Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Inserción inmediata posparto del dispositivo intrauterino para la anticoncepción

Information

DOI:
https://doi.org/10.1002/14651858.CD003036.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 26 June 2015see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Fertility Regulation Group

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • Laureen M Lopez

    Correspondence to: Clinical and Epidemiological Sciences, FHI 360, Durham, USA

    [email protected]

  • Alissa Bernholc

    Biostatistics, FHI 360, Durham, USA

  • David Hubacher

    Contraceptive Technology Innovation Dept, FHI 360, Durham, USA

  • Gretchen Stuart

    Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA

  • Huib AAM Van Vliet

    Department of Gynaecology, Division of Reproductive Medicine, Catharina Hospital Eindhoven, Eindhoven, Netherlands

Contributions of authors

Initial review (2001): David A Grimes (formerly of FHI 360) and Kenneth F Schulz (FHI 360) developed the proposal, conducted the literature search, extracted the data, and performed the analysis. Huib van Vliet and Nancy Stanwood were co‐authors who contributed to the writing and revising of the review. At the time, N Stanwood was with the University of Rochester Medical Center (NY).

2005 to 2010: LM Lopez wrote the plain language summary, entered data from original studies into tables, and reviewed search results. In 2010, she incorporated data from an abstract.

2015: LM Lopez conducted the searches, marked the data for extraction from the included studies, and wrote the results and discussion. A Bernholc entered study characteristics and outcome data, and drafted summary tables. G Stuart and D Hubacher clarified technical and clinical issues in the text, and commented on the responses to the peer reviewers. All authors reviewed and commented on the manuscript.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Institute of Child Health and Human Development, USA.

    2000 to 2015: Support for conducting the review and updates at FHI 360

  • US Agency for International Development, USA.

    2000 to 2010: Support for conducting the review and updates at FHI 360
    2014: This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of The Evidence Project, cooperative agreement no. AID‐OAA‐A‐13‐00087. The findings and conclusions are the sole responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.

Declarations of interest

Family Health International, now known as FHI 360, conducted two trials (Cole 1984: Kisnisci 1985). An employee of FHI 360 was involved in two trials (Lavin 1983; Apelo 1985). Authors of this review are employed at FHI 360, but none were involved in those trials.

Acknowledgements

Carol Manion of FHI 360 assisted with the literature searches for the initial review and updates.

Version history

Published

Title

Stage

Authors

Version

2015 Jun 26

Immediate postpartum insertion of intrauterine device for contraception

Review

Laureen M Lopez, Alissa Bernholc, David Hubacher, Gretchen Stuart, Huib AAM Van Vliet

https://doi.org/10.1002/14651858.CD003036.pub3

2010 May 12

Immediate post‐partum insertion of intrauterine devices

Review

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

https://doi.org/10.1002/14651858.CD003036.pub2

2001 Apr 23

Immediate post‐partum insertion of intrauterine devices

Review

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

https://doi.org/10.1002/14651858.CD003036

Keywords

MeSH

Medical Subject Headings Check Words

Female; Humans; Pregnancy;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram (2015)
Figures and Tables -
Figure 1

Study flow diagram (2015)

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 1 Placement (insertion).
Figures and Tables -
Analysis 1.1

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 1 Placement (insertion).

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 2 Expulsion by 6 months.
Figures and Tables -
Analysis 1.2

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 2 Expulsion by 6 months.

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 3 Use at 3 months.
Figures and Tables -
Analysis 1.3

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 3 Use at 3 months.

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 4 Use at 6 months.
Figures and Tables -
Analysis 1.4

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 4 Use at 6 months.

Study

Time frame

Immediate insertion

Early insertion

Reported P

Ahuja 2014

‐‐‐

N = 131

N = 132

‐‐‐

Ahuja 2014

6 weeks

24.1%

9.1%

.0037

Singh 2014

‐‐‐

N = 100

N = 100

‐‐‐

Singh 2014

6 months

8.3%

10.5%

.06

Figures and Tables -
Analysis 1.5

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 5 Expulsion.

