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 The best option is either to place the IUD immediately after
delivery, when there is only a 10 percent risk of the uterus
expelling the device, or to wait at least four weeks afterward, when
the risk drops to 4 percent, an analysis of existing research found.
When women get an IUD implanted in the uterus more than 10 minutes
after delivery but less than four weeks later, the risk of expulsion
is 30 percent overall, researchers report in Obstetrics &
Gynecology. With a vaginal delivery, the risk of expulsion of an IUD
inserted within four weeks is also more than five times greater than
with a cesarean-section delivery.
"The uterus grows during pregnancy and has to shrink back down in
the weeks following delivery," said lead study author Dr. Tara
Jatlaoui of the U.S. Centers for Disease Control and Prevention in
Chamblee, Georgia.
"It is that process during the postpartum period that likely
increases the risk of IUD expulsion compared with IUD placement at
another time," Jatlaoui said by email.
IUDs are T-shaped devices about the size of a quarter that are
inserted into the uterus. The devices can be used for several years;
they prevent pregnancy by stopping sperm from reaching the egg.
While placing an IUD immediately after birth carries a slightly
increased risk that it may loosen and fall out, the risks of other
complications, such as infections, are small and similar to the odds
of side effects from an IUD placed later in the doctor's office.
The American College of Obstetricians and Gynecologists (ACOG)
recommends that women having hospital births get the opportunity to
receive long-acting birth control like IUDs before they leave the
hospital. The advantage of this approach is that it may help avoid
pregnancies spaced too close together, which carry a risk of serious
complications for both mothers and babies.
The current study analyzed data from 48 previously published studies
on the risk of IUD expulsion postpartum.
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ACOG considered much of the same research when it endorsed the
option of IUD placement right after delivery, noted Dr. Ann Borders
of the NorthShore University HealthSystem in Evanston, Illinois, and
the University of Chicago Pritzker School of Medicine.
"Many women prefer the convenience of immediate postpartum placement
with high likelihood of success," Borders, who wasn't involved in
the current study, said by email
For some women, concerns about access to care, out-of-pocket costs,
and insurance coverage may influence their decision about whether or
when to get an IUD, said Dr. Michelle Moniz, a researcher at the
University of Michigan in Ann Arbor who wasn't involved in the
study.
Even though contraceptives are generally covered by insurance, women
may still have fees for extra doctor visits needed to insert an IUD
after they leave the hospital as well as for follow-up visits to
make sure the IUD has remained in place.
Women who want long-acting contraception can also use
hormone-releasing implants about the size of a matchstick that are
inserted under the skin in the upper arm and can prevent pregnancy
for several years, or they could also get contraceptive shots that
last for several months.
If they choose an IUD, they should be on the lookout for problems,
Moniz said by email.
"Women should be aware of the signs of IUD expulsion such as
cramping, bleeding, or seeing a small T-shaped device in clothing or
in the toilet," Moniz advised. "The IUD stops working immediately if
it falls out."
SOURCE: https://bit.ly/2ykQOhS Obstetrics & Gynecology, online
October 1, 2018.
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