Expulsion rates of intrauterine devices placed postpartum vary based on several factors

Référence

Averbach SH, Ermias Y, Jeng G, et al. Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis. Am J Obstet Gynecol 2020;223:177-188.

Sommaire

This meta-analysis of data from 48 studies with 7661 participants synthesized the literature to obtain pooled absolute rates of expulsion after postpartum placement of IUDs. Studies ranges in size from 7 to 2733 women, with follow-up ranging from 4 weeks to 5 years. The authors evaluated 3 postpartum time frames of less than 4 weeks—immediate placement (within 10 minutes), early inpatient (from 10 minutes to less than 72 hours), and early outpatient (from 72 hours to less than 4 weeks)—and the usual postpartum time frame of placement at 4 weeks or more. Studies that did not permit data analysis by these time frames were excluded. The authors limited the data to the 2 brands available in the United States: Mirena (LNG-IUD) and Paragard (copper T). They also separately considered vaginal and cesarean deliveries. For IUDs placed in the immediate time frame, the weighted mean average for complete expulsion rates were 27% for LNG-IUD after vaginal delivery (range 19% - 45%) and 12% for copper T after vaginal delivery (range 5% - 38%). The rates were lower after cesarean deliveries with little difference between device types: 2% (range 0 - 2%), and 4% (range 0 - 15%) for LNG-IUD and copper T, respectively. For IUD placements in the early inpatient period, the weighted mean average of complete expulsions rates were 37% for LNG-IUD after vaginal delivery (range 27% - 47%) and for 7% for copper T after vaginal delivery (range 4% - 24%). In 3 studies with 136 women, no expulsions occurred among women who had IUD placements in the early outpatient time frame.