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December 31, 2024 – San Leandro, CA
A recent study published in Obstetrics & Gynecology suggests that immediate postpartum placement of intrauterine devices (IUDs) does not lead to higher overall healthcare utilization compared to delayed placement. Conducted by researchers at Kaiser Permanente Northern California, the study highlights that while immediate placement slightly increases imaging rates, it reduces the need for surgical interventions for IUD-related complications.
Study Overview
The retrospective cohort study analyzed electronic health records from 11,875 patients who received an IUD within 63 days postpartum between 2016 and 2020. Of these, 1,543 had an IUD placed immediately (within 24 hours of delivery), while the rest received delayed placement (24 hours to six weeks postpartum).
The primary focus was on outpatient visits to obstetricians or gynecologists (OB/GYNs) within one year of delivery. Secondary measures included imaging studies, surgical interventions, hospitalizations related to IUDs, and pregnancy rates within a year of placement.
Key Findings
- Reduced OB/GYN Visits:
Patients with immediate IUD placement averaged fewer OB/GYN visits compared to those with delayed placement (2.30 vs. 2.47 visits; adjusted risk ratio [aRR], 0.91; 95% CI, 0.87-0.94; P < .001). - Increased Imaging:
Immediate placement was associated with a higher frequency of imaging studies performed outside of OB/GYN visits (aRR, 2.26; P < .001). - Lower Surgical Interventions:
The need for laparoscopic surgeries due to IUD complications was lower in the immediate placement group (0.0% vs. 0.4%; P = .005). - Rare Hospitalizations:
Hospitalizations were uncommon but more frequent in the immediate placement group (0.4% vs. 0.02%; P < .001). - Comparable Pregnancy Rates:
Repeat pregnancy rates within one year were similar between the two groups, emphasizing the effectiveness of immediate IUD placement in preventing unintended pregnancies.
Implications for Practice
The findings reinforce the safety and practicality of immediate postpartum IUD placement, offering reassurance to healthcare providers and patients. The authors emphasized its role in reducing short-interval unintended pregnancies without increasing significant risks.
“This study can guide patient counseling and consent for immediate IUD,” noted lead researcher Dr. Talis M. Swisher of Kaiser Permanente San Leandro Medical Center.
Study Limitations
The study did not assess patient satisfaction or cost-effectiveness due to varying insurance plans and regional disparities. Additionally, virtual healthcare visits were excluded, and findings were based on a single healthcare system, limiting generalizability to other settings.
Conclusion
Immediate postpartum IUD placement is a safe, effective option that does not increase overall healthcare visits while reducing surgical risks. This evidence could inform clinical practices and support patient-centered decision-making regarding postpartum contraception.
The research was funded by the Kaiser Permanente Northern California Graduate Medical Education Program, with no reported conflicts of interest.
