Insertion technique, not design, affects expulsion rates of postpartum intrauterine device

A Lippes type intrauterine device (IUD) was modified to be used for immediate postpartum insertion. In 114 patients in whom the modified IUD was inserted immediately after delivery, expulsion rates at six months averaged approximately 30%. Expulsion rates were significantly different, at p less than 0.05, for women in whom the IUD was inserted digitally (19.5 +/- 5.6% at 6 months) compared to those in whom it was inserted using surgical forceps (39.6 +/- 7.1%). Furthermore, expulsion rates were higher for inexperienced inserters (p less than 0.01). We conclude that: 1) this modification of an otherwise standard IUD has a continued high expulsion rate, and 2) the technique of insertion has significant impact upon the likelihood of expulsion.