Study

Immediate insertion

Early insertion

Reported P

Ahuja 2014

88.9%

74.1%

.0054

Ahuja 2014

N = 131

N = 132

‐‐‐

Singh 2014

83.5%

77.1%

.13

Singh 2014

N = 100

N = 100

‐‐‐

Figures and Tables -
Analysis 1.6

Comparison 1 Immediate postplacental insertion versus early insertion, Outcome 6 Use at 6 months.

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 1 Placement (insertion) per protocol.
Figures and Tables -
Analysis 2.1

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 1 Placement (insertion) per protocol.

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 2 Expulsion by 6 months.
Figures and Tables -
Analysis 2.2

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 2 Expulsion by 6 months.

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 3 Use at 6 months.
Figures and Tables -
Analysis 2.3

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 3 Use at 6 months.

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 4 Use at 3 months.
Figures and Tables -
Analysis 2.4

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 4 Use at 3 months.

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 5 Use at 12 months.
Figures and Tables -
Analysis 2.5

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 5 Use at 12 months.

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 6 Placement (insertion).
Figures and Tables -
Analysis 2.6

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 6 Placement (insertion).

Study

Immediate insertion

Early insertion

Ogburn 2013

N = 78

N = 78

Ogburn 2013

57%

59%

Figures and Tables -
Analysis 2.7

Comparison 2 Immediate postplacental insertion versus standard insertion, Outcome 7 Continued use at 12 months.

Study

Delta Loop

Lippes Loop D

Cole 1984

99.7%

99.7%

Figures and Tables -
Analysis 3.1

Comparison 3 Immediate postpartum insertion: Delta Loop versus Lippes Loop D, Outcome 1 Insertion per protocol.

Study

Delta Loop

Lippes Loop D

Cole 1984

15.7

21.5

Figures and Tables -
Analysis 3.2

Comparison 3 Immediate postpartum insertion: Delta Loop versus Lippes Loop D, Outcome 2 Life‐table rates per 100 women for expulsion (6‐month).

Study

Delta Loop

Lippes Loop D

Cole 1984

78.5

73.8

Figures and Tables -
Analysis 3.3

Comparison 3 Immediate postpartum insertion: Delta Loop versus Lippes Loop D, Outcome 3 Life‐table rates per 100 women for continuation (6‐month).

Study

Delta Loop

Lippes Loop D

Cole 1984

62.7%

66.1%

Figures and Tables -
Analysis 3.4

Comparison 3 Immediate postpartum insertion: Delta Loop versus Lippes Loop D, Outcome 4 Life‐table rates per 100 women for follow‐up (6‐month).

Study

Delta T

TCu 220 C

Cole 1984

99.9%

99.7%

Figures and Tables -
Analysis 4.1

Comparison 4 Immediate postpartum insertion: Delta T versus TCu 220 C, Outcome 1 Insertion per protocol.

Study

Delta T

TCu 220 C

Cole 1984

11.6

11.5

Figures and Tables -
Analysis 4.2

Comparison 4 Immediate postpartum insertion: Delta T versus TCu 220 C, Outcome 2 Life‐table rates per 100 women for expulsion (6‐month).

Study

Delta T

TCu 220 C

Cole 1984

81.8

81.8

Figures and Tables -
Analysis 4.3

Comparison 4 Immediate postpartum insertion: Delta T versus TCu 220 C, Outcome 3 Life‐table rates per 100 women for continuation (6‐month).

Study

Delta T

TCu 220 C

Cole 1984

71.0%

70.9%

Figures and Tables -
Analysis 4.4

Comparison 4 Immediate postpartum insertion: Delta T versus TCu 220 C, Outcome 4 Life‐table rates per 100 women for follow‐up (6‐month).

Study

Delta Loop
Hand Insertion

Delta Loop
Instrument Insertion

Cole 1984

99.7%

99.7%

Figures and Tables -
Analysis 5.1

Comparison 5 Immediate postpartum insertion: Delta Loop (hand versus instrument insertion), Outcome 1 Insertion per protocol.

