Importance of the delivery‐to‐insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis

Objective To evaluate the delivery‐to‐insertion interval for copper postpartum intrauterine devices ( PPIUD s). Methods Secondary analysis of two related studies at five academic sites in India from March 2015 to July 2016. IUD s were inserted within 48 hours of vaginal delivery. Women (n=560) were grouped by whether they underwent postplacental (≤10 minutes) or immediate (>10 minutes) insertion. Outcomes were complete expulsion at the 6–8‐week follow‐up (primary), and IUD ‐to‐fundus distance, as assessed by postinsertion ultrasound (secondary). Results Overall, 93 (16.6%) women received a postplacental PPIUD and 467 (83.4%) received an immediate PPIUD . Complete expulsion at follow‐up was 3.2% (n=3) in the postplacental and 7.5% (n=35) in the immediate postpartum group ( P =0.176; difference in proportions, 4.3%; 95% confidence interval, −2.0 to 8.1). Distance from the fundus did not differ between the two groups ( P =0.107); high fundal placement (≤10 mm from the internal endometrial verge) was achieved for most women. Conclusion The present data challenge previous guidance on the timing of PPIUD insertion. The 10‐minute insertion window is a barrier to uptake and should be reassessed for inclusion in service delivery guidelines. A flexible interval would accommodate the multiple post‐delivery tasks of providers and increase access to PPIUD .