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Contraceptive Pearl: Contraception During COVID-19: Post-Placental IUD Insertion

An intrauterine device (IUD) can be inserted immediately postpartum, minutes after delivery of the placenta. Post-placental IUD insertion is simple and safe, with a low rate of complications. This video demonstrates the procedure. Pregnant patients who choose an IUD can get one without experiencing the risk of an extra office visit during the COVID-19 epidemic.

The risk of IUD expulsion is somewhat higher among patients who opt for immediate post-placental insertion (compared with delayed insertion). The expulsion risk may be slightly greater for vaginal than for cesarean deliveries, and slightly higher for the copper than the progestin IUD. Expulsion rates vary across studies, and most studies are small.

Clinicians should inform pregnant patients who are considering an IUD about the option of post-placental insertion. This is especially important in the COVID-19 era so that the patient does not need to travel postpartum for an extra office visit to have their IUD placed.

 

Resources

RHAP IUD After Childbirth Fact Sheet

RHAP IUD Fact Sheet

 

Sources

American Congress of Obstetricians and Gynecologists. Postpartum Contraceptive Access Initiative. Insertion and Removal. Updated 2017. pcainitiative.acog.org/clinical-considerations/insertion-and-removal/.

Laporte M, Marangoni M Jr, Surita F, Juliato CT, Midaira M, Bahamondes L. Postplacental placement of intrauterine devices: A randomized clinical trial. Contraception. 2020 Mar;101(3):153-158. doi: 10.1016.j/contraception.2019.12.006.

Levi E. Long-Acting Reversible Contraception (LARC): A Hospital-Based Physician Initiative. Immediate Post-Placental LARC Insertion.American Congress of Obstetricians and Gynecologists. cfweb.acog.org/district_ii/larc/section4.html.

Lopez LM, Berhoic A, Hubacher D, Stuart G, Van Vliet HA. Immediate postpartum insertion of intrauterine device for contraception. Cochrane Database Syst Rev. 2015 Jun;(6):CD003036. doi: 10.1002/14651858.CD003036.pub3.

Whitaker AK, Chen BA. Society of Family Planning Guidelines: postplacental insertion of intrauterine devices. Contraception. 2018 Jan;97(1):2-13. doi: 10.1016/j.contraception.2017.09.014.

 

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.