Postplacental Mirena IUD Insertion and Estimating Expulsion Rates.

Experimental Study Examining Mirena IUD Insertion and Estimating Rates of Expulsion Immediately After Placental Delivery.

This study aims to demonstrate that the expulsion rate is increased but acceptable when inserting Mirena IUDs immediately postpartum, termed 'postplacental IUD insertion'. The investigators will compare the postplacental insertion expulsion rate estimate with rates reported in the literature for 6 week postpartum insertion, which is currently the American standard for IUD insertion postpartum. Secondary outcomes will also be examined; endometritis, uterine perforation, continuation and pregnancy among others.

The average expulsion rate for 6 week postpartum IUD insertion is approximately 10-12% with a range between 3-20% at 1 year. An acceptable expulsion rate for postplacental insertion (PPI) has not been defined and varies between studies. There are limited data on the expulsion rates of levonorgestrel intrauterine systems. Expulsion rates range widely from 1-3% to as high as 30-40% depending on the IUD and the study. Studies report an average rate of expulsion in ranges approximating 10-12%, similar to 6 week insertion rates.

There are many limitations to published studies including the use of older model IUDs no longer in use, multiple insertion techniques that have been deemed ineffective in reducing expulsion rates as well as varying follow up times making comparison of expulsion rates difficult.

Inclusion Criteria:

• age 18 or greater
• obstetric patient in greater Portland, ME area

Exclusion Criteria:

• Evidence of chorioamnionitis (persistent fetal tachycardia, intra-partum fever >38.0)
• prolonged rupture of membranes (greater than 24 hours)
• intrauterine fetal demise
• use of general anesthesia at time of delivery
• postpartum hemorrhage (>500ml vaginal, >1000ml cesarean)
• magnesium administration in labor due to HELLP syndrome or preeclampsia
• preterm delivery.