Health Care Utilization After Immediate Compared With Delayed Postpartum Intrauterine Device Placement.

Abstract

Objective: To investigate differences in health care utilization between immediate (within 10 minutes of placental delivery) and delayed (after 24 hours) intrauterine device (IUD) placement.

Methods: This retrospective cohort study was conducted with data from Kaiser Permanente Northern California from 2017 to 2019 and included patients with an IUD placed between 0 and 63 days postpartum. The primary outcome for health care utilization was the number of obstetrician-gynecologist (ob-gyn) or women's health office visits within 1 year. Secondary outcomes included formal imaging studies, surgical intervention, and hospitalizations related to IUD complications within 1 year. An additional secondary outcome was live births at 120 days and 1 year.

Results: Among 1,543 immediate and 10,332 delayed postpartum IUD placements, the number of visits to an ob-gyn or women's health office within 1 year was slightly increased with delayed placement (mean 2.30 vs 2.47, P<.001). Imaging was increased in the immediate compared with the delayed group (10.5% vs 4.1%, P<.001). Laparoscopy was decreased in the immediate compared with the delayed group (0.0% vs 0.4%, P=.005), with no significant difference in hysteroscopy (0.2% vs 0.1%, P=.413). Hospitalizations were rare and increased in the immediate group (0.4% vs 0.02%, P<.001). Lastly, there was no difference in repeat pregnancies between groups at 120 days (both 0.2%) or at 1 year (2.9% vs 2.5%, P=.342).

Conclusion: Compared with delayed placement, immediate postpartum IUD placement is not associated with increased office visits. Immediate placement is associated with an increase in imaging but a decrease in laparoscopic surgery to manage IUD-related complications. There was no difference in live birth rates at 6 months or 1 year between groups.