Outcomes of an Immediate Postplacental Intrauterine Device Placement Program in Adolescents and Young Adults: A Retrospective Cohort.

OBJECTIVE

This study aims to retrospectively assess outcomes, including intrauterine device (IUD) continuation, repeat pregnancy, and complication rates, of immediate postplacental levonorgestrel 52 mg 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

A total of 285 patients with a mean age of 19 years (range 14-21) had a PPIUD 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%).

CONCLUSION

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.