Averbach Sarah, Vaida Florin, Hinz Erica, Kully Gennifer, Dey Arnab K, Lutgendorf Monica A, Haider Sadia, Hofler Lisa G
Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, CA (Averbach, and Kully).
Center on Gender Equity and Health, University of California, San Diego, CA (Averbach, Kully, and Dey).
AJOG Glob Rep. 2025 Jul 20;5(3):100547. doi: 10.1016/j.xagr.2025.100547. eCollection 2025 Aug.
The early postpartum period, 2 to 4 weeks postpartum, is an optimal time for intrauterine device (IUD) initiation; placement can be co-located with early postpartum or infant visits. We aimed to compare expulsion rates at 12 months postpartum for IUDs placed early compared to the standard interval 6-week visit.
This is a randomized controlled trial conducted at four U.S. medical centers. Participants were randomly assigned to early (14-28 days) or interval (42-56 days) postpartum IUD placement after vaginal or cesarean birth. We used transvaginal ultrasound to confirm IUD presence and position at 6 months. Chart review and telephone surveys were used to verify IUD presence and position at 12 months.
Between March 2018 and June 2021, 203 participants were assigned to early and 201 to interval IUD placement; 238 (58.9%) contributed outcome data by phone survey (and electronic medical record review) at 12-months postpartum. Among participants who received an IUD and provided 12-month outcome data, complete expulsion rates were 4 in 124 (3.2%; 95% confidence interval [CI], 0.90 to 8.2) and 0 in 114 (0%; 95% CI, 0 to 3.2) in the early and interval groups; a between-group difference of 3.2 percentage points (95% CI, -0.01 to 8.0, =.054). Partial expulsion counts and rates were 16 (12.9%; 95% CI, 7.6 to 20.1) and 13 (11.4%; 95% CI, 6.2 to 18.7) in the early and interval groups; a difference of 1.5 percentage points (95% CI, -7.2 to 10.2, =.75). Among all 404 participants, IUD utilization rates at 12-month follow-up were 113 (55.7%; 95% CI, 48.5 to 62.6 among participants in the early group) compared to 95 (47.3%; 95% CI, 40.2 to 54.1, =.10 among participants in the interval group). Participants were more satisfied with early compared to interval placement, 107 (86.3%; 95% CI 79.0 to 91.8) vs 87 (76.3%, 95% CI 67.4 to 83.8 95%) =.048
Complete expulsion rates at 12 months are low (<5%) when IUDs are placed in the early and interval postpartum period. Satisfaction is higher with early postpartum IUD placement.
产后早期，即产后2至4周，是放置宫内节育器（IUD）的最佳时机；放置IUD可与产后早期或婴儿访视同时进行。我们旨在比较与标准间隔6周访视相比，早期放置IUD在产后12个月时的排出率。
这是一项在美国四个医疗中心进行的随机对照试验。参与者在阴道分娩或剖宫产术后被随机分配至产后早期（14 - 28天）或间隔期（42 - 56天）放置IUD。我们使用经阴道超声在6个月时确认IUD的存在和位置。通过查阅病历和电话调查来核实IUD在12个月时的存在和位置。
在2018年3月至2021年6月期间，203名参与者被分配至早期放置IUD组，201名被分配至间隔期放置IUD组；238名（58.9%）参与者在产后12个月时通过电话调查（以及电子病历回顾）提供了结局数据。在接受IUD并提供12个月结局数据的参与者中，早期组124人中有4人（3.2%；95%置信区间[CI]，0.90至8.2）完全排出，间隔期组114人中有0人（0%；95%CI，0至3.2）完全排出；组间差异为3.2个百分点（95%CI，-0.01至8.0，P = 0.054）。早期组和间隔期组的部分排出数及排出率分别为16（12.9%；95%CI，7.6至20.1）和13（11.4%；95%CI，6.2至18.7）；差异为1.5个百分点（95%CI，-7.2至10.2，P = 0.75）。在所有404名参与者中，12个月随访时IUD使用率在早期组为113人（55.7%；95%CI，48.5至62.6），间隔期组为95人（47.3%；95%CI，40.2至54.1，P = 0.10）。与间隔期放置相比，参与者对早期放置更满意，分别为107人（86.3%；95%CI，79.0至91.8）和87人（76.3%，95%CI，67.4至83.8，P = 0.048）。
在产后早期和间隔期放置IUD时，12个月时的完全排出率较低（<5%）。产后早期放置IUD的满意度更高。
