Intrauterine device (IUD) insertion is convenient and efficient in the postplacental and immediate postpartum periods. Insertion at these times is demonstrably safe, having a low incidence of infection, few bleeding problems, and low perforation rates. IUD expulsion rates can vary widely, and are a function of timing of insertion, type of IUD, and insertion technique. When a copper T device is inserted postplacentally or immediately postpartum by an experienced and trained clinician, expulsion rates of about 7-15 per 100 users at six months can be expected. Women must be told how to detect expulsions and instructed to return for reinsertion or for another method. Most investigators emphasize that high fundal IUD placement will reduce the expulsion rate. Unplanned pregnancy rates for postplacental IUD insertion range from 2.0-2.8 per 100 users at 24 months when using modern copper IUDs, correct insertion technique, careful postinsertion instructions and good follow-up. Postplacental insertions are performed manually or with a ring forceps. Immediate postpartum insertions (10 minutes to 48 hours after delivery) are performed with the ring forceps.
PIP: Postpartum IUD insertions include postplacental, immediate postpartum, puerperal or delayed, post puerperal, and interval. IUDs can even be inserted safely after a 1st trimester abortion. Various studies show that postpartum IUD infection rates vary from 0.1-1.1% and do not increase the chance of infection. It appears that manual or ring forceps insertion result in very low perforation rates, e.g., 1/1150 immediate postpartum IUD insertions in 1 study. In studies comparing immediate postpartum IUD insertions with interval insertions, the removal rate due to bleeding is lower for the immediate postpartum IUD insertions, e.g., 13.7% vs. 23.6% in a study in India. IUDs inserted postplacentally and in the immediate postpartum period are more likely to be expelled than those inserted in the interval period. This is less likely to occur with copper T IUDs, postplacental insertions, high fundal placement, and clinicians trained and experienced in insertions, however. 90-95% of women are able to detect their own expulsions. Further reinsertion rates range from 73-95%. Pregnancy rates of postplacental insertions correspond with those for interval IUDs. 24 month postinsertion pregnancy rates vary from 1-2.8%. Long term continuation rates for postpartum IUDs tend to be somewhat lower than interval IUDs. For example, a study shows that 65.5% of postpartum IUD women still had the IUD after 2 years compared to 71.3% of interval IUD women. In Lima, Peru, overall contraceptives prevalence is 13% higher among women in inhospital family planning services that offer postplacental and immediate postpartum IUD insertion than it is in those that do not include them. Contraindications for postpartum IUD use are the same as for any IUD use. In a cesarean section, IUD placed in the uterus before closure rarely result in infection, perforation, or bleeding. Clinicians should encourage women with postpartum IUDs to return for follow up 1 month after insertion.