Review on immediate and delayed postpartum intrauterine device insertion

Introduction: Intrauterine contraceptives (IUC) are affordable and effective long-acting reversible contraception options in women. Traditionally offered at 6 weeks postpartum, there is an increasing trend towards insertion at time of delivery in both vaginal and caesareans after placental delivery. This literature review analyses current data on differences in outcomes in IUC insertion immediately after placental delivery versus delayed insertion across both modalities of delivery.

Methods: A literature search in the following databases were used for publication dates between 2012 and 2022; Medline, Embase, Cochrane, Google Scholar.

Results: There are multiple studies which show the benefit of insertion of IUC during caesarean section as well as immediately post vaginal birth. With both portraying high patient satisfaction as well as compliance 6 months later. There were low uterine perforation and infection rates when inserted immediately post-partum.

Discussion: Overall, insertion of IUCs at time of delivery in caesareans was associated with lower rates of expulsion in most studies and higher rates of missing strings at follow-up, with vaginal deliveries overall having a higher expulsion rate at both immediate and delayed. Continuation of IUC use varied across all modes of delivery and timing of insertion. New novel techniques of IUC insertion may further reduce the risk of expulsion and uterine perforation.

Conclusion: Providing long acting reversible contraception in the postpartum period helps prevent unintended pregnancies. Women should be educated and encouraged on the use of IUC insertion in the postpartum period