THE ASSOCIATION OF INSERTION METHODS ON IMMEDIATE POSTPARTUM INTRAUTERINE DEVICE EXPULSION RATES: A RETROSPECTIVE COHORT STUDY

Objectives

We sought to evaluate the method of immediate postpartum IUD (ppIUD) insertion (manual versus ring forceps) and expulsion rate within six weeks postpartum.

Methods

We performed a retrospective cohort study of patients who had a singleton vaginal delivery and had an immediate ppIUD inserted at Rush University from January 2014 to September 2023. Subjects were excluded if they had a postpartum hemorrhage, no insertion data available, or did not have documentation of postpartum follow up. The primary outcome was rate of expulsion within six weeks postpartum. The rate of expulsion was compared by method of insertion, either using a manual technique versus using ring forceps. Univariable analyses were performed for the association between baseline maternal characteristics and the primary outcome.

Results

A total of 219 participants met eligibility with 117 immediate ppIUDs inserted manually and 102 inserted with ring forceps. Baseline maternal demographics were similar across study groups. In unadjusted analysis, expulsion rate in patients who had IUDs placed using ring forceps was significantly higher as compared to manual insertion (30.4% vs 16.2%, p =0.01). After adjusting for factors determined a priori (estimated blood loss, body mass index, GA at delivery, multiparity, type of IUD), ring forceps continued to be significantly more likely to result in expulsion (adjusted OR (aOR) 2.45, CI 1.28-4.90).

Conclusions

Insertion of immediate ppIUD with ring forceps was associated with a significantly increased rate of expulsion within six weeks postpartum when compared with manual insertion.