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Subject Area

Obstetrics and Gynecology

Article Type

Original Study

Abstract

Objective To assess the role of ultrasound in predicting the successful insertion of intrauterine contraceptive device (IUD) immediately after delivery. Background Waiting until the 6-week postpartum visit to initiate a method of birth control puts women at risk for unintended pregnancy. Patients and methods A single experienced doctor measured the distance from each wall of the uterus to the body of the IUD and from the lower edge of the IUD to the internal cervical OS following delivery and again at 6 weeks following delivery in women who received a postpartum IUD and then compared in unsuccessful and successful cases of postvaginal delivery (PVD) and postcesarean section (PCS) IUD insertion. The difference in success between the two modes of delivery and the optimal cutoff distance for successful retention were assessed using logistic regression and receiver-operating characteristics curve analysis, respectively. Results One hundred women, comprising 63 PVD and 37 PCS IUD insertions, were recruited. Eleven PVD and eight PCS IUDs were either expelled or extracted due to improper placement at the 6-week visit. The mean difference between the distance from the internal OS to the lower end of the IUD in successful versus unsuccessful cases was 8.91 ± 5.64 and 11.77 ± 5.25 mm (P < 0.001) in PVD and PCS insertions, respectively. This distance at the discharge scan was moderately accurate in predicting retention of the IUD, with an area under the curve of 0.72 (sensitivity, 73%; specificity, 83%). Conclusion Ultrasound could be considered for predicting the success of IUD retention after delivery.

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