Postpartum Intrauterine Device Utilization Rate at an Academic Institution [12F

Abstract

INTRODUCTION: In the first year postpartum, 70% of pregnancies are unintended. Long acting reversible contraceptives, such as intrauterine devices (IUDs), are among the most effective forms of contraception and have been successful in reducing unintended pregnancy rates. Many institutions do not place IUDs until several weeks postpartum despite the American College of Obstetricians and Gynecologists’ recent Committee Opinion No. 670. METHODS: A retrospective cohort study was performed among women who delivered from 7/2014 through 6/2015 at our institution. Those who expressed desire to use an IUD as contraception prior to discharge from the hospital following delivery were included. Billing lists with ICD-10 codes for IUD insertion were used to cross reference inpatient lists from the postpartum hospital stays. Primary outcome measure was percentage of patients who had an IUD inserted by three months postpartum. Additional reasons for not receiving an IUD were examined. RESULTS: 196 patients were identified who desired an IUD for postpartum contraception, and 86 (43.9%) received one. The most common reason for not receiving an IUD was loss to follow up (60%). Other reasons included choosing to use another form of contraception: hormonal (28.1%), barrier (9.1%), or abstinence (1.8%). CONCLUSION: More than half of our patients do not receive their desired method of postpartum contraception. As loss to follow up is the most common reason, institution of immediate postplacental IUD placement may allow for increased utilization and fewer unintended pregnancies. Further study is necessary to elucidate the barriers to immediate postpartum contraception.