Longitudinal impact of a residency-based postplacental levonorgestrel intrauterine device insertion program: Expulsion rates in years 1, 2, and 3.

OBJECTIVES: To evaluate expulsion rates in the first three years of an academic postplacental levonorgestrel intrauterine device (LNG-IUD) insertion program.

STUDY DESIGN: Retrospective case series, January, 2016-December, 2018. We measured LNG-IUD expulsion rates by 12 weeks postpartum.

RESULTS: Of 235 LNG-IUD insertions, in years 1, 2, and 3, expulsion rates were 11/39 (28%), 9/94 (10%), and 15/102 (15%) (p=0.03). After vaginal delivery, manual insertion was associated with a higher expulsion rate than ring-forceps (10/28 [36%] vs. 17/105 [16%], p=0.04).

CONCLUSIONS: LNG-IUD expulsion rates decreased after program year 1, suggesting program maturity may be associated with a lower expulsion risk.

IMPLICATIONS: Program maturation may be associated with lower LNG-IUD expulsion rates at training institutions, as may certain insertion technique decisions.