Postpartum IUD placement at 2 to 4 weeks is noninferior to placement at 6 to 8 weeks, with caveats

Référence

Averbach S, Kully G, Hinz E, et al. Early vs interval postpartum intrauterine device placement: A randomized trial. JAMA 2023;329(11):910-917.

Sommaire

The purpose of this randomized controlled trial was to assess whether the risks of intrauterine device (IUD) placement in the early postpartum period (2-4 weeks) are noninferior to the risks of placement in the usual time frame of 6 to 8 weeks postpartum (interval placement). People were excluded if they had conditions precluding IUD placement, intrauterine infection, fourth-degree perineal laceration, another long-term contraceptive method, or if they desired pregnancy within 6 months. Both hormonal and copper IUDs were permitted (the majority were hormonal). Outcome assessment was masked. Among the 404 enrolled participants, 13% had no IUD placement and 14% were lost to follow-up and not included in the analysis. Patients in the early placement group had the procedure outside of the prescribed window (30/140 [20%] vs 10/145 [7%]). At 6 months postpartum, there was no difference in IUD use (141 [69.5%] vs 139 [67.2%]; NS). The principal outcome was expulsion rate, with a not-more-than 6% difference considered noninferior. By that metric, the complete expulsion rate was noninferior (3/149 [2%]; 95% CI 0.4 - 5.8% vs 0/145 [0%]; 0% - 2.5%; between group difference 2.0; -0.5 to 5.7). However, partial expulsion was higher in the early group (14/149 [9.4%]; 5.2% - 15.3% vs 11/145 [7.6%] 3.9% - 13.2%; between group difference 1.8; -4.8 to 8.6%). Secondary outcomes included malposition, removal, and pelvic infection, which all had nonsignificant trends that favored interval placement, though the sample size was not based on an assessment of these outcomes. There was no difference in pregnancy rate, and no perforations in either group.