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Intrauterine Devices (IUDs)
Introduction Contents Post-Test References Go To Presenter Info

Goals

Section 1

- Introduction
- Objectives
- IUD/IUCD Use
- Safety
- Overview
- Early IUDs
- Copper IUDs
- Mechanisms
- Failure Rates
- Comparison
- Method Costs
- Characteristics
- Characteristics
- PID
- Incidence Rate
- Reducing Risk
- Perforations
- Ectopic
- Expulsions
> Rates

Section 2
Section 3

Summary

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Section 1 - Intrauterine Devices (IUDs)

Expulsion Rates for Interval and Postpartum Insertions

Source: Chi, et al, 1985.
Slide 19


The lowest expulsion rates are associated with interval insertions, or those which take place any time other than the four weeks following delivery. As can be seen on this slide, studies have shown that the expulsion rate is generally higher during the postpartum period. The rate varies according to when during the postpartum period the insertion is done. The higher expulsion risk is due to the changes the uterus undergoes as it returns to its normal size.

Based on this, researchers have made specific recommendations about when to insert an IUD during the postpartum period. The expulsion rate is only slightly higher for insertions done in the immediate postpartum period, within the first 10 minutes after the placenta is expelled. It is moderately higher if inserted after 10 minutes but before the woman is discharged from the hospital, usually 48 hours after delivery. Data on expulsion rates for late postpartum insertions, done between 48 hours and 4 weeks after delivery, are limited. However, inserting an IUD during this time window is not recommended due to a greater risk of perforation. Before performing postpartum insertions, providers need to receive specific training and supervised practice. As previously noted, the inserter’s skill can greatly affect the risk of expulsion.

Although the expulsion rate for postpartum insertions is higher, postpartum IUD insertion does have a number of advantages. The primary advantage is convenience for the woman. However, clients should be counseled that the risk of expulsion is greater if the IUD is inserted during this period.

 

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