Efficacy and Success of Immediate Postpartum IUD Insertion in a Northern Ontario Tertiary Care Centre

Immediate postpartum intrauterine device (PPIUD) insertion, despite being endorsed by the Society of Obstetricians and Gynecologists of Canada, is not a widely available practice in northern Ontario. This region is marked by obstetrical challenges such as delayed postpartum contraception discussions, high rates of missed follow-ups, and the use of less effective methods. This study aimed to assess the efficacy, adherence, and success of immediate PPIUD insertion in the northern Ontario context.

This exploratory proof of concept study was conducted at Health Sciences North, a tertiary care centre in northern Ontario. Immediate PPIUD was defined as insertion within 10 minutes following delivery of the placenta. Participants had 3 follow-up visits over 1 year. Outcomes looked at efficacy and success, continuation rates at 1 year, complications, and overall patient satisfaction with PPIUD insertion.

Of 27 participants, 18 (66.7%) proceeded with immediate PPIUD, with high satisfaction (8.33/10) and recommendation (92%). All were hormonal intrauterine devices, and 11.1% were inserted during a cesarean delivery. Despite complications including partial embedding (1/18), low-lying rotation (1/18), and abnormal bleeding (6/27), only 16.7% experienced premature removal. Patients who had initially consented to receive immediate PPIUD insertion (33.3%) reported changing their mind, forgetting the device, and physician recommendations.

Immediate PPIUD insertion is safe and efficacious in a northern Ontario tertiary care setting. Our results underscore safety with minimal complications. Distinctions from existing literature include low discontinuation rates and high satisfaction. This method offers a promising solution to enhance postpartum care and reduce unplanned pregnancies in underserved regions.