Postplacental Insertion of Intrauterine Devices

Publication Date: October 1, 2015
Last Updated: March 14, 2022

Conclusions and recommendations

The rate of expulsion is higher after postplacental insertion than after delayed insertion. (A)
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Usage of the IUD is similar or greater after postplacental insertion than after delayed insertion in settings where replacement of expelled IUDs is readily available. (A)
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Postplacental insertion is safe and does not have higher risks of perforation or infection than insertion at other time frames. (A)
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The rate of expulsion is lower after cesarean delivery than after vaginal delivery. (B)
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The rate of expulsion after early postpartum insertion is similar to or possibly higher than the rate of expulsion after postplacental insertion. (B)
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Provider experience may play a role in expulsion rates. (B)
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IUD insertion techniques and modifications do not influence expulsion rates. (B)
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Inability to visualize IUD strings at the external cervical os may be more common after postplacental inertion than after interval insertion, and is higher after insertion at the time of cesarean delivery compared to insertion immediately after vaginal delivery. (B)
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Lack of ultrasound guidance should not prohibit provision of postplacental insertion. (C)
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Contraceptive coercion or perceived coercion may be more likely with LARC methods. Comprehensive patient-centered counseling on contraception with full disclosure of risks and benefits of postplacental IUD insertion must be undertaken for all women who are considering this option. (C)
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Recommendation Grading

Overview

Title

Postplacental Insertion of Intrauterine Devices

Authoring Organization

Publication Month/Year

October 1, 2015

Last Updated Month/Year

August 4, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

These guidelines present an evidence-based assessment of postplacental IUD placement after vaginal and cesarean delivery.

Target Patient Population

Patients prefers postplacental IUD insertion

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D003267 - Contraception, D003270 - Contraceptive Agents, D003273 - Contraceptive Devices, D007434 - Intrauterine Devices, D007436 - Intrauterine Devices, Medicated, D007435 - Intrauterine Devices, Copper, D049590 - Postpartum Period, D007433 - Intrauterine Device Expulsion, D003274 - Contraceptive Devices, Female

Keywords

contraceptive agents, intrauterine devices