparisons between groups. RESULTS: A total of 253 women had a post-placental IUD. Fifty-four percent had IUD insertion after vaginal delivery and 46% after cesarean section. Of these 253 women, 66% (n=167) had documented follow up visits. Of the 167 women with follow up, strings were visualized in 52% (95% CI 44, 59%). Strings were not visible in 31% (n=52) or were not assessed or previously expulsed in 17% (n=29). The proportion of women with non-visible strings was not different between vaginal (45%) versus cesarean (53%) deliveries (Fisher’s exact p-value: 0.28). Among those with non-visualized IUD strings, 11.5% (n=6) required complicated removal. CONCLUSION: Post-placental IUD insertion was associated with a substantial proportion of non-visible strings in the post-partum setting, leading to a higher potential for complicated IUD removals and need for improved patient counseling.