Trial reportInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2026
Manual versus forceps postplacental IUD insertion after vaginal delivery: A randomized clinical trial.
Trial report in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The trial behind it
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Who cites it
1 citing paper in PubMed.
- 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
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study compares the expulsion rate of the postplacental copper intrauterine device (IUD) based on the insertion technique: manual versus ring forceps. Pain, perforation, infection, and increased bleeding were assessed as secondary outcomes.
methodThe study consisted of a randomized clinical trial involving 210 women (with 105 in each group) admitted for vaginal delivery at a teaching hospital who wanted to use an IUD and had no contraindications to use an IUD. Patient recruitment occurred between December 2021 and June 2024. Pain was evaluated using the visual analog scale immediately after insertion. Descriptive statistics and bivariate analysis were performed. The Cochran-Armitage test was used to assess the temporal trend of expulsion. Participants were followed up between 6 and 12 weeks postpartum.
resultsThe complete IUD expulsion rate was 20.5%, with no significant difference between forceps and manual insertion (25% vs. 16.7%, P = 0.168). Expulsions were easily perceived by the women and occurred early. Notably, in this teaching hospital setting, the turnover of new medical residents (P = 0.057) performing insertions did not affect the expulsion rates throughout the year. Manual insertion was associated with greater discomfort compared to forceps (P = 0.001), even with epidural anesthesia (P = 0.002). There were no cases of uterine perforation or infection.
conclusionThe postplacental IUD expulsion rate was lower with manual insertion, although not statistically significant. Insertion discomfort was lower in the forceps group, regardless of analgesia. Postplacental IUD insertion was well tolerated, safe, and easily reproducible by junior doctors.
trial registrationThis study was approved by the Ethics and Research Commission of the University of Campinas (UNICAMP) and the Brazilian Registry of Clinical Trials (REBEC): https://ensaiosclinicos.gov.br/rg/RBR-4j62jv6, (number RBR-4j62jv6).
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