Author details

postpartum visit to request contraception. IUDs may be placed at the time of a vaginal delivery by a skilled provider using sterile techniques. For women who request IUD insertion at the time of delivery, the risk of expulsion, symptoms, and follow-up should be discussed. When an IUD is placed immediately after a vaginal delivery, it should be done within 10 min of delivery of the placenta, and it may be subsequently expelled 20–30% of the time. There is some concern that the LNG IUD may have a higher expulsion risk than the copper IUD. When placed at the time of cesarean, it is expelled approximately 8%. When placed at a later interval greater than 4 weeks postpartum, the expulsion rate is 3–5% (Table 2). The use of instruments, IUD modifications, and suturing the IUD in situ do not alter expulsion rates [21–23]. Additionally, as the uterus involutes, the IUD strings may lengthen and extend out of the vagina. A patient should be educated that she may need to return to have the strings trimmed and should try not to remove the IUD accidentally. Contraindication to postplacental IUD includes intrauterine

There is a robust body of research demonstrating that IUDs and hormonal contraceptive arm implants are methods that are able to reduce unintended pregnancy rates because they are not user dependent or coitus dependent, removing the need for adherence or maintenance. IUDs and implants are collectively referred to as long-acting reversible contraceptive methods or LARC. They are placed and removed by a practitioner, are extremely discrete, and do not require any ongoing effort from the user. Additionally, return to fertility and conception can occur within days of removal of the device. LARC methods are not only the most effective contraceptive methods but also have the highest satisfaction, cost efficiency, and continuation rates when compared to other forms of family planning [24]. Uptake of IUDs and the implant in the United States has almost tripled over the last decade. In 2002 less than 3% of women using contraception used an IUD or implant; in 2009 that increased to 8.5% women [25, 26]. The American College of Obstetricians and Gynecologists recommends that LARC methods are offered as the first-line contraception for the majority of women, including adolescents and women with complex medical problems. Increased uptake of these methods has the potential to decrease the rate of unintended pregnancy in the United States as well as around the globe [24, 27]. There are very few contraindications to immediate postpartum LARC. Institutions and healthcare systems should work to ensure that the resources, processes, and infrastructure

A clinical trial in the United States entitled the Contraceptive CHOICE Project demonstrated that adolescents and adults both had high continuation rates for IUD and implant methods. At 24 months continuation for the copper IUD was 77%, for the LNG IUD 79%, and for the

Table 2. United States Centers for Disease Control and Prevention Medical Eligibility for Contraceptive Use for IUDs in

Cu IUD LNG IUD

infection, uterine anomalies, hemorrhage, and cervical or uterine cancer.

are in place to offer LARC to postpartum women at the time of delivery.

<10 min after placental delivery 1 2 10 min–4 weeks after delivery 2 2 >4 weeks after delivery 1 1

breastfeeding women.

252 Family Planning

Jessica Maria Atrio<sup>1</sup> \*, Isha Kachwala<sup>2</sup> and Karina Avila<sup>2</sup>

\*Address all correspondence to: jatrio@montefiore.org

1 Montefiore Medical Center and Einstein School of Medicine, New York City, New York, USA

2 Einstein School of Medicine, New York City, New York, USA