Study

Hand insertion

Instrument insertion

Cole 1984

11.2

11.5

Figures and Tables -
Analysis 5.2

Comparison 5 Immediate postpartum insertion: Delta Loop (hand versus instrument insertion), Outcome 2 Life‐table rates per 100 women for expulsion (6‐month).

Study

Hand insertion

Instrument insertion

Cole 1984

84.2

82.6

Figures and Tables -
Analysis 5.3

Comparison 5 Immediate postpartum insertion: Delta Loop (hand versus instrument insertion), Outcome 3 Life‐table rates per 100 women for continuation (6‐month).

Study

Delta Loop
Hand insertion

Delta Loop
Instrument insertion

Cole 1984

84.2%

83.0%

Figures and Tables -
Analysis 5.4

Comparison 5 Immediate postpartum insertion: Delta Loop (hand versus instrument insertion), Outcome 4 Life‐table rates per 100 women for follow‐up (6‐month).

Comparison 6 Immediate postpartum insertion: Delta T versus Delta Loop, Outcome 1 Insertion per protocol.
Figures and Tables -
Analysis 6.1

Comparison 6 Immediate postpartum insertion: Delta T versus Delta Loop, Outcome 1 Insertion per protocol.

Study

Delta T

Delta Loop

Kisnisci 1985

7.6

3.7

Figures and Tables -
Analysis 6.2

Comparison 6 Immediate postpartum insertion: Delta T versus Delta Loop, Outcome 2 Life‐table rates per 100 women for expulsion (12‐month).

Study

Delta T

Delta Loop

Kisnisci 1985

0

2.1

Figures and Tables -
Analysis 6.3

Comparison 6 Immediate postpartum insertion: Delta T versus Delta Loop, Outcome 3 Life‐table rates per 100 women for pregnancy (12‐month).

Study

Delta T

Delta Loop

Kisnisci 1985

1.0

1.1

Figures and Tables -
Analysis 6.4

Comparison 6 Immediate postpartum insertion: Delta T versus Delta Loop, Outcome 4 Life‐table rates per 100 women for removal due to bleeding or pain (12‐month).

Study

Delta T

Delta Loop

Kisnisci 1985

90.7

93.3

Figures and Tables -
Analysis 6.5

Comparison 6 Immediate postpartum insertion: Delta T versus Delta Loop, Outcome 5 Life‐table rates per 100 women for continuation (12‐month).

Study

Delta T

Delta Loop

Kisnisci 1985

86.7%

78.9%

Figures and Tables -
Analysis 6.6

Comparison 6 Immediate postpartum insertion: Delta T versus Delta Loop, Outcome 6 Life‐table rates per 100 women for follow‐up (12‐month).

Study

TCu 200

Progestasert

Lavin 1983

9.0

35.8

Figures and Tables -
Analysis 7.1

Comparison 7 Immediate postpartum insertion: TCu 200 versus Progestasert, Outcome 1 Hand insertion: Life‐table rates per 100 women for expulsion (12‐month).

Study

TCu 200

Progestasert

Lavin 1983

8.1

35.2

Figures and Tables -
Analysis 7.2

Comparison 7 Immediate postpartum insertion: TCu 200 versus Progestasert, Outcome 2 Instrument insertion: Life‐table rates per 100 women for expulsion (12‐month).

Study

TCu 200

Progestasert

Lavin 1983

86.3

59.9

Figures and Tables -
Analysis 7.3

Comparison 7 Immediate postpartum insertion: TCu 200 versus Progestasert, Outcome 3 Hand insertion: Life‐table rates per 100 women for continuation (12‐month).

Study

TCu 200

Progestasert

Lavin 1983

86.1

57.2

Figures and Tables -
Analysis 7.4

Comparison 7 Immediate postpartum insertion: TCu 200 versus Progestasert, Outcome 4 Instrument insertion: Life‐table rates per 100 women for continuation (12‐month).

Study

Insertion method

TCu 200

Progestasert

Lavin 1983

Hand

76.1

77.4

Lavin 1983

Instrument

69.7

67.7

Figures and Tables -
Analysis 7.5

Comparison 7 Immediate postpartum insertion: TCu 200 versus Progestasert, Outcome 5 Life‐table rates per 100 women for follow‐up (12‐month).

