Association between Position of Post-Partum Intrauterine Device (PPIUCD) as Detected by Immediate Sonography and Expulsion Rate at 6- Weeks and 12-Weeks

Background: The postpartum period is a critical time for initiating effective contraception to prevent unintended pregnancies and promote maternal health. Intrauterine contraceptive devices (IUCDs), particularly the copper T device, are favored for their long-term efficacy and minimal maintenance. However, the expulsion of postpartum IUCDs (PPIUCDs) remains a significant concern, potentially compromising their effectiveness. This study aims to investigate the association between the expulsion of PPIUCDs at 6 weeks and 12 weeks post-insertion and their location as confirmed by ultrasonography. Methods: This was a prospective cohort study of 100 postpartum women who underwent normal vaginal delivery followed by PPIUCD placement was studied. IUCD positioning was confirmed via ultrasonography and expulsion rates were recorded at 6- and 12-weeks post-insertion. Results: The mean age of the participants was 25.3 years. 67 IUCDs were correctly positioned at the fundus and 33 mispositioned (11 lower, 11 lateral, and 11 mid-cavity). At 6 weeks, 5 women experienced IUCD expulsion, with 4 of these expulsions occurring in mid-cavity positions. By 12 weeks, an additional 9 expulsions were recorded, distributed across various mispositions. Statistical analysis revealed a significant association between IUCD location and expulsion rates, while age and parity were not significantly associated with expulsion. Conclusion: The study highlights the critical role of IUCD location in determining expulsion rates. Ensuring correct fundal placement and routine ultrasonographic follow-up can significantly improve the success rates of PPIUCDs, enhancing postpartum contraception efficacy and reducing unintended pregnancies.