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Immediate post-placental insertion of the levonorgestrel-releasing intrauterine system after cesarean delivery vs. 4-8 week post-delivery interval insertion

Amy Whitaker, University of Chicago, 2007
See also executive summary.

Project abstract

Background: Post-placental insertion of the intrauterine device (IUD) after cesarean delivery has been studied extensively abroad; most studies have shown low 12-month expulsion rates (~4-7%) and high continuation rates (~70-90%). The only study of post-placental insertion of the LNG-IUS after cesarean delivery, a South African study of 20 women, showed no expulsions and a 6-month continuation rate of 95%. There are little data looking at the rate of placement of interval IUDs post-partum, but it may be as low as 45-60%. Despite these findings, interval insertion remains the standard of care in the United States, and there are no randomized controlled studies comparing post-placental to interval insertion of the IUD.

Study design: Extension of a randomized controlled trial comparing post-placental insertion of the LNGIUS after cesarean delivery to interval insertion 4-8 weeks after delivery.

Population: 120 women desiring the LNG-IUS for post-partum contraception who are scheduled to have cesarean delivery.

Primary outcome: Rates of use at 12 months after delivery.

Secondary outcomes: Rates of insertion, expulsion, pregnancy, patterns of vaginal bleeding, safety, satisfaction, quality of life.

Hypothesis: The proportion of women using the LNG-IUS for contraception at 12 months after delivery will be higher in the group randomized to immediate post-placental insertion.

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