title: Two-week postpartum intrauterine contraception insertion: a study of feasibility, patient acceptability and short-term outcomes.
abstract: To determine the feasibility and acceptability of inserting the levonorgestrel intrauterine system, LNG 52 mg IUS (LNG IUS), at 2 weeks postpartum.
  
  
  
  This prospective study of feasibility and patient acceptability recruited women interested in a postpartum LNG IUS and placed the LNG IUS under ultrasound guidance on days 14-20 postpartum. We determined feasibility by our ability to recruit and insert the LNG IUS in our predetermined sample size of 50 women. We measured our primary acceptability outcome at 6 months postpartum with the question: "Would you recommend Mirena placement at 2 weeks postpartum to a friend?" Other outcomes included expulsion and pain. The three study visits consisted of (1) insertion visit (14-20 days postpartum), (2) standard postpartum visit with a string check (6 weeks postpartum) and (3) research visit with sonography and assessment of the primary outcome (6 months postpartum).
  
  
  
  We enrolled 50 women over 8 months, all of whom received LNG IUS. Forty-three of the 50 (86%) provided follow-up data for the primary outcome. Of those, 93% (40/43) would recommend 2-week LNG IUS insertion to a friend, and 86% (37/43) continued using their LNG IUS at the conclusion of the 6-month visit. There were two partial expulsions; one was symptomatic. There were no uterine perforations.
  
  
  
  LNG IUS inserted at 2 weeks postpartum is feasible and acceptable to patients. These results offer evidence to support intrauterine contraception insertion prior to the onset of ovulation and at a potentially more convenient time point in the postpartum period.
  
  
  
  This study supports offering the LNG IUS beginning on the 14th postpartum day. The 4% expulsion rate is consistent with the rate of interval insertion and lower than immediate postplacental insertion. Additional research is needed to ensure a low risk of adverse events with other brands of intrauterine contraception.
authors.affiliation: Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA; WakeMed Health & Hospitals, 10,000 Falls of Neuse Rd., Raleigh, NC 27614, USA. Electronic address: mzerden@gmail.com.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Zerden
authors.affiliation: Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA.
authors.forename: Gretchen S
authors.initials: GS
authors.lastname: Stuart
authors.affiliation: Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Charm
authors.affiliation: Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Bryant
authors.affiliation: Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA; Department of Epidemiology in the Gillings School of Public Health, University of North Carolina, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Garrett
authors.affiliation: Division of Family Planning in the Department of Obstetrics & Gynecology, University of North Carolina School of Medicine. 4002 Old Clinic Building, Chapel Hill, NC 27599-7570, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Morse
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage; D009657:North Carolina; D010146:Pain; D010549:Personal Satisfaction; D049590:Postpartum Period; D011446:Prospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Intrauterine device; Intrauterine device insertion; LARC; LNG IUS; Levonorgestrel intrauterine system; Postpartum contraception