Study

TCu 200 (hand)

TCu 200 (inserter)

IPCS‐52 (hand)

IPCS‐52 (inserter)

Apelo 1985

19.9

10.3

39.0

14.2

Figures and Tables -
Analysis 8.1

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month) by device and insertion method.

Study

TCu 200 (hand)

TCu 200 (inserter)

IPCS‐52 (hand)

IPCS‐52 (inserter)

Apelo 1985

5.5

0

3.2

5.2

Figures and Tables -
Analysis 8.2

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 2 Life‐table rates per 100 women for removal due to bleeding or pain (12‐month) by device and insertion method.

Study

TCu 200 (hand)

TCu 200 (inserter)

IPCS‐52 (hand)

IPCS‐52 (inserter)

Apelo 1985

73.8

84.9

57.3

77.1

Figures and Tables -
Analysis 8.3

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 3 Life‐table rates per 100 women for continuation (12‐month) by device and insertion method.

Study

TCu 200 (hand)

TCu 200 (inserter)

IPCS‐52 (hand)

IPCS‐52 (inserter)

Apelo 1985

19.9

13.1

39.0

24.2

Figures and Tables -
Analysis 8.4

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 4 Life‐table rates per 100 women for expulsion (36‐month) by device and insertion method.

Study

TCu 200 (hand)

TCu 200 (inserter)

IPCS‐52 (hand)

IPCS‐52 (inserter)

Apelo 1985

67.7

62.9

52.3

55.8

Figures and Tables -
Analysis 8.5

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 5 Life‐table rates per 100 women for continuation (36‐month) by device and insertion method.

Study

TCu 200 (pooled)

IPCS‐52 (pooled)

Apelo 1985

16.4

31.3

Figures and Tables -
Analysis 8.6

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 6 Life‐table rates per 100 women for expulsion (36‐month) by device pooled.

Study

Hand (pooled)

Inserter (pooled)

Apelo 1985

29.2

18.5

Figures and Tables -
Analysis 8.7

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 7 Life‐table rates per 100 women for expulsion (36‐month) by method pooled.

Study

TCu 200 (hand)

TCu 200 (inserter)

IPCS‐52 (hand)

IPCS‐52 (inserter)

Apelo 1985

71.1%

99.1%

82.8%

82.5%

Figures and Tables -
Analysis 8.8

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 8 Life‐table rates per 100 women for follow‐up (12‐month) by device and insertion method.

Study

TCu 200 (hand)

TCu 200 (inserter)

IPCS‐52 (hand)

IPCS‐52 (inserter)

Apelo 1985

55.6%

63.9%

66.7%

54.8%

Figures and Tables -
Analysis 8.9

Comparison 8 Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg, Outcome 9 Life‐table rates per 100 women for follow‐up (36‐month) by device and insertion method.

Study

Nova‐T‐PP

Lippes Loop

Copper 7

WHO 1980

41.3

44.1

34.8

Figures and Tables -
Analysis 9.1

Comparison 9 Immediate postpartum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month).

Study

Nova‐T‐PP

Lippes Loop

Copper 7

WHO 1980

5.6

12.1

7.2

Figures and Tables -
Analysis 9.2

Comparison 9 Immediate postpartum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7, Outcome 2 Life‐table rates per 100 women for pregnancy (12‐month).

Study

Nova‐T‐PP

Lippes Loop

Copper 7

WHO 1980

53.1

60.9

47.7

Figures and Tables -
Analysis 9.3

Comparison 9 Immediate postpartum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7, Outcome 3 Life‐table rates per 100 women for discontinuation (12‐month).

Study

Nova‐T‐PP

Lippes Loop

Copper 7

WHO 1980

17.8%

16.2%

16.0%

Figures and Tables -
Analysis 9.4

Comparison 9 Immediate postpartum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7, Outcome 4 Loss to follow‐up (unclear time frame).

Study

Nova‐T‐PP

Nova‐T

Van Kets 1987

6.2

6.6

Figures and Tables -
Analysis 10.1

Comparison 10 Immediate postpartum insertion: Nova‐T‐PP versus Nova‐T, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month).

