Immediate post‐partum insertion of intrauterine devices

David A Grimes; Laureen M Lopez; Kenneth F Schulz; Huib AAM Van Vliet; Nancy L. Stanwood

doi:10.1002/14651858.CD003036.pub2

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Study	Delta Loop	Lippes Loop D
Cole 1984	15.7	21.5

Analysis 1.1

Comparison 1 Immediate post‐partum insertion: Delta Loop versus Lippes Loop D, Outcome 1 Life‐table rates per 100 women for expulsion (6‐month).

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Study	Delta Loop	Lippes Loop D
Cole 1984	78.5	73.8

Analysis 1.2

Comparison 1 Immediate post‐partum insertion: Delta Loop versus Lippes Loop D, Outcome 2 Life‐table rates per 100 women for continuation (6‐month).

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Study	Delta T	TCu 220 C
Cole 1984	11.6	11.5

Analysis 2.1

Comparison 2 Immediate post‐partum insertion: Delta T versus TCu 220 C, Outcome 1 Life‐table rates per 100 women for expulsion (6‐month).

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Study	Delta T	TCu 220 C
Cole 1984	81.8	81.8

Analysis 2.2

Comparison 2 Immediate post‐partum insertion: Delta T versus TCu 220 C, Outcome 2 Life‐table rates per 100 women for continuation (6‐month).

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Study	Hand insertion	Instrument insertion
Cole 1984	11.2	11.5

Analysis 3.1

Comparison 3 Immediate post‐partum insertion: Delta Loop (hand versus instrument insertion), Outcome 1 Life‐table rates per 100 women for expulsion (6‐month).

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Study	Hand insertion	Instrument insertion
Cole 1984	84.2	82.6

Analysis 3.2

Comparison 3 Immediate post‐partum insertion: Delta Loop (hand versus instrument insertion), Outcome 2 Life‐table rates per 100 women for continuation (6‐month).

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Study	Delta T	Delta Loop
Kisnisci 1985	7.6	3.7

Analysis 4.1

Comparison 4 Immediate post‐partum insertion: Delta T versus Delta Loop, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month).

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Study	Delta T	Delta Loop
Kisnisci 1985	0	2.1

Analysis 4.2

Comparison 4 Immediate post‐partum insertion: Delta T versus Delta Loop, Outcome 2 Life‐table rates per 100 women for pregnancy (12‐month).

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Study	Delta T	Delta Loop
Kisnisci 1985	1.0	1.1

Analysis 4.3

Comparison 4 Immediate post‐partum insertion: Delta T versus Delta Loop, Outcome 3 Life‐table rates per 100 women for removal due to bleeding / pain (12‐month).

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Study	Delta T	Delta Loop
Kisnisci 1985	90.7	93.3

Analysis 4.4

Comparison 4 Immediate post‐partum insertion: Delta T versus Delta Loop, Outcome 4 Life‐table rates per 100 women for continuation (12‐month).

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Study	T Cu 200	Progestasert
Lavin 1983	9.0	35.8

Analysis 5.1

Comparison 5 Immediate post‐partum insertion: T Cu 200 versus Progestasert, Outcome 1 Hand insertion: Life‐table rates per 100 women for expulsion (12‐month).

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Study	T Cu 200	Progestasert
Lavin 1983	8.1	35.2

Analysis 5.2

Comparison 5 Immediate post‐partum insertion: T Cu 200 versus Progestasert, Outcome 2 Instrument insertion: Life‐table rates per 100 women for expulsion (12‐month).

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Study	T Cu 200	Progestasert
Lavin 1983	86.3	59.9

Analysis 5.3

Comparison 5 Immediate post‐partum insertion: T Cu 200 versus Progestasert, Outcome 3 Hand insertion: Life‐table rates per 100 women for continuation (12‐month).

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Study	T Cu 200	Progestasert
Lavin 1983	86.1	57.2

Analysis 5.4

Comparison 5 Immediate post‐partum insertion: T Cu 200 versus Progestasert, Outcome 4 Instrument insertion: Life‐table rates per 100 women for continuation (12‐month).

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Study	T Cu 200 (hand)	T Cu 200 (inserter)	IPCS‐52 (hand)	IPCS‐52 (inserter)
Apelo 1985	19.9	10.3	39.0	14.2

Analysis 6.1

Comparison 6 Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month) by device and insertion method.

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Study	T Cu 200 (hand)	T Cu 200 (inserter)	IPCS‐52 (hand)	IPCS‐52 (inserter)
Apelo 1985	5.5	0	3.2	5.2

Analysis 6.2

Comparison 6 Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg, Outcome 2 Life‐table rates per 100 women for removal due to bleeding / pain (12‐month) by device and insertion method.

