Insertion of the intrauterine device (IUD) in the early postpartum period at 2 to 4 weeks is noninferior to IUD placement at the standard interval of 6 to 8 weeks, according to a study from the United States published in JAMA.¹

Averbach et al conducted this multicenter noninferiority trial to determine the expulsion rate of IUD when placed 2 to 4 weeks after birth compared to the standard interval of 6 to 8 weeks postpartum. For this, 203 women who had a vaginal or cesarean birth were randomized to IUD placement in the early postpartum period, while in 201 women, the IUD was placed at the standard interval. The participants were recruited between March 2018 and July 2021. Their mean age was 29.9 years. The IUD placement was checked at the 6-month postpartum follow up visit.

Out of the 404 participants enrolled, 294 participants completed the 6-month follow up visit.

At the 6-month follow-up visit, the complete IUD expulsion rate, which was also the primary endpoint of the study, was 2% (3/149) in the early placement group compared to 0% (0/145) in the interval placement group with a between-group difference of 2.0 percentage points.

A secondary outcome of the study was partial expulsion of the IUD. Among the women in the early placement group, partial expulsion occurred in 9.4% vs 7.6% in the interval placement group with a between-group difference of 1.8 percentage points. Use of IUD at 6 months postpartum, which was another secondary endpoint of the study, was found to be comparable between the two groups: 69.5% (early placement group) vs 67.2% (interval group). In the early placement group, IUD was removed in 16.8% women, whereas in the standard interval group, the IUD was removed in 11.7% women. More women (2%) developed pelvic infection in the early group vs none (0)%) in the interval group. None of the participants in either group developed uterine perforation. Nearly 85% of participants in the early placement group expressed satisfaction with the timing of insertion compared to 89.0% in the standard interval group.

This study demonstrates the noninferiority of early placement of IUD compared to placement in the standard interval for the risk of complete expulsion, but not partial expulsion. The ACOG recommends an early postpartum visit within the first 3 weeks after childbirth. They may be offered IUD placement at this visit itself rather than waiting till 6 to 8 weeks. These findings can be utilised by both doctors and patients to make an “informed choice” about the time of insertion of the IUD.

References

1. Averbach S, et al. Early vs interval postpartum intrauterine device placement: a randomized clinical trial. JAMA. 2023 Mar 21;329(11):910-917. doi: 10.1001/jama.2023.1936.
2. MedPage Today. March 21, 2023. Available at: https://www.medpagetoday.com/obgyn/generalobgyn/103644. Accessed on March 22.3.23.