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Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum: A Randomized Controlled Trial

Levi, Erika E. MD, MPH; Stuart, Gretchen S. MD, MPHTM; Zerden, Matthew L. MD, MPH; Garrett, Joanne M. PhD; Bryant, Amy G. MD, MSCR

doi: 10.1097/AOG.0000000000000882
Contents: Family Planning: Original Research

OBJECTIVE: To compare intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean delivery (during cesarean delivery) IUD placement compared with women who planned for interval IUD placement 6 or more weeks postpartum.

METHODS: In this nonblinded randomized trial, women who were undergoing a cesarean delivery and desired an IUD were randomized to intracesarean delivery or interval IUD placement. The primary outcome was IUD use at 6 months postpartum. A sample size of 112 (56 in each group) was planned to detect a 15% difference in IUD use at 6 months postpartum between groups.

RESULTS: From March 2012 to June 2014, 172 women were screened and 112 women were randomized into the trial. Baseline characteristics were similar between groups. Data regarding IUD use at 6 months postpartum were available for 98 women, 48 and 50 women in the intracesarean delivery and interval groups, respectively. A larger proportion of the women in the intracesarean delivery group were using an IUD at 6 months postpartum (40/48 [83%]) compared with those in the interval group (32/50 [64%], relative risk 1.3, 95% confidence interval 1.02–1.66). Among the 56 women randomized to interval IUD insertion, 22 (39%) of them never received an IUD; 14 (25%) never returned for IUD placement, five (9%) women declined an IUD, and three (5%) had a failed IUD placement.

CONCLUSION: Intrauterine device placement at the time of cesarean delivery leads to a higher proportion of IUD use at 6 months postpartum when compared with interval IUD placement.

LEVEL OF EVIDENCE: I

Intrauterine device placement during cesarean delivery increases intrauterine device use at 6 months postpartum compared with interval placement 6 or more weeks postpartum.

Division of Family Planning and Global Health, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York; and the Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Corresponding author: Erika E. Levi, MD, MPH, 1695 Eastchester Road, Suite 302, Bronx, NY 10461; e-mail: elevi@montefiore.org.

This project was funded by the Society of Family Planning Research Fund. TEVA Women's Health provided the Copper T380A devices for this project. The project was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number 1UL1TR001111.

The authors thank Karen Dorman and her research team and all the residents, clinical staff, and clinical faculty at the North Carolina Women's Hospital for their enthusiastic support for the study.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.