title: Intrauterine device placement at 3 versus 6 weeks postpartum: a randomized trial.
abstract: OBJECTIVE
  To investigate whether early placement of an intrauterine device (IUD) at 3 weeks after delivery, compared to placement at 6 weeks, is associated with greater use at 3 months postpartum.
  
  
  METHODS
  This prospective randomized, controlled trial enrolled inpatient postpartum women intending to use intrauterine contraception. Participants were assigned to an early (3 week) or standard (6 week) postpartum visit with IUD placement and were followed for 6 months. We used transvaginal ultrasonography to confirm placement and measure uterine dimensions. We measured pain with IUD insertion and satisfaction with IUD timing using 100-mm visual analog scales. Data were analyzed based on randomization and actual timing of insertion (18-24 vs. 39-45 days).
  
  
  RESULTS
  Between February 2012 and December 2013, 201 subjects were enrolled (early=101; standard=100). Most participants returned for IUD placement as scheduled; 70.1% (53/75) in the early group, 74.3% (58/78) in the standard group (p=.06). IUD use did not differ between groups at 3 months (73/100, 73.0% and 73/97, 75.3%, respectively, p=.72) or 6 months (80.3% and 82.8%, p=.71) amongst those women for whom follow-up was available. Women randomized to 6-week insertion were more likely to have resumed intercourse prior to the IUD appointment (15/64, 23.4% vs. 5/68, 7.3%, p=.01). Pain with insertion (19.9 vs. 25.1, respectively, p=.21) and satisfaction (89.6 vs. 93.4, respectively, p=.23) did not vary based on actual timing of insertion.
  
  
  CONCLUSIONS
  Offering IUD placement at 3 weeks postpartum compared to standard scheduling at 6 weeks does not result in increased use at 3 months. However, early IUD placement is acceptable to women and without increased pain.
  
  
  CONCLUSIONS
  This study demonstrates that IUD placement as early as 3 weeks postpartum is feasible. Larger studies are needed to evaluate risks and benefits of IUD placement at this early interval. While earlier timing does not result in increased IUD uptake, early placement should be explored as an option since many women resume intercourse before 6 weeks.
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR, 97239. Electronic address: schaum@ohsu.edu.
authors.forename: Maureen K
authors.initials: MK
authors.lastname: Baldwin
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR, 97239.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Edelman
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR, 97239.
authors.forename: Jeong Y
authors.initials: JY
authors.lastname: Lim
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR, 97239.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Nichols
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR, 97239.
authors.forename: Paula H
authors.initials: PH
authors.lastname: Bednarek
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR, 97239.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jensen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices; D010147:Pain Measurement; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods; D014599:Uterus / Q000000981:diagnostic imaging
keywords: Contraception; Insertion timing; Intrauterine device; Postpartum; Uptake