Postplacental LNG-IUD Ultrasound Use Study

Postplacental LNG-IUD Ultrasound Use Study

This study will enroll women planning to have an intrauterine device (IUD) placed for contraception immediately following a vaginal delivery. Women will be randomized to have this procedure done with or without ultrasound guidance. We intend to determine if the routine use of ultrasound to confirm device position reduces the rates of IUD expulsion.

Participants will be screened and consented for participation in the study when they are admitted to Labor and Delivery for delivery and express desire for a post-placental LNG-IUD. If the patient consents for study participation and meets eligibility criteria above, she will be enrolled in the study after achieving vaginal delivery when she is randomized to either IUD insertion with ultrasound or without ultrasound use. See protocol for detailed description of IUD placement and ultrasound use.

After placement of IUD with or without ultrasound guidance, patients will be scheduled for a routine postpartum follow-up visit 6-10 weeks after delivery. At the postpartum follow-up visit, providers will assess for IUD expulsion with usual clinical practice, including history, pelvic exam, and additional imaging if IUD strings are not visualized on exam. Several attempts to contact participants who do not attend their postpartum visits will be made to attempt to reschedule appointments and conduct a phone questionnaire assessing for IUD expulsion.

Inclusion Criteria:

• Patients admitted to Thomas Jefferson University Labor and Delivery who desire and consent to post-placental LNG-IUD placement
• English- and Spanish- speaking patients

Exclusion Criteria:

• Patients undergoing planned or unplanned Cesarean delivery
• Patients who have an allergy or other contraindication to use of LNG-IUD
• Patients who tested positive for gonorrhea or chlamydia during pregnancy without treatment and a subsequent negative test of cure
• Patients with one or more leiomyomata greater than 3 cm in diameter impinging the uterine cavity
• Clinical diagnosis of chorioamnionitis or presumed chorioamnionitis in labor
• Postpartum hemorrhage as defined by need for transfusion, estimated blood loss greater than 1000mL, or use of 3 or more doses of uterotonic medications