Improving the Post-Placental Intrauterine Device Protocol to Reduce Patient Visits [2H

Abstract

INTRODUCTION: Immediate post-partum intrauterine device (IUD) insertion is a safe and effective means of long-acting birth control. This project analyzes demographics, string visualization, and follow up of women who opted for post-partum IUD insertion and considers the need for follow up including ultrasound (TVS). METHODS: From March 2016 to March 2017, the Post-Placental IUD Insertion Protocol was used for immediate post-partum Mirena® and ParaGard® IUD insertion at University Hospital, San Antonio, Texas. Retrospective chart analysis was used to assess patient demographics, follow up rates, and expulsion rates. RESULTS: A total of 128 women received post-partum IUDs, 70 post-cesarean and 58 post-vaginal delivery. Patient age ranged from 16-43 (average = 26.76) and parity ranged from 1-10 (average = 3.1). Over 80% of the population was Hispanic. Per protocol, patients were scheduled for a string check follow up 7-14 days post insertion. Of the 89 patients who followed up, 27 were in the first three weeks of post-insertion. Over 88% (15/17) of the post-cesarean and 25% (2/8) of post-vaginal insertions did not have visible strings at the visit and 50% (44-89) eventually needed a TVS to confirm placement, 75% of which were post-cesarean. The expulsion rate was 9% (8/89) and 9 IUDs required removal per patient request or IUD not being at the uterine fundus. CONCLUSION: The Post-Placental IUD Insertion Protocol can be improved in efficiency and cost-effectiveness by reducing the number of post-partum visits to only one at six weeks as well as scheduling a pre-clinic TVS, especially for post-cesarean patients.