Expulsion rates 12 months after early versus interval postpartum intrauterine device placement: a randomized trial

The early postpartum period, 2 to 4 weeks postpartum, is an optimal time for intrauterine device (IUD) initiation; placement can be co-located with early postpartum or infant visits. We aimed to compare expulsion rates at 12 months postpartum for IUDs placed early compared to the standard interval 6-week visit.

This is a randomized controlled trial conducted at four U.S. medical centers. Participants were randomly assigned to early (14-28 days) or interval (42-56 days) postpartum IUD placement after vaginal or cesarean birth. We used transvaginal ultrasound to confirm IUD presence and position at 6 months. Chart review and telephone surveys were used to verify IUD presence and position at 12 months.

Between March 2018 and June 2021, 203 participants were assigned to early and 201 to interval IUD placement; 238 (58.9%) contributed outcome data by phone survey (and electronic medical record review) at 12-months postpartum. Among participants who received an IUD and provided 12-month outcome data, complete expulsion rates were 4 in 124 (3.2%; 95% confidence interval [CI], 0.90 to 8.2) and 0 in 114 (0%; 95% CI, 0 to 3.2) in the early and interval groups; a between-group difference of 3.2 percentage points (95% CI, -0.01 to 8.0, P=.054). Partial expulsion counts and rates were 16 (12.9%; 95% CI, 7.6 to 20.1) and 13 (11.4%; 95% CI, 6.2 to 18.7) in the early and interval groups; a difference of 1.5 percentage points (95% CI, -7.2 to 10.2, P=.75). Among all 404 participants, IUD utilization rates at 12-month follow-up were 113 (55.7%; 95% CI, 48.5 to 62.6 among participants in the early group) compared to 95 (47.3%; 95% CI, 40.2 to 54.1, P=.10 among participants in the interval group). Participants were more satisfied with early compared to interval placement, 107 (86.3%; 95% CI 79.0 to 91.8) vs 87 (76.3%, 95% CI 67.4 to 83.8 95%) P=.048.

Complete expulsion rates at 12 months are low (<5%) when IUDs are placed in the early and interval postpartum period. Satisfaction is higher with early postpartum IUD placement.