Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis

Area of Science:

• Reproductive Health
• Contraception
• Maternal Health

Background:

• In-hospital placement of intrauterine devices (IUDs) and contraceptive implants is a growing method for highly effective postpartum contraception.
• Immediate postpartum IUD insertion has higher expulsion rates than interval placement.
• Emerging data suggests levonorgestrel IUDs may have higher expulsion rates than copper IUDs.

Purpose of the Study:

• To evaluate the in-hospital provision, expulsion rates, and 6-month continuation of immediate postpartum copper T380 IUDs, levonorgestrel IUDs, and contraceptive implants.

Main Methods:

• Prospective observational trial enrolling women requesting postpartum contraception.
• Participants received their preferred long-acting reversible contraception (LARC) device prior to hospital discharge.
• Data collected via questionnaires and validated by chart abstraction for expulsions at 6 months.

Main Results:

• 350 women enrolled; 325 received a device (88 copper IUDs, 123 levonorgestrel IUDs, 114 implants).
• At 6 months, levonorgestrel IUD users reported 17% expulsion vs. 4% for copper IUD users (adjusted hazard ratio 5.8).
• Overall 6-month continuation was ≥80% for all LARC methods.

Conclusions:

• Immediate postpartum LARC programs effectively provide women with desired contraception before hospital discharge.
• While levonorgestrel IUDs show higher expulsion rates, most women continue LARC use at 6 months postpartum.