Postplacental Levonorgestrel Intrauterine Device String Complications at a Large County Hospital in Texas [ID 1130]

INTRODUCTION: Postplacental intrauterine device (IUD) placement, although safe and effective, has increased risk compared to delayed placement; risk must be balanced with access considerations. We describe string complications following postplacental levonorgestrel (LNG) IUD availability at a high-volume county hospital. METHODS: Patients who delivered at over 24 weeks of gestation and received a postplacental IUD from August 2022 to February 2023 were included in this cohort study. Intrauterine device-related outcomes were collected 1 year post-delivery with string complications defined as missing or long strings necessitating ultrasound (US) IUD localization or strings requiring trimming. RESULTS: A total of 487 patients received postplacental IUD; 321 (65.9%) delivered vaginally (VD) and 166 (34.1%) via cesarean (CD). Postpartum follow-up rate was 61.8%. A total of 138 (28.3%) patients experienced string complications; missing or long strings requiring ultrasound IUD localization accounted for 55.8% of complications and string trim alone accounted for the remaining. There was no difference in overall string complication rates between VD and CD patients; however, there was a significantly higher proportion of patients requiring US IUD localization after CD than VD (26.5% versus 10.3%, P <.0001). Of the 62 patients who completed US, 75.8% had an appropriately positioned IUD in situ. CONCLUSIONS/IMPLICATIONS: In this study, which is the largest single-site US cohort, string complications occurred in 28% of patients. Although US localization was more common after CD, most US confirmed an appropriately placed IUD. String complications may require additional visits and create stress for patients. Patients should be counseled about string complication risks to make an informed decision about IUD placement timing after delivery.