Intrauterine Device Placement Success for Adolescents and Young Adults at Community-Based Reproductive Health Clinics

Abstract

BackgroundDespite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYA) by leading professional organizations and demonstrated acceptance and desirability by AYA, clinicians may worry about procedural difficulty of IUD device placement in younger patients. ObjectiveThe aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history. Study DesignWe performed a retrospective cohort study of patients <25 years at reproductive health clinics with an IUD placement attempt between January 1-August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first attempt IUD placement by VD history. We also assessed frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications. ResultsWe included 1,325 participants (median age=21.3 years) including 42 (3.2%) with a prior VD. Nearly all IUD placements were successful at first attempt (n=1,301, 98.2%) and performed by advanced practice clinicians (n=1,314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (p>0.999). Ancillary measures other than NSAIDS were used infrequently (n=16, 3.6%.) .(Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within six months of placement were rare (n=29) and mostly comprised of expulsions (n=27, 93.1%). ConclusionIUD placement success among AYA at community-based reproductive health clinics is very high and is not associated with a history of prior vaginal delivery.