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Grand Rounds

Does LNG IUD Inserted Immediately Postpartum Affect Breastfeeding Success?

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BACKGROUND AND PURPOSE:

  • There is limited data on whether the timing of levonorgestrel (LNG) IUD placement postpartum can affect breastfeeding
  • Turok et al. (AJOG, 2017) examine the effect of immediate versus delayed postpartum LNG IUD placement on breastfeeding outcomes

METHODS:

  • Noninferiority randomized controlled trial
  • Women were categorized into the following groups
    • Immediate postpartum insertion within 30 minutes (132 women)
    • Delayed (12 weeks postpartum) insertion (127)
  • Ultrasound guidance not required but routinely used
  • Primary outcome was breastfeeding continuation at eight weeks
  • Secondary outcome was time to lactogenesis
  • Subjects were followed for 6 months

RESULTS:

  • Breastfeeding at 8 weeks in immediate group was not inferior to delayed group
  • Time to lactogenesis was noninferior to the delayed group (mean difference between groups was 1.7 hours)
  • 24 IUD expulsions occurred in the immediate group compared to 2 in the delayed group
    • 19% vs 2%, P < .001

CONCLUSION:

  • Results suggest that immediate postpartum IUD insertion is an acceptable option for women planning to breastfeed and use the levonorgestrel IUD
  • Although expulsion rates are higher in immediate insertion, this is outweighed by the benefits of this technique

Learn More – Primary Sources:

Immediate postpartum levonorgestrel IUD insertion & breastfeeding outcomes: A noninferiority randomized controlled trial

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Related ObG Topics:

IUDs and Implants: How to Manage Potential LARC Complications
Outcomes after Immediate Postpartum IUD Insertion

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