Journal article
Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis
Obstetrics and gynecology (New York. 1953), Vol.132(4), pp.895-905
10/2018
DOI: 10.1097/AOG.0000000000002822
PMCID: PMC6549490
PMID: 30204688
Abstract
OBJECTIVETo estimate expulsion rates among women with postpartum intrauterine device (IUD) placement by timing of insertion, IUD type, and delivery method. DATA SOURCESWe searched PubMed, Cochrane Library, and ClinicalTrials.gov from 1974 to May 2018. METHODS OF STUDY SELECTIONWe searched databases for any published studies that examined postpartum placement of a copper IUD or levonorgestrel intrauterine system and reported counts of expulsions. We assessed study quality using the U.S. Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of IUD expulsion and estimated adjusted relative risks (RRs) for timing of postpartum placement, delivery method, and IUD type using log-binomial multivariable regression model. TABULATION, INTEGRATION, AND RESULTSWe identified 48 level I to II-3 studies of poor to good quality. Pooled rates of expulsion varied by timing of IUD placement, ranging from 1.9% with interval placements (4 weeks postpartum or greater), 10.0% for immediate placements (10 minutes or less after placental delivery), and 29.7% for early placements (greater than 10 minutes to less than 4 weeks postpartum). Immediate and early postpartum placements were associated with increased risk of expulsion compared with interval placement (adjusted RR 7.63, 95% CI 4.31-13.51; adjusted RR 6.17, 95% CI 3.19-11.93, respectively). Postpartum placement less than 4 weeks after vaginal delivery was associated with an increased risk of expulsion compared with cesarean delivery (adjusted RR 5.19, 95% CI 3.85-6.99). Analysis of expulsion rates at less than 4 weeks postpartum also indicated that the levonorgestrel intrauterine system was associated with a higher risk of expulsion (adjusted RR 1.91, 95% CI 1.50-2.43) compared with CuT380A. CONCLUSIONPostpartum IUD expulsion rates vary by timing of placement, delivery method, and IUD type. These results can aid in counseling women to make an informed choice about when to initiate their IUD and to help institutions implement postpartum contraception programs.
Details
- Title: Subtitle
- Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis
- Creators
- Tara C Jatlaoui - Centers for Disease Control and PreventionMaura K Whiteman - University of North Carolina at Chapel HillGary Jeng - Emory UniversityNaomi K TepperErin Berry-BibeeDenise J JamiesonPolly A MarchbanksKathryn M Curtis
- Resource Type
- Journal article
- Publication Details
- Obstetrics and gynecology (New York. 1953), Vol.132(4), pp.895-905
- DOI
- 10.1097/AOG.0000000000002822
- PMID
- 30204688
- PMCID
- PMC6549490
- ISSN
- 0029-7844
- eISSN
- 1873-233X
- Language
- English
- Date published
- 10/2018
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446272802771
Metrics
2 Record Views