title: A pilot clinical trial of ultrasound-guided postplacental insertion of a levonorgestrel intrauterine device.
abstract: 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.
authors: Department of Gynecology and Obstetrics, Grady Memorial Hospital, Emory University, Atlanta, GA 30303, USA. jhayes@mail.magee.edu
authors: Jennifer L
authors: JL
authors: Hayes
authors: Carrie
authors: C
authors: Cwiak
authors: Peggy
authors: P
authors: Goedken
authors: Miriam
authors: M
authors: Zieman
mesh_terms: 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*
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel