This case-control study reviews complications and contraceptive outcomes following incidental, immediate post-placental intrauterine device (IUD) placement in the setting of chorioamnionitis (CDC contraindication category 4), versus waiting to receive an interval IUD per standard guidelines.
We conducted an institutional review board (IRB)-compliant retrospective chart review of individuals delivering an infant and desiring an IUD for postpartum contraception in the setting of chorioamnionitis (2015-2020). We collected demographics, histopathologic confirmation of chorioamnionitis, timing of IUD placement, duration of use, short term outcomes/complications (e.g., worsening infection), and long-term outcomes/complications (e.g., IUD retention, IUD expulsion, pelvic inflammatory disease). Data were compared between individuals receiving post-placental IUDs and those waiting to receive outpatient, interval IUDs. We conducted phone interviews to validate and follow-up on medical record data.
Fifty-five individuals with chorioamnionitis desired an IUD for postpartum contraception (mean age: 27 years, gestational age at delivery: 39 weeks); 25% provided phone interviews. Nearly half (45%) of clinician-diagnosed chorioamnionitis was confirmed on histopathology. Among IUD recipients (22 post-placental, 10 interval), four re-presented with five complaints (one vaginal discharge, three pelvic pain, one IUD malposition). Incidence of re-presentation did not differ by timing (P=.77) or presence (P=.91) of IUD. Individuals who received a post-placental IUD were significantly more likely (P<.01) to have their IUD in place at 12 months than those intending to receive a post-partum interval IUD.
No severe complications occurred among individuals receiving a post-placental IUD in the setting of chorioamnionitis. Recipients of immediate versus interval IUDs were more likely to have an IUD at 1 year follow-up.