Background: Immediately
postpartum contraception decreases maternal mortality, low birth weight,
preterm births and infant mortality. Missing strings in the setting of a
well positioned IUD are more common following postpartum placement as compared
to interval placement. This difference may be explained by variation in
residents’ techniques for placement in the postpartum setting.
Methods: A
retrospective chart review of 306 women receiving immediate postpartum IUD insertion
by residents was performed between July 1, 2017-February 15th, 2018.
Variables analyzed included: type of IUD, length of strings prior to placement,
method of insertion (applicator, ring-forceps, manual), and delivery
type.
Results: Sixty-two
(20%) women attended postpartum follow-up between four to six weeks after
delivery. Eleven of 14 (79%) post-cesarean section and 39 of 48 (81%)
post-vaginal delivery had strings visualized. Insertion via the IUD
applicator was associated with significantly more IUD strings visualized at the
postpartum visit when compared to manual insertion (p <0.05) and ring
forceps (p <0.05). There was no difference in string visualization between
IUD types or after cutting the string to 10 cm.
Discussions: Mode of placement
affects postpartum IUD string visibility. Future research will include
developing a protocol for best practices for post-placental IUD placement to
improve string visibility at the postpartum visit. Additional research is
needed on the low postpartum follow up rate in this subset of the population.
Topics: CREOG & APGO Annual Meeting, 2019, Student, Resident, Faculty, Patient Care, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, GME, Quality & Safety, Public Health, Contraception or Family Planning, General Ob-Gyn,
Leah Roberts,
MD, Temple
University Hospital; Sarah Martin, MD;
Kristin Kean,
MD; Molly
Singer, MD;
Dana Clark,
Medical Student; Tanise Branche, MD
