SynthesisObstetrics and gynecology2018
Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis.
Synthesis in Obstetrics and gynecology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.The Cochrane database of systematic reviews · 2022Pooled it
- Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis.American journal of obstetrics and gynecology · 2020Pooled it
- Manual versus forceps postplacental IUD insertion after vaginal delivery: A randomized clinical trial.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Trial
- Trial
- Optimal Timing for Intrauterine Device Insertion During the Menstrual Cycle: A Comparative Study of Pain, Bleeding, and Postprocedural Outcomes.Clinics and practice · 2026Article
- Using updated clinical recommendations to support contraceptive decision-making: U.S. medical eligibility criteria for contraceptive use, 2024.Contraception · 2026Review
- Strangulated Small Bowel Obstruction Caused by a Migrated Ring-Shaped Intrauterine Device: Two Case Reports and a Literature Review.The American journal of case reports · 2026Review
- Use of copper intrauterine devices in the immediate postpartum period: a prospective longitudinal study.Revista brasileira de enfermagem · 2026Article
- Post-placental intrauterine device: expanding access to reproductive health in an African province.Annals of medicine · 2025Article
- Barriers and facilitators to contraception provision among rural healthcare providers.Contraception and reproductive medicine · 2025Article
- Immediate postplacental intrauterine device placement: retrospective cohort study of expulsion and associated risk factors.AJOG global reports · 2025Article
- Risk factors of uterine perforation when using contraceptive intrauterine devices.BMC women's health · 2024Article
- U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2024Article
- Knowledge, Attitude, and Practice of Brazilian Physicians about Immediate Postpartum and Postabortion Intrauterine Device Insertion.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2023Article
- Does Timing of Levonorgestrel Insertion in Women with Abnormal Uterine Bleeding Affect its Expulsion and Bleeding Pattern? A Follow-Up Study.Journal of obstetrics and gynaecology of India · 2023Article
- Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2023Article
- A systematic review and meta-analysis of immediate postpartal intrauterine contraceptive device use in Ethiopia.Heliyon · 2022Review
- Patient acceptability, continuation and complication rates with immediate postpartum levonorgestrel intrauterine device insertion at caesarean section and vaginal birth.The Australian & New Zealand journal of obstetrics & gynaecology · 2022Article
- Continuation of Copper T in Immediate Postplacental, Immediate Postabortal and Interval Period of Insertion.Journal of obstetrics and gynaecology of India · 2022Article
- Assessment of a Novel Fixation Method of a Frameless Intrauterine Contraceptive Device Inserted during Cesarean Delivery as a Means of Preventing Displacements and Expulsions: A Prospective Observational Study.Life (Basel, Switzerland) · 2022Article
Corrections and comments
- Commented on by
- Commented on byIn Reply.2019
Authors and funding
8 authors.
Funding
Abstract
objectiveTo estimate expulsion rates among women with postpartum intrauterine device (IUD) placement by timing of insertion, IUD type, and delivery method. DATA SOURCES: We searched PubMed, Cochrane Library, and ClinicalTrials.gov from 1974 to May 2018. METHODS OF STUDY SELECTION: We searched databases for any published studies that examined postpartum placement of a copper IUD or levonorgestrel intrauterine system and reported counts of expulsions. We assessed study quality using the U.S. Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of IUD expulsion and estimated adjusted relative risks (RRs) for timing of postpartum placement, delivery method, and IUD type using log-binomial multivariable regression model. TABULATION, INTEGRATION, AND
resultsWe identified 48 level I to II-3 studies of poor to good quality. Pooled rates of expulsion varied by timing of IUD placement, ranging from 1.9% with interval placements (4 weeks postpartum or greater), 10.0% for immediate placements (10 minutes or less after placental delivery), and 29.7% for early placements (greater than 10 minutes to less than 4 weeks postpartum). Immediate and early postpartum placements were associated with increased risk of expulsion compared with interval placement (adjusted RR 7.63, 95% CI 4.31-13.51; adjusted RR 6.17, 95% CI 3.19-11.93, respectively). Postpartum placement less than 4 weeks after vaginal delivery was associated with an increased risk of expulsion compared with cesarean delivery (adjusted RR 5.19, 95% CI 3.85-6.99). Analysis of expulsion rates at less than 4 weeks postpartum also indicated that the levonorgestrel intrauterine system was associated with a higher risk of expulsion (adjusted RR 1.91, 95% CI 1.50-2.43) compared with CuT380A.
conclusionPostpartum IUD expulsion rates vary by timing of placement, delivery method, and IUD type. These results can aid in counseling women to make an informed choice about when to initiate their IUD and to help institutions implement postpartum contraception programs.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.