Two-week postpartum intrauterine contraception insertion: a study of feasibility, patient acceptability and short-term outcomes.

Abstract

OBJECTIVE To determine the feasibility and acceptability of inserting the levonorgestrel intrauterine system, LNG 52 mg IUS (LNG IUS), at 2 weeks postpartum. STUDY DESIGN This prospective study of feasibility and patient acceptability recruited women interested in a postpartum LNG IUS and placed the LNG IUS under ultrasound guidance on days 14-20 postpartum. We determined feasibility by our ability to recruit and insert the LNG IUS in our predetermined sample size of 50 women. We measured our primary acceptability outcome at 6 months postpartum with the question: "Would you recommend Mirena placement at 2 weeks postpartum to a friend?" Other outcomes included expulsion and pain. The three study visits consisted of (1) insertion visit (14-20 days postpartum), (2) standard postpartum visit with a string check (6 weeks postpartum) and (3) research visit with sonography and assessment of the primary outcome (6 months postpartum). RESULTS We enrolled 50 women over 8 months, all of whom received LNG IUS. Forty-three of the 50 (86%) provided follow-up data for the primary outcome. Of those, 93% (40/43) would recommend 2-week LNG IUS insertion to a friend, and 86% (37/43) continued using their LNG IUS at the conclusion of the 6-month visit. There were two partial expulsions; one was symptomatic. There were no uterine perforations. CONCLUSIONS LNG IUS inserted at 2 weeks postpartum is feasible and acceptable to patients. These results offer evidence to support intrauterine contraception insertion prior to the onset of ovulation and at a potentially more convenient time point in the postpartum period. IMPLICATIONS This study supports offering the LNG IUS beginning on the 14th postpartum day. The 4% expulsion rate is consistent with the rate of interval insertion and lower than immediate postplacental insertion. Additional research is needed to ensure a low risk of adverse events with other brands of intrauterine contraception.

DOI: 10.1016/j.contraception.2016.08.005

Cite this paper

@article{Zerden2017TwoweekPI, title={Two-week postpartum intrauterine contraception insertion: a study of feasibility, patient acceptability and short-term outcomes.}, author={Matthew L Zerden and Gretchen S. Stuart and Samantha Charm and Amy G. Bryant and Joanne Mills Garrett and Jessica E Morse}, journal={Contraception}, year={2017}, volume={95 1}, pages={65-70} }