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Evaluating the Rates of Visualized IUD Strings Following Immediate Post-Partum Placement by Ob/Gyn Residents

Purpose: Compare the incidence of visualized IUD strings at follow up by mode of postpartum IUD placement by residents 

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: General Ob-Gyn, Contraception or Family Planning, Public Health, Quality & Safety, GME, Practice-Based Learning & Improvement, Systems-Based Practice & Improvement, Patient Care, Faculty, Resident, Student, 2019, CREOG & APGO Annual Meeting,

General Information


Intended
Audience
Student,Resident,Faculty,
Competencies
Addressed
Patient Care,Systems-Based Practice & Improvement,Practice-Based Learning & Improvement,
Educational
Continuum
GME,
Educational
Focus
Quality & Safety,Public Health,
Clinical Focus
Contraception or Family Planning,General Ob-Gyn,

Author Information

Leah Roberts, MD, Temple University Hospital; Sarah Martin, MD; Kristin Kean, MD; Molly Singer, MD; Dana Clark, Medical Student; Tanise Branche, MD

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