Early placement of intrauterine device (IUD) at 2 to 4 weeks after childbirth was not inferior to later placement at 6 to 8 weeks postpartum with comparable complete expulsion rates between the two group, according to a study published in JAMA.¹

The randomized noninferiority trial was conducted with the objective to determine IUD expulsion rates inserted in the early postpartum versus IUDs placed at the standard interval after childbirth. For this, 404 women, with mean age of 29.9 years, who had delivered between March 2018 to July 2021 were selected for the study. IUD was inserted 2 to 4 weeks after delivery in 203 women, while 210 received it after 6 to 8 weeks of childbirth. A total of 294 women who underwent IUD placement were available for follow-up at 6 months.

Complete expulsion, which was the primary study outcome, occurred in 2% (3/149) in the early placement group compared to none (0/145) in the interval placement group with between-group difference of 2.0. The partial expulsion rate, a secondary outcome, was 9.4% in the early placement group vs 7.6% in the interval placement group with a between-group difference of 1.8. At 6 months, the use of IUDs, which was also a secondary outcome of the study, was comparable between the two groups; 69.5% (early group) vs 67.2% (interval group).

Based on these findings, the study concluded that early IUD placement was noninferior to later postpartum IUD placement for complete expulsion, but not for partial expulsion. “Understanding the risk of expulsion at these time points may help patients and clinicians make informed choices about the timing of IUD placement”, conclude the authors.

Reference

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.