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

Clinical Question

Is intrauterine device placement at 2 to 4 weeks postpartum noninferior to placement at 6 to 8 weeks?

Bottom line

The rate of complete expulsion of IUDs placed at 2 to 4 weeks postpartum was noninferior (within 6%) to placement at 6 to 8 weeks. IUD continuation at 6 months postpartum did not differ. However, the rate of partial expulsion after early placement was inferior, and other outcomes, such as malposition, trended to favor placement at 6 to 8 weeks. In individual decision-making, the small differences in favor of later placement should be balanced with a potential risk of pregnancy due to delay in placement, which was not observed in this study. There were no perforations in either group. 1b

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Outpatient (primary care)

Reviewer

Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH


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Comments

Arup Kumar Dhara

Assessment

Excellent

Anonymous

Post partum IUDs

Very useful information but depends on the willingness of FP clinics to undertake IUD insertion so early postpartum.