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Manual versus forceps postplacental IUD insertion after vaginal delivery: A randomized clinical trial
Thuany Bento Herculano1, Andressa Aparecida Luciano Batista1, Cássia Raquel Teatin Juliato1
1Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, São Paulo, Brazil.
Objectives:
This study compares the expulsion rate of the postplacental copper intrauterine device (IUD) based on the insertion technique: manual versus ring forceps. Pain, perforation, infection, and increased bleeding were assessed as secondary outcomes.
Method:
The study consisted of a randomized clinical trial involving 210 women (with 105 in each group) admitted for vaginal delivery at a teaching hospital who wanted to use an IUD and had no contraindications to use an IUD. Patient recruitment occurred between December 2021 and June 2024. Pain was evaluated using the visual analog scale immediately after insertion. Descriptive statistics and bivariate analysis were performed. The Cochran-Armitage test was used to assess the temporal trend of expulsion. Participants were followed up between 6 and 12 weeks postpartum.
Results:
The complete IUD expulsion rate was 20.5%, with no significant difference between forceps and manual insertion (25% vs. 16.7%, P = 0.168). Expulsions were easily perceived by the women and occurred early. Notably, in this teaching hospital setting, the turnover of new medical residents (P = 0.057) performing insertions did not affect the expulsion rates throughout the year. Manual insertion was associated with greater discomfort compared to forceps (P = 0.001), even with epidural anesthesia (P = 0.002). There were no cases of uterine perforation or infection.
Conclusion:
The postplacental IUD expulsion rate was lower with manual insertion, although not statistically significant. Insertion discomfort was lower in the forceps group, regardless of analgesia. Postplacental IUD insertion was well tolerated, safe, and easily reproducible by junior doctors.
Trial Registration:
This study was approved by the Ethics and Research Commission of the University of Campinas (UNICAMP) and the Brazilian Registry of Clinical Trials (REBEC): https://ensaiosclinicos.gov.br/rg/RBR-4j62jv6, (number RBR-4j62jv6).
