Gurney EP, et al. - Researchers ascertained the proportion of TCu380A (copper) intrauterine devices expelled, partially expelled, malpositioned, and retained, as well as contraceptive use by 6 months postpartum. They also looked for the risk factors for expulsion and partial expulsion. Observations indicated a complete intrauterine device expulsion proportion of 8.0% at 6 months. Prior research findings suggesting the association of increasing parity with expulsion were supported. They noted a high proportion of partially expelled and malpositioned intrauterine devices. As per the area under the receiver operating characteristics curve of 0.5, a string check is suggested to be a poor test for assessing device position. They recommended counseling women considering a postplacental intrauterine device regarding the risk of position abnormalities, as well as the possibility of nonvisible strings.

Methods

• Researchers performed a prospective, observational study enrolling women who received a postplacental TCu380A intrauterine device at vaginal delivery postpartum.
• For clinical follow-up, participants returned at 6 weeks, and for a research visit with a pelvic exam and ultrasound, participants returned at 6 months.
• Intrauterine device outcomes and 6-month contraceptive use were recorded.
• In this study, they defined partial expulsion as an intrauterine device protruding from the external cervical os, or a transvaginal ultrasound displaying the distal end of the intrauterine device below the internal os of the cervix.
• Risk factors associated with expulsion and partial expulsion by 6 months were identified employing multinomial logistic regression models.
• They assessed the ability of a string check to predict the correct placement of a postplacental intrauterine device via using the area under the receiver operating characteristics curve.
• The proportion of intrauterine devices expelled at 6 months was assessed as the primary outcome.

Results

• Two hundred women were enrolled.
• At 6 months, 162 participants had follow-up data available; 13/162 (8.0%; 95% confidence interval, 4.7–13.4%) experienced complete expulsion and 26/162 (16.0%; 95% confidence interval, 11.1–22.6%) partial expulsion.
• Twenty five malpositioned intrauterine devices (15.4%; 95% confidence interval, 10.2–21.9%) were identified; 14/25 were not at the fundus (8.6%; 95% confidence interval, 5.2–14.1%) and 11/25 were rotated within the uterus (6.8%; 95% confidence interval, 3.8–11.9%).
• As per multinomial logistic regression modeling, higher parity (odds ratio, 2.05; 95% confidence interval, 1.21–3.50; P=.008) was noted to be correlated with expulsion.
• Partial expulsion was observed in association with provider specialty (obstetrics vs family medicine; odds ratio, 5.31; 95% confidence interval, 1.20–23.59; P=.03) and gestational weight gain (normal vs excess; odds ratio, 9.12; 95% confidence interval, 1.90–43.82; P=.004).
• At 6 months, long-acting reversible contraceptive method use was 80.9% (95% confidence interval, 74.0–86.6%).
• No visible intrauterine device strings was noted in 35 of 149 (23.5%; 95% confidence interval, 16.9–31.1%) participants at 6 weeks postpartum.
• To detect an incorrectly positioned intrauterine device, a string check displayed a sensitivity of 36.2%, and to predict a correctly positioned intrauterine device, it showed specificity of 84.5%.
• In this study, this corresponds to an area under the receiver operating characteristics curve of 0.5.