A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device.
BACKGROUND
Postplacental intrauterine device (IUD) insertion is a safe, convenient and effective option for postpartum contraception. Few studies involve ultrasound-guided insertion, and none involve the levonorgestrel IUD or take place in the United States.


METHODS
The study was conducted to assess the safety and feasibility of ultrasound-guided postplacental insertion of the levonorgestrel IUD following vaginal delivery in a U.S. residency program. Levonorgestrel IUDs were inserted under ultrasound guidance within 10 min of placental delivery by hand or using ring forceps. Subjects were examined at 4 and 10 weeks postpartum for evidence of expulsion or infection.


RESULTS
Thirty-four subjects were enrolled and 20 received an IUD. Follow-up data are available for 19 subjects over the 10-week follow-up period; 16 subjects returned for the 4-week follow-up, and 14 returned at 10 weeks. Two additional subjects could be contacted by telephone only. At 4 and 10 weeks postpartum, no subjects had evidence of infection. There were two expulsions (2/19, 10.5%) by 10 weeks postpartum. None of the subjects examined had a partial expulsion (intracervical location of the IUD).


CONCLUSIONS
In this pilot study, ultrasound-guided postplacental insertion of the levonorgestrel IUD was feasible and not associated with infection. The risk of expulsion was acceptable. Ultrasound-guided postplacental insertion of the levonorgestrel IUD may be an alternative to delayed insertion but warrants further study.
Hayes
Jennifer L
JL
Department of Gynecology and Obstetrics, Grady Memorial Hospital, Emory University, Atlanta, GA 30303, USA. jhayes@mail.magee.edu
Cwiak
Carrie
C
Goedken
Peggy
P
Zieman
Miriam
M
D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage; D010865:Pilot Projects; D049590:Postpartum Period; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*; D014599:Uterus / Q000000981:diagnostic imaging*
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel