Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Feb 10, 2016; 5(1): 134-139
Published online Feb 10, 2016. doi: 10.5317/wjog.v5.i1.134
Postpartum intrauterine device contraception: A review
Shadi Rezai, Pameela Bisram, Hasan Nezam, Ray Mercado, Cassandra E Henderson
Shadi Rezai, Ray Mercado, Cassandra E Henderson, Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY 10451, United States
Pameela Bisram, St. George’s University School of Medicine, Grenada, West Indies
Hasan Nezam, Department of Obstetrics and Gynecology, University of Toledo Medical Center, Toledo, OH 43614, United States
Author contributions: All of the authors contributed significantly to this investigation.
Conflict-of-interest statement: No author has any conflict of interest or financial disclosure to report.
Data sharing statement: Not applicable.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cassandra E Henderson, MD, CDE, Director of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, NY 10451, United States. cassandra.henderson@nychhc.org
Telephone: +1-718-5795513 Fax: +1-718-5794469
Received: March 30, 2015
Peer-review started: March 31, 2015
First decision: July 10, 2015
Revised: November 2, 2015
Accepted: November 24, 2015
Article in press: November 25, 2015
Published online: February 10, 2016
Abstract

AIM: To review the safety (infection, perforation) and efficacy (expulsion, continuation rates, pregnancy) of intrauterine device (IUD) insertion in the postpartum period.

METHODS: MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented specifically, immediate post placenta period (within 10 min), early post placenta period (10 min to 72 h), and delayed/interval period (greater than 6 wk). Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD.

RESULTS: IUD insertion in the immediate postpartum (within 10 min of placental delivery), early postpartum (10 min up to 72 h) and Interval/Delayed (6 wk onward) were found to be safe and efficacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any significant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal (copper) IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding.

CONCLUSION: IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk benefit ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.

Keywords: Access to intrauterine devices, Contraception, Expulsion, Intrauterine device, Long acting reversible contraception, Postpartum contraception, Postpartum intrauterine device, Postpartum intrauterine device placement, Post-placental insertion

Core tip: Intrauterine device (IUD) insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk benefit ratio in support of postpartum IUD insertion.