Immediate Versus Delayed Insertion of the Levonorgestrel Intrauterine Device in Postpartum Adolescents: A Randomized Pilot Study

Abstract

This pilot study assessed the feasibility of conducting a larger randomized controlled trial comparing the proportion of adolescents using a levonorgestrel intrauterine device (LNG IUD) at six months postpartum when it is inserted immediately after vaginal delivery (within 10 minutes after placental expulsion) compared to insertion four to six weeks postpartum. Pregnant adolescents (14 to 19 years) who desired a LNG IUD for postpartum contraception were randomized to insertion of the LNG IUD either within 10 minutes of delivery of the placenta or at 4-6 weeks postpartum. Study follow-up visits were conducted at 4-6 weeks postpartum, 10 weeks postpartum, and 6 months postpartum. From November 2013 to June 2015, eleven adolescents were randomized - six participants to the immediate postpartum LNG IUD insertion group, and five to the delayed insertion group. All six women in the immediate insertion group had successful immediate postpartum insertion; two of five women in the delayed insertion group had an IUD inserted. At six months postpartum, four of six women in the immediate insertion group had a LNG IUD in place; of the five women in the delayed group, three did not have a LNG IUD in place and two were pregnant. The study was discontinued after 19 months because of suboptimal enrollment. Though insertion of a LNG IUD immediately after delivery is an appropriate option for some adolescents, a larger prospective study comparing immediate to delayed LNG IUD insertion is unlikely to be feasible at our institution.

Keywords: adolescent contraception; intrauterine device (IUD); long-acting reversible contraception (LARC); postpartum contraception.

Figure 1

Study Participants and Follow-up