IUD Placement at 2 to 4 Weeks Postpartum Noninferior

HealthDay News — Intrauterine device (IUD) placement at 2 to 4 weeks postpartum is noninferior to placement at 6 to 8 weeks postpartum for complete expulsion, according to a study published in the March 21 issue of the Journal of the American Medical Association.

Sarah Averbach, MD, from the University of California San Diego in La Jolla, and colleagues conducted a randomized, noninferiority trial involving people who had a vaginal or cesarean birth to assess expulsion rates for IUDs placed early postpartum compared to those placed at the standard interval 6-week visit. A total of 404 participants were enrolled and randomly assigned to early IUD placement (14 to 28 days; 203 participants) or interval IUD placement (42 to 56 days; 201 participants).

The primary outcome was complete IUD expulsion by six months postpartum; the noninferiority margin was 6%. Of the 294 participants who received an IUD and completed 6-month follow-up, the researchers found that the complete expulsion rates were 2.0 and 0% in the early and interval placement groups, respectively (between-group difference, 2.0 [95% CI, −0.05 to 5.7] percentage points). Partial expulsion occurred in 9.4 and 7.6% of participants in the early and interval placement groups, respectively (between-group difference, 1.8 [95% CI, −4.8 to 8.6] percentage points). At 6 months, IUD use was similar between the groups (69.5 and 67.2%, respectively).

“The early placement group in this study had a small absolute increase in risk of partial expulsion, which did not meet the prespecified criterion for noninferiority,” the authors write.

One author disclosed financial ties to Bayer Pharmaceuticals.

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