Outcomes of an immediate postplacental intrauterine device placement program in adolescents and young adults: a retrospective cohort.

Abstract

Objective: This study aims to retrospectively assess outcomes, including IUD continuation, repeat pregnancy, and complication rates, of immediate postplacental levonorgestrel 52mg IUD (PPIUD) placement in obstetric patients aged 21 and under at a high-volume county hospital.

Methods: We retrospectively reviewed charts of patients who received a PPIUD between March 1, 2021 and August 15, 2022 at our institution. The primary outcome was continued IUD use. Secondary outcomes were repeat pregnancy, reason for IUD discontinuation including complete and partial expulsion, pelvic infection, and string complications (strings lost or trimmed).

Results: 285 patients with a mean age of 19 years (range 14-21) had a postplacental IUD placed. Electronic medical record data was collected retrospectively through 8/31/23 to ensure follow up for at least 1 year following IUD placement or until repeat pregnancy, whichever came first; the median length of data collection after initial IUD placement was 20 months (range 2-30 months). There was continued IUD use in 197(69.1%). IUD expulsion was the most common reason for discontinuation and occurred in 32 patients; overall expulsion rate was 15.4%. Repeat pregnancy occurred in 25(8.8%) patients, all of whom had IUD removal or expulsion. No pelvic infections occurred. Strings were not visualized in 63(21.9%) patients and trimmed in 24(8.3%).

Conclusions: Immediate PPIUD placement in adolescents and young adults results in high continuation and low repeat pregnancy rates in this population. Expulsion and infection rates were comparable to prior studies. Patients should be counseled on potential PPIUD string complications.