Placement of intrauterine contraceptive contraception (IUC) in a woman after vaginal delivery, but before leaving the hospital may be an advantageous time to initiate long acting reversible contraception. Successful insertion of post-partum intrauterine device (IUD) insertion is dependent upon the skill of the IUD inserter. Older dogma warns against placing the IUD from 10 minutes to 48 hours after delivery due to elevated risk of IUD expulsion, however, recent data from Kenya indicated an expulsion rate of 5% after 6 months; this low rate was dependent on the clinicians skilled in the insertion technique who placed the IUDs. Allowing greater flexibility in the acceptable time frame for postpartum IUD insertion may result in increased of the IUD,
The primary objectives of this study are to obtain feasibility data and preliminary expulsion rate data when the levonorgestrel-releasing IUD is placed from 10 minutes to 48 hours after delivery. Forty women aged 21-40 years who desire the levonorgestrel-releasing intrauterine contraception (Mirena®) as their postpartum contraception will be enrolled. Participants will have a six month observation period which will include follow-up office visits with physical exam and ultrasound to confirm intrauterine placement of the IUD.
The proposed research evaluates a novel approach to postpartum contraception by investigating placement of the IUD after the post-placental time period but before the woman leaves the hospital. More data are needed to provide contraceptive choices to women so they can avoid an unintended pregnancy. The study proposed in this grant application meets that need by providing preliminary data on placement of the IUD from 10 minutes to 48 hours postpartum.