Study

Nova‐T‐PP

Nova‐T

Van Kets 1987

0.6

0

Figures and Tables -
Analysis 10.2

Comparison 10 Immediate postpartum insertion: Nova‐T‐PP versus Nova‐T, Outcome 2 Life‐table rates per 100 women for pregnancy (12‐month).

Study

Nova‐T‐PP

Nova‐T

Van Kets 1987

87.4

78.2

Figures and Tables -
Analysis 10.3

Comparison 10 Immediate postpartum insertion: Nova‐T‐PP versus Nova‐T, Outcome 3 Life‐table rates per 100 women for continuation (12‐month).

Study

Nova‐T‐PP

Nova‐T

Van Kets 1987

6.2

6.2

Figures and Tables -
Analysis 10.4

Comparison 10 Immediate postpartum insertion: Nova‐T‐PP versus Nova‐T, Outcome 4 Life‐table rates per 100 women for loss to follow‐up (12‐month).

Study

TCu 200

ML Cu 250

Thiery 1980

11.2

9.9

Figures and Tables -
Analysis 11.1

Comparison 11 Immediate postpartum insertion: TCu 200 versus ML Cu 250, Outcome 1 Life‐table rates per 100 women for expulsion (12‐month).

Study

TCu 200

ML Cu 250

Thiery 1980

0.5

2.4

Figures and Tables -
Analysis 11.2

Comparison 11 Immediate postpartum insertion: TCu 200 versus ML Cu 250, Outcome 2 Life‐table rates per 100 women for pregnancy (12‐month).

Study

TCu 200

ML Cu 250

Thiery 1980

77.2

77.3

Figures and Tables -
Analysis 11.3

Comparison 11 Immediate postpartum insertion: TCu 200 versus ML Cu 250, Outcome 3 Life‐table rates per 100 women for continuation (12‐month).

Study

TCu 200

ML Cu 250

Thiery 1980

2.0

1.6

Figures and Tables -
Analysis 11.4

Comparison 11 Immediate postpartum insertion: TCu 200 versus ML Cu 250, Outcome 4 Life‐table rates per 100 women for loss to follow‐up (12‐month).

Comparison 12 Immediate postpartum insertion: CuT 380A (hand versus instrument insertion), Outcome 1 Expulsion by 6 months.
Figures and Tables -
Analysis 12.1

Comparison 12 Immediate postpartum insertion: CuT 380A (hand versus instrument insertion), Outcome 1 Expulsion by 6 months.

Comparison 12 Immediate postpartum insertion: CuT 380A (hand versus instrument insertion), Outcome 2 Continuation at 6 months.
Figures and Tables -
Analysis 12.2

Comparison 12 Immediate postpartum insertion: CuT 380A (hand versus instrument insertion), Outcome 2 Continuation at 6 months.

Immediate insertion compared with early insertion for postpartum IUC

Patient or population: postpartum women with desire for contraceptive

Setting: hospital or clinic

Intervention: immediate postplacental insertion (within 10 minutes)

Comparison: early insertion (10 minutes to 48 hours post delivery)

Outcomes

Relative effect
(95% CI)

Participants
(studies)

Quality of the evidence
(GRADE)

Expulsion by 6 months

OR 1.00

(95% CI 0.20 to 5.04)

30
(1 study)

⊕⊕⊕⊝

Moderate

IUC use at 6 months

OR 0.46

(95% CI 0.04 to 5.75)

30
(1 study)

⊕⊕⊕⊝
Moderate

CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -

Immediate insertion compared with standard insertion for postpartum IUC

Patient or population: postpartum women with desire for contraceptive

Setting: hospital or clinic

Intervention: immediate postplacental insertion (within 10 minutes)

Comparison: standard insertion (at postpartum visit)

Outcomes

Relative effect
(95% CI)

Participants
(studies)

Quality of the evidence
(GRADE)

Placement per protocol

OR 4.07

(95% CI 0.54 to 30.40); I2 = 68%

243

(4 studies)

⊕⊕⊕⊝
Moderate

Expulsion by 6 months

OR 4.89

(95% CI 1.47 to 16.32)