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Study	T Cu 200 (hand)	T Cu 200 (inserter)	IPCS‐52 (hand)	IPCS‐52 (inserter)
Apelo 1985	73.8	84.9	57.3	77.1

Analysis 6.3

Comparison 6 Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg, Outcome 3 Life‐table rates per 100 women for continuation (12‐month) by device and insertion method.

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Study	T Cu 200 (hand)	T Cu 200 (inserter)	IPCS‐52 (hand)	IPCS‐52 (inserter)
Apelo 1985	19.9	13.1	39.0	24.2

Analysis 6.4

Comparison 6 Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg, Outcome 4 Life‐table rates per 100 women for expulsion (36‐month) by device and insertion method.

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Study	T Cu 200 (hand)	T Cu 200 (inserter)	IPCS‐52 (hand)	IPCS‐52 (inserter)
Apelo 1985	67.7	62.9	52.3	55.8

Analysis 6.5

Comparison 6 Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg, Outcome 5 Life‐table rates per 100 women for continuation (36‐month) by device and insertion method.

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Study	T Cu 200 (pooled)	IPCS‐52 (pooled)
Apelo 1985	16.4	31.3

Analysis 6.6

Comparison 6 Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg, Outcome 6 Life‐table rates per 100 women for expulsion (36‐month) by device pooled.

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Study	Hand (pooled)	Inserter (pooled)
Apelo 1985	29.2	18.5

Analysis 6.7

Comparison 6 Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg, Outcome 7 Life‐table rates per 100 women for expulsion (36‐month) by method pooled.

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Study	Nova‐T‐PP	Lippes Loop	Copper 7
WHO 1980	41.3	44.1	34.8

Analysis 7.1

Comparison 7 Immediate post‐partum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month).

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Study	Nova‐T‐PP	Lippes Loop	Copper 7
WHO 1980	5.6	12.1	7.2

Analysis 7.2

Comparison 7 Immediate post‐partum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7, Outcome 2 Life‐table rates per 100 women for pregnancy (12‐month).

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Study	Nova‐T‐PP	Lippes Loop	Copper 7
WHO 1980	53.1	60.9	47.7

Analysis 7.3

Comparison 7 Immediate post‐partum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7, Outcome 3 Life‐table rates per 100 women for discontinuation (12‐month).

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Study	Nova‐T‐PP	Nova‐T
Van Kets 1987	6.2	6.6

Analysis 8.1

Comparison 8 Immediate post‐partum insertion: Nova‐T‐PP versus Nova‐T, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month).

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Study	Nova‐T‐PP	Nova‐T
Van Kets 1987	0.6	0

Analysis 8.2

Comparison 8 Immediate post‐partum insertion: Nova‐T‐PP versus Nova‐T, Outcome 2 Life‐table rates per 100 women for pregnancy (12‐month).

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Study	Nova‐T‐PP	Nova‐T
Van Kets 1987	87.4	78.2

Analysis 8.3

Comparison 8 Immediate post‐partum insertion: Nova‐T‐PP versus Nova‐T, Outcome 3 Life‐table rates per 100 women for continuation (12‐month).

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Study	T Cu 200	ML Cu 250
Thiery 1980	11.2	9.9

Analysis 9.1

Comparison 9 Immediate post‐partum insertion: T Cu 200 versus ML Cu 250, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month).

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Study	T Cu 200	ML Cu 250
Thiery 1980	0.5	2.4

Analysis 9.2

Comparison 9 Immediate post‐partum insertion: T Cu 200 versus ML Cu 250, Outcome 2 Life‐table rates per 100 women for pregnancy (12‐month).

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Study	T Cu 200	ML Cu 250
Thiery 1980	77.2	77.3

Analysis 9.3

Comparison 9 Immediate post‐partum insertion: T Cu 200 versus ML Cu 250, Outcome 3 Life‐table rates per 100 women for continuation (12‐month).

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Study	Hand insertion	Instrument insertion
Xu 1996	13.3	12.7

Analysis 10.1

Comparison 10 Immediate post‐partum insertion: TCu 380A (hand versus instrument insertion), Outcome 1 Life‐table rates per 100 women for expulsion (6‐month).

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Study	Hand insertion	Instrument insertion
Xu 1996	2.1	1.0

Analysis 10.2

Comparison 10 Immediate post‐partum insertion: TCu 380A (hand versus instrument insertion), Outcome 2 Life‐table rates per 100 women for removal for bleeding / pain (6‐month).

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Analysis 11.1

Comparison 11 Immediate postplacental insertion versus delayed insertion of LNG IUD after vaginal delivery, Outcome 1 Pregnancy by 6 months.

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Analysis 11.2

Comparison 11 Immediate postplacental insertion versus delayed insertion of LNG IUD after vaginal delivery, Outcome 2 Expulsion by 6 months.

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Analysis 11.3

Comparison 11 Immediate postplacental insertion versus delayed insertion of LNG IUD after vaginal delivery, Outcome 3 Use at 6 months.

