RHL Commentary by Asmita Muthal-Rathore
EVIDENCE SUMMARY
The review assesses the safety and efficacy of immediate postpartum insertion of the intrauterine device (IUD). The a priori hypothesis was that this practice is safe but associated with a higher expulsion rate than interval insertion.
There were no trials comparing various timings (immediate postpartum, delayed postpartum and interval) of IUD insertion. Eight trials that compared different IUDs or modifications of IUDs to aid retention in utero were included.
The principle outcome measures included pregnancy, spontaneous expulsion and continuation rates. The twelve month pregnancy rates reported in these studies range from 0.0 to 12.1. The expulsion rates at 6-36 months range from 6.2 to 44.1 per 100 women and 6-36 month continuation rates varied from 39.1to 93.3 per 100 women. One trial studied removal due to pain and bleeding. The trials had not assessed rare outcomes such as displacement of the IUD, perforation and infection.
The modifications of the conventional IUD by adding chromic catgut or additional appendages had no impact on clinical outcomes.
In terms of expulsion rates The TCu 200 proved superior to progesterone-releasing IUDs (progestasert/IPCS-52) for immediate postpartum insertion. MLCu250 and TCu 200 were found to be similar. The choice of insertion techniques (hand versus instrument) appears clinically unimportant.
The review was last updated in October 2002. The search strategy of the review was comprehensive. Trial quality was assessed rigorously and authors were contacted when necessary. Data were extracted by two reviewers independently and discrepancies resolved by discussion. Meta analysis could not be performed as studies were not judged to be similar. The depiction of primary outcome measures could have been clearer.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Applicability of results
- Implementation of the intervention
Research
References
This document should be cited as: Asmita Muthal-Rathore. Immediate post-partum insertion for intrauterine devices: RHL commentary (last revised: 27 August 2004). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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