Intrauterine device insertion in the postpartum period: a systematic review.
OBJECTIVE
Given new research on postpartum placement of levonorgestrel and copper intrauterine devices (IUDs), our objective was to update a prior systematic review of the safety and expulsion rates of postpartum IUDs.


METHODS
We searched MEDLINE, CENTRAL, LILACS, POPLINE, Web of Science, and ClinicalTrials.gov databases for articles between the database inception until July 2013. We included studies that compared IUD insertion time intervals and routes during the postpartum period. We used standard abstract forms and the United States Preventive Services Task Force grading system to summarise and assess the quality of the evidence.


RESULTS
We included 18 articles. New evidence suggests that a levonorgestrel releasing-intrauterine system (LNG-IUS) insertion within 48 hours of delivery is safe. Postplacental insertion and insertion between 10 minutes and 48 hours after delivery result in higher expulsion rates than insertion 4 to 6 weeks postpartum, or non-postpartum insertion. Insertion at the time of caesarean section is associated with lower expulsion rates than postplacental insertion at the time of vaginal delivery.


CONCLUSIONS
This review supports the evidence that insertion of an intrauterine contraceptive within the first 48 hours of vaginal or caesarean delivery is safe. Expulsion rates should be further studied in larger randomised controlled trials.
* University of Pennsylvania , Philadelphia, PA , USA.
Sarita
S
Sonalkar
Nathalie
N
Kapp
D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion / Q000209:etiology*; D007434:Intrauterine Devices / Q000009:adverse effects*; D049590:Postpartum Period; D013997:Time Factors
Intrauterine device; Long-acting reversible contraception; Postpartum IUD placement; Postpartum contraception