Importance of the delivery-to-insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis.

Abstract

To evaluate the delivery-to-insertion interval for copper postpartum intrauterine devices (PPIUDs). Secondary analysis of two related studies at five academic sites in India from March 2015 to July 2016. IUDs were inserted within 48hours of vaginal delivery. Women (n=560) were grouped by whether they underwent postplacental (≤10minutes) or immediate (>10minutes) insertion. Outcomes were complete expulsion at the 6-8-week follow-up (primary), and IUD-to-fundus distance, as assessed by postinsertion ultrasound (secondary). Overall, 93 (16.6%) women received a postplacental PPIUD and 467 (83.4%) received an immediate PPIUD. Complete expulsion at follow-up was 3.2% (n=3) in the postplacental and 7.5% (n=35) in the immediate postpartum group (P=0.176; difference in proportions, 4.3%; 95% confidence interval, -2.0 to 8.1). Distance from the fundus did not differ between the two groups (P=0.107); high fundal placement (≤10mm from the internal endometrial verge) was achieved for most women. The present data challenge previous guidance on the timing of PPIUD insertion. The 10-minute insertion window is a barrier to uptake and should be reassessed for inclusion in service delivery guidelines. A flexible interval would accommodate the multiple post-delivery tasks of providers and increase access to PPIUD.