Postplacental intrauterine device insertion at a teaching hospital

• Published in: Contraception (Stoneham) Vol. 89; no. 6; pp. 528 - 533
• Main Authors: Jatlaoui, Tara C., Marcus, Michele, Jamieson, Denise J., Goedken, Peggy, Cwiak, Carrie
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2014; Elsevier
• Subjects: Adolescent; Adult; Biological and medical sciences; Birth control; Clinical Competence; Cohort Studies; Feasibility Studies; Female; Follow-Up Studies; Genital system. Reproduction; Georgia - epidemiology; Gynecology. Andrology. Obstetrics; Hospitals, Teaching; Humans; Internship and Residency; Intrauterine device; Intrauterine Device Expulsion - etiology; Intrauterine Device Migration - etiology; Intrauterine Devices, Copper - adverse effects; Intrauterine Devices, Medicated - adverse effects; Medical sciences; Obstetrics and Gynecology; Obstetrics and Gynecology Department, Hospital - manpower; Other methods of contraception. Sterilization; Patient Satisfaction; Pelvic Infection - epidemiology; Pelvic Infection - prevention & control; Pharmacology. Drug treatments; Postnatal Care; Postpartum contraception; Prospective Studies; Risk Factors; Vaginal delivery; Young Adult; Georgia; Postpartum contraception; Vaginal delivery; Intrauterine device; Educational program; Teaching hospital; Intravaginal administration; Laying process; Insertion; Intrauterine contraceptive device; Resident (student); Contraception; Puerperium
• ISSN: 0010-7824; 1879-0518; 1879-0518
• DOI: 10.1016/j.contraception.2013.10.008

To determine whether postplacental intrauterine device (IUD) insertion can be safely and effectively performed within a teaching program. This was a prospective cohort of 177 subjects planning vaginal delivery enrolled antenatally who desired postplacental IUD insertion of either the copper T380A IUD or levonorgestrel IUS. Insertions were performed primarily by resident physicians following a training session. Follow-up included a 4- to 8-week visit and telephone calls at 3 and 6 months. Ninety-nine subjects underwent successful postplacental IUD insertion of 100 attempts. Seventeen expulsions (17%) were noted: 10 complete and 7 partial. The study identified no differences in outcome by training level; however, the study lacked statistical power to evaluate anything other than large differences. Postplacental IUD insertions can be safely and effectively performed within a training program. A training protocol may safely and feasibly be initiated among physicians, advanced practice clinicians or trainees with no prior experience with postplacental IUD insertion. By initiating this practice, access to highly effective contraception may increase for patients who have difficulty returning for a visit or otherwise receiving effective methods.