Health Care Utilization After Immediate Compared With Delayed Postpartum Intrauterine Device Placement

Area of Science:

• Reproductive Health
• Contraception
• Postpartum Care

Background:

• Intrauterine devices (IUDs) are highly effective long-acting reversible contraceptives.
• Timing of postpartum IUD placement, immediate versus delayed, may influence healthcare utilization and complication management.

Purpose of the Study:

• To compare healthcare utilization, including office visits, imaging, surgical interventions, and hospitalizations, between immediate and delayed postpartum IUD placement.
• To assess differences in repeat pregnancy rates between the two IUD placement timing groups.

Main Methods:

• Retrospective cohort study using Kaiser Permanente Northern California data (2017-2019).
• Included patients with IUD placement between 0-63 days postpartum.
• Primary outcome: ob-gyn/women's health office visits within 1 year. Secondary outcomes: imaging, surgery, hospitalizations, and repeat pregnancies.

Main Results:

• Immediate placement (n=1,543) had slightly more office visits than delayed (n=10,332) (2.30 vs 2.47, P <.001).
• Imaging increased with immediate placement (10.5% vs 4.1%, P <.001), while laparoscopy decreased (0.0% vs 0.4%, P =.005).
• Hospitalizations were rare but higher in the immediate group (0.4% vs 0.02%, P <.001); no significant difference in repeat pregnancies.

Conclusions:

• Immediate postpartum IUD placement is not associated with increased office visits compared to delayed placement.
• Immediate IUD placement is linked to increased imaging but decreased need for laparoscopic surgery for complications.
• No significant difference in repeat pregnancy rates was observed between immediate and delayed postpartum IUD placement.