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Comparison 1. Immediate post‐partum insertion: Delta Loop versus Lippes Loop D

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (6‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for continuation (6‐month) Show forest plot			Other data	No numeric data

Comparison 1. Immediate post‐partum insertion: Delta Loop versus Lippes Loop D

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Comparison 2. Immediate post‐partum insertion: Delta T versus TCu 220 C

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (6‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for continuation (6‐month) Show forest plot			Other data	No numeric data

Comparison 2. Immediate post‐partum insertion: Delta T versus TCu 220 C

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Comparison 3. Immediate post‐partum insertion: Delta Loop (hand versus instrument insertion)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (6‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for continuation (6‐month) Show forest plot			Other data	No numeric data

Comparison 3. Immediate post‐partum insertion: Delta Loop (hand versus instrument insertion)

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Comparison 4. Immediate post‐partum insertion: Delta T versus Delta Loop

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (12‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for pregnancy (12‐month) Show forest plot			Other data	No numeric data

3 Life‐table rates per 100 women for removal due to bleeding / pain (12‐month) Show forest plot			Other data	No numeric data

4 Life‐table rates per 100 women for continuation (12‐month) Show forest plot			Other data	No numeric data

Comparison 4. Immediate post‐partum insertion: Delta T versus Delta Loop

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Comparison 5. Immediate post‐partum insertion: T Cu 200 versus Progestasert

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hand insertion: Life‐table rates per 100 women for expulsion (12‐month) Show forest plot			Other data	No numeric data

2 Instrument insertion: Life‐table rates per 100 women for expulsion (12‐month) Show forest plot			Other data	No numeric data

3 Hand insertion: Life‐table rates per 100 women for continuation (12‐month) Show forest plot			Other data	No numeric data

4 Instrument insertion: Life‐table rates per 100 women for continuation (12‐month) Show forest plot			Other data	No numeric data

Comparison 5. Immediate post‐partum insertion: T Cu 200 versus Progestasert

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Comparison 6. Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (12‐month) by device and insertion method Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for removal due to bleeding / pain (12‐month) by device and insertion method Show forest plot			Other data	No numeric data

3 Life‐table rates per 100 women for continuation (12‐month) by device and insertion method Show forest plot			Other data	No numeric data

4 Life‐table rates per 100 women for expulsion (36‐month) by device and insertion method Show forest plot			Other data	No numeric data

5 Life‐table rates per 100 women for continuation (36‐month) by device and insertion method Show forest plot			Other data	No numeric data

6 Life‐table rates per 100 women for expulsion (36‐month) by device pooled Show forest plot			Other data	No numeric data

7 Life‐table rates per 100 women for expulsion (36‐month) by method pooled Show forest plot			Other data	No numeric data

Comparison 6. Immediate post‐partum insertion: T Cu 200 versus IPCS‐52 mg

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Comparison 7. Immediate post‐partum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (12‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for pregnancy (12‐month) Show forest plot			Other data	No numeric data

3 Life‐table rates per 100 women for discontinuation (12‐month) Show forest plot			Other data	No numeric data

Comparison 7. Immediate post‐partum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7

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Comparison 8. Immediate post‐partum insertion: Nova‐T‐PP versus Nova‐T

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (12‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for pregnancy (12‐month) Show forest plot			Other data	No numeric data

3 Life‐table rates per 100 women for continuation (12‐month) Show forest plot			Other data	No numeric data

Comparison 8. Immediate post‐partum insertion: Nova‐T‐PP versus Nova‐T

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Comparison 9. Immediate post‐partum insertion: T Cu 200 versus ML Cu 250

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (12‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for pregnancy (12‐month) Show forest plot			Other data	No numeric data

3 Life‐table rates per 100 women for continuation (12‐month) Show forest plot			Other data	No numeric data

Comparison 9. Immediate post‐partum insertion: T Cu 200 versus ML Cu 250

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Comparison 10. Immediate post‐partum insertion: TCu 380A (hand versus instrument insertion)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Life‐table rates per 100 women for expulsion (6‐month) Show forest plot			Other data	No numeric data

2 Life‐table rates per 100 women for removal for bleeding / pain (6‐month) Show forest plot			Other data	No numeric data

Comparison 10. Immediate post‐partum insertion: TCu 380A (hand versus instrument insertion)

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Comparison 11. Immediate postplacental insertion versus delayed insertion of LNG IUD after vaginal delivery

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pregnancy by 6 months Show forest plot	1	102	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 Expulsion by 6 months Show forest plot	1	97	Odds Ratio (M‐H, Fixed, 95% CI)	6.77 [1.43, 32.14]

3 Use at 6 months Show forest plot	1	102	Odds Ratio (M‐H, Fixed, 95% CI)	1.65 [0.61, 4.47]

Comparison 11. Immediate postplacental insertion versus delayed insertion of LNG IUD after vaginal delivery

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