Manual Versus Forceps Postplacental IUD Insertion After Vaginal Delivery: A Randomized Clinical Trial

( Int J Gynaecol Obstet . 2026 Jan;172(1):510–517. doi: 10.1002/ijgo.70355) A randomized clinical trial evaluated whether the method used to insert a copper intrauterine device (IUD) immediately after vaginal delivery (VD) influences expulsion rates and patient outcomes. Specifically, it compared manual insertion with insertion using ring forceps, while also assessing pain, infection, uterine perforation, and bleeding as secondary outcomes. The study included 210 women admitted for VD at a teaching hospital in Brazil between December 2021 and June 2024. Participants were between 18 and 43 years old, had a singleton pregnancy beyond 37 weeks, and expressed a desire for a copper IUD without contraindications. They were randomly assigned in equal numbers to either manual insertion or forceps insertion. Women with certain complications, such as uterine abnormalities, infection or need for cesarean delivery, were excluded.