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Randomized Controlled Trial
. 2015 Jul;126(1):5-11.
doi: 10.1097/AOG.0000000000000882.

Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum: A Randomized Controlled Trial

Erika E Levi  1 , Gretchen S Stuart, Matthew L Zerden, Joanne M Garrett, Amy G Bryant
Affiliations
Randomized Controlled Trial

Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum: A Randomized Controlled Trial

Erika E Levi et al. Obstet Gynecol. 2015 Jul.

Abstract

Objective: To compare intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean delivery (during cesarean delivery) IUD placement compared with women who planned for interval IUD placement 6 or more weeks postpartum.

Methods: In this nonblinded randomized trial, women who were undergoing a cesarean delivery and desired an IUD were randomized to intracesarean delivery or interval IUD placement. The primary outcome was IUD use at 6 months postpartum. A sample size of 112 (56 in each group) was planned to detect a 15% difference in IUD use at 6 months postpartum between groups.

Results: From March 2012 to June 2014, 172 women were screened and 112 women were randomized into the trial. Baseline characteristics were similar between groups. Data regarding IUD use at 6 months postpartum were available for 98 women, 48 and 50 women in the intracesarean delivery and interval groups, respectively. A larger proportion of the women in the intracesarean delivery group were using an IUD at 6 months postpartum (40/48 [83%]) compared with those in the interval group (32/50 [64%], relative risk 1.3, 95% confidence interval 1.02-1.66). Among the 56 women randomized to interval IUD insertion, 22 (39%) of them never received an IUD; 14 (25%) never returned for IUD placement, five (9%) women declined an IUD, and three (5%) had a failed IUD placement.

Conclusion: Intrauterine device placement at the time of cesarean delivery leads to a higher proportion of IUD use at 6 months postpartum when compared with interval IUD placement.

Level of evidence: I.

Trial registration: ClinicalTrials.gov NCT01539759.

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Figures

Figure 1
Figure 1
Flowchart of study participants. *Excluded from analysis (lost to follow-up), n=8. †Excluded from analysis (lost to follow-up), n=6.
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