210

(4 studies)

⊕⊕⊕⊝

Moderate

IUC use at 6 months

OR 2.04

(95% CI 1.01 to 4.09)

243

(4 studies)

⊕⊕⊕⊝
Moderate

CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figures and Tables -
Table 1. Intervention and quality summary

Study

Delivery type

IUC

Inadequate
randomization
and allocation concealment

No blinding

Loss to follow‐up
> 20%

Quality of evidencea

Immediate versus early insertion (10 minutes to 48 hours)

Dahlke 2011

Vaginal

LNG‐IUS

_

‐1

_

Moderate

Ahuja 2014b

Vaginal

CuT 380A

_

‐1

Unclear

Moderate

Singh 2014b

Vaginal or cesarean

CuT 380A

‐1

Unclear

Unclear

Low

Immediate versus standard insertion (weeks)

Chen 2010

Vaginal

LNG‐IUS (6 to 8 weeks)

_

_

_

High

Dahlke 2011

Vaginal

LNG‐IUS (> 6 weeks)

_

‐1

_

Moderate

Whitaker 2014

Cesarean

LNG‐IUS (4 to 8 weeks)

_

_

‐1

Moderate

Lester 2015

Cesarean

CuT 380A (6 weeks)

_

‐1

_

Moderate

Ogburn 2013b

Vaginal or cesarean

CuT 380A (4 to 12 weeks)

‐1

Unclear

Unclear

Low

Immediate insertion: IUC types, modifications, or insertion techniques

Thiery 1980

Unclear

Multiload 250 versus CuT 200

‐1

Unclear

_

Moderate

WHO 1980

Vaginal

Copper 7 versus Lippes Loop D vs Nova‐T‐PP

_

‐1

_

Moderate

Van Kets 1987

Unclear

Nova‐T‐PP vs Nova T

‐1

Unclear

_

Moderate

Lavin 1983

Unclear

Progestasert vs CuT 200

_

Unclear

‐1

Moderate

Apelo 1985

Vaginal

IPCS‐52 vs CuT 200

_

Unclear

‐1

Moderate

Cole 1984

Vaginal

  • Delta T vs TCu 220

  • Delta Loop vs Lippes Loop D

  • Delta T (hand vs mechanical insertion)

_

Unclear

‐1

Moderate

Kisnisci 1985

Unclear

Delta Loop vs Delta T

_

Unclear

_

Moderate

Xu 1996

Vaginal

CuT 380A: hand vs ring‐forceps insertion

_

_

_

High

aRCTs considered high quality initially, then downgraded for (1) no information on randomization sequence generation or allocation concealment, or one was clearly inadequate; (2) no blinding; (3) losses > 20%; (4) information missing for both blinding and losses. Follow‐up time not shown as all studies met criteria.
bNo full report; sources included conference abstracts and clinical trial listings.

Figures and Tables -
Table 1. Intervention and quality summary
Table 2. Immediate versus early or standard insertion: placement summary

Study

N

Placement (insertion) per protocol (%)

Immediate

Early

Standard

Chen 2010a

102

88

_

90

Dahlke 2011a

46

100

100

94

Whitaker 2014a

42

95

_

82

Lester 2015a

68

100

_

53

Ogburn 2013

156

87

_

77

Ahuja 2014

263

_

_

_

Singh 2014

200

_

_

_

aIn sensitivity analysis; sufficient outcome data and evidence of moderate or high quality (Table 1).

Figures and Tables -
Table 2. Immediate versus early or standard insertion: placement summary
Table 3. Immediate versus early or standard insertion: use and expulsion summary

Study

N

Use at
6 monthsa (%)

Expulsion by
6 monthsb (%)

Immediate

Early

Standard

Immediate

Early

Standard

Chen 2010c

102

84

_

77

22d

_

4

Dahlke 2011c

46

87

93

94

27

27

0

Whitaker 2014c

42

70

_

59

20

_

0

Lester 2015c

68

79

_

47

3

_

6

Ogburn 2013

156

57

_

59

_

_

_

Ahuja 2014

263

89

74

_

9

24

_

Singh 2014

200

84

77

_

8

11

_

aUse based on women randomized; Ogburn 2013 assessed at 12 months.
bExpulsion based on IUC placed (Table 2); Ahuja 2014 assessed at 6 weeks.
cIn sensitivity analysis; sufficient outcome data and evidence of moderate or high quality (Table 1).
dExcludes 5 women with IUC placed 11 to 15 minutes postplacental; does not significantly affect results.

