(92) Outcomes of an Immediate Postplacental Intrauterine Device Placement Program in Adolescents and Young Adults

Background: Immediate postplacental intrauterine device (IUD) placement is safe and convenient but with increased rates of expulsion and string complications compared to interval placement. While the decision for immediate postplacental IUD placement should be individualized and informed, it may be an effective option to prevent unintended repeat pregnancy. In our county, the teen birth rate is 14% higher than the overall state rate (27.1 per 1,000 teens aged 15 to 19). Further, 1 in 6 is a repeat teen birth. A pilot program at our institution, a high-volume obstetric county hospital in a state with limited postpartum insurance coverage, offered immediate postplacental IUD placement to patients age 21 and under.

Methods: In this retrospective cohort study with institutional IRB approval, we reviewed outcomes of patients who elected to receive postplacental IUD between March 2021 and August 2022 at our institution. During this timeframe, all patients age 21 and under were offered alevonorgestrel (LNG) 52 mg IUD within 10 minutes of placental delivery following vaginal or cesarean birth. Exclusion criteria included positive screening for gonorrhea or chlamydia without a subsequent negative result, rupture of membranes >18hours, active uterine infection, hemorrhage at delivery, known anatomical uterine anomaly, and uterine or breast malignancy. The primary outcomes were continued IUD use and repeat pregnancy through March 2023, with secondary outcomes of expulsion, infection, and IUD string complications.

Results: Under the pilot program, 288 adolescents and young adults with a mean age of 19 years (range 14-21) received an immediate postplacental LNG-IUD following a vaginal (78.1%) or cesarean (21.9%) delivery; for many patients (39.2%), this was at least their second pregnancy. As of March 2023, mean follow-up time was 15.3 months (range 7.6-24.3). There was continued IUD use in 219(76.0%) patients and repeat pregnancy in 9(3.1%). The overall expulsion or partial expulsion rate for all IUDs placed was 12.1%. There were no cases of pelvic inflammatory disease, and no IUDs were removed due to infection. Strings were not visualized in 63(21.9%) patients postpartum. String trimming was documented in 24(8.3%) patients; most of these patients (62.5%) sought additional care for long strings outside of routine postpartum care.

Conclusions: Immediate postplacental IUD placement in adolescents and young adults results in high method continuation and low repeat pregnancy rates. Expulsion and infection rates were comparable to previously published studies. Patients should be made aware of potential postpartum IUD string complications.