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Importance of the delivery‐to‐insertion interval in immediate postpartum intrauterine device insertion: A secondary analysis
Author(s) -
Lerma Klaira,
Bhamrah Renita,
Singh Sharad,
Blumenthal Paul D.
Publication year - 2020
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13115
Subject(s) - medicine , intrauterine device , confidence interval , fundus (uterus) , vaginal delivery , significant difference , obstetrics , surgery , family planning , pregnancy , population , research methodology , environmental health , biology , genetics
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 .