Figures and Tables -
Table 3. Immediate versus early or standard insertion: use and expulsion summary
Table 4. Comparisons of devices or insertion techniques: outcome summary

Study

IUC

N

Insertion
technique

Placement
(insertion)
per protocol
(reported %)

Use at
6 monthsa

Expulsion by
6 monthsa

Life‐table rates
(reported)

Thiery 1980

TCu 200

269

_

_

85.0

9.4

Multiload 250

293

_

_

88.8

7.4

WHO 1980b

Copper 7

277

_

_

64.6

31.1

Lippes Loop D

250

_

_

48.1

41.3

Nova‐T‐PP

277

_

_

52.3

39.4

Van Kets 1987

Nova‐T‐PP

205

_

_

87.5

5.5

Nova T

203

_

_

88.4

6.0

Lavin 1983

Progestasert

100

Hand

_

59.9

35.8

100

Inserter

_

57.2

35.2

TCu 200

100

Hand

_

86.3

9.0

100

Inserter

_

86.1

8.1

Apelo 1985

IPCS‐52 mg

50

Hand

_

57.3

39.0

50

Inserter

_

79.6

14.2

TCu 200

50

Hand

_

81.9

14.1

50

inserter

_

89.7

10.3

Cole 1984

Delta T

728

_

99.9

81.8

11.6

TCu 220

718

_

99.7

81.8

11.5

Delta Loop

662

_

99.7

78.5

15.7

Lippes Loop D

648

_

99.7

73.8

21.5

Delta T

518

Hand

99.7

84.2

11.2

517

Mechanical

99.7

82.6

11.5

Kisnisci 1985

Delta Loop

122

_

99.2

96.3

3.7

Delta T

124

_

100.0

90.7

7.6

Percent

Xu 1996

CuT 380A

470

Hand

_

81.3

13.0

440

Ring‐forceps

_

79.1

12.5

aLavin 1983 reported use and expulsion by 12 months.
bWHO 1980 excluded expulsions within 48 hours.

Figures and Tables -
Table 4. Comparisons of devices or insertion techniques: outcome summary
Comparison 1. Immediate postplacental insertion versus early insertion

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Placement (insertion) Show forest plot

1

30

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Expulsion by 6 months Show forest plot

1

30

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.20, 5.04]

3 Use at 3 months Show forest plot

1

30

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.04, 5.75]

4 Use at 6 months Show forest plot

1

30

Odds Ratio (M‐H, Fixed, 95% CI)

0.46 [0.04, 5.75]

5 Expulsion Show forest plot

Other data

No numeric data

6 Use at 6 months Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 1. Immediate postplacental insertion versus early insertion
Comparison 2. Immediate postplacental insertion versus standard insertion

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Placement (insertion) per protocol Show forest plot

4

243

Odds Ratio (M‐H, Random, 95% CI)

4.07 [0.54, 30.40]

2 Expulsion by 6 months Show forest plot

4

210

Odds Ratio (M‐H, Random, 95% CI)

4.89 [1.47, 16.32]

3 Use at 6 months Show forest plot

4

243

Odds Ratio (M‐H, Random, 95% CI)

2.04 [1.01, 4.09]

4 Use at 3 months Show forest plot

1

31

Odds Ratio (M‐H, Fixed, 95% CI)

0.43 [0.04, 5.35]

5 Use at 12 months Show forest plot

1

42

Odds Ratio (M‐H, Fixed, 95% CI)

2.17 [0.63, 7.44]

6 Placement (insertion) Show forest plot

1

156

Odds Ratio (M‐H, Fixed, 95% CI)

2.04 [0.87, 4.76]

7 Continued use at 12 months Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 2. Immediate postplacental insertion versus standard insertion
Comparison 3. Immediate postpartum insertion: Delta Loop versus Lippes Loop D

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Insertion per protocol Show forest plot

Other data

No numeric data

2 Life‐table rates per 100 women for expulsion (6‐month) Show forest plot

Other data

No numeric data

3 Life‐table rates per 100 women for continuation (6‐month) Show forest plot

Other data

No numeric data

4 Life‐table rates per 100 women for follow‐up (6‐month) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 3. Immediate postpartum insertion: Delta Loop versus Lippes Loop D
Comparison 4. Immediate postpartum insertion: Delta T versus TCu 220 C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Insertion per protocol Show forest plot

Other data

No numeric data

2 Life‐table rates per 100 women for expulsion (6‐month) Show forest plot

Other data

No numeric data

3 Life‐table rates per 100 women for continuation (6‐month) Show forest plot

Other data

No numeric data

4 Life‐table rates per 100 women for follow‐up (6‐month) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 4. Immediate postpartum insertion: Delta T versus TCu 220 C
Comparison 5. Immediate postpartum insertion: Delta Loop (hand versus instrument insertion)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Insertion per protocol Show forest plot

Other data

No numeric data

2 Life‐table rates per 100 women for expulsion (6‐month) Show forest plot

Other data

No numeric data

3 Life‐table rates per 100 women for continuation (6‐month) Show forest plot

Other data

No numeric data

4 Life‐table rates per 100 women for follow‐up (6‐month) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 5. Immediate postpartum insertion: Delta Loop (hand versus instrument insertion)
Comparison 6. Immediate postpartum insertion: Delta T versus Delta Loop

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Insertion per protocol Show forest plot

1

246

Odds Ratio (M‐H, Fixed, 95% CI)

3.07 [0.12, 76.20]

2 Life‐table rates per 100 women for expulsion (12‐month) Show forest plot

Other data

No numeric data

3 Life‐table rates per 100 women for pregnancy (12‐month) Show forest plot

Other data

No numeric data

4 Life‐table rates per 100 women for removal due to bleeding or pain (12‐month) Show forest plot

Other data

No numeric data

5 Life‐table rates per 100 women for continuation (12‐month) Show forest plot

Other data

No numeric data

6 Life‐table rates per 100 women for follow‐up (12‐month) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 6. Immediate postpartum insertion: Delta T versus Delta Loop
Comparison 7. Immediate postpartum insertion: TCu 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

5 Life‐table rates per 100 women for follow‐up (12‐month) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 7. Immediate postpartum insertion: TCu 200 versus Progestasert
Comparison 8. Immediate postpartum insertion: TCu 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 or 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

8 Life‐table rates per 100 women for follow‐up (12‐month) by device and insertion method Show forest plot

Other data

No numeric data

9 Life‐table rates per 100 women for follow‐up (36‐month) by device and insertion method Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 8. Immediate postpartum insertion: TCu 200 versus IPCS‐52 mg
Comparison 9. Immediate postpartum 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

4 Loss to follow‐up (unclear time frame) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 9. Immediate postpartum insertion: Nova‐T‐PP versus Lippes Loop versus Copper 7
Comparison 10. Immediate postpartum 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

4 Life‐table rates per 100 women for loss to follow‐up (12‐month) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 10. Immediate postpartum insertion: Nova‐T‐PP versus Nova‐T
Comparison 11. Immediate postpartum insertion: TCu 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

4 Life‐table rates per 100 women for loss to follow‐up (12‐month) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 11. Immediate postpartum insertion: TCu 200 versus ML Cu 250
Comparison 12. Immediate postpartum insertion: CuT 380A (hand versus instrument insertion)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Expulsion by 6 months Show forest plot

1

910

Odds Ratio (M‐H, Fixed, 95% CI)

1.04 [0.71, 1.54]

2 Continuation at 6 months Show forest plot

1

910

Odds Ratio (M‐H, Fixed, 95% CI)

1.15 [0.83, 1.59]

Figures and Tables -
Comparison 12. Immediate postpartum insertion: CuT 380A (hand versus instrument insertion)