a) Immediately post-placental, or during or immediately after a Cesarean-section (special training required).
b) Prior to hospital discharge (up to 48 hours after delivery) (special training required).
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a-b) With the appropriate technique, IUDs inserted immediately after placental delivery or Cesarean section can be safe and effective. Expulsion rates for postpartum insertion vary greatly depending on both the IUD type and provider's technique. Current information indicates that the expulsion rates may be higher from 10 minutes to 48 hours after delivery than in the first 10 minute period. To minimize risk of expulsion, only properly trained providers (according to relevant national or institutional standards) should insert IUDs postpartum. Use of an inserter for IUD placement tends to reduce expulsion risk. Clients should be counseled that expulsion rates are higher postpartum than for interval insertion and should be carefully trained to detect expulsions.
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c) As early as 4 to 6 weeks postpartum, to accommodate women who come to the clinic for routine postpartum care and who request an IUD. Copper T IUDs may be safely inserted at this time. For other types of IUDs, it may be prudent to wait until 6 weeks postpartum.
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c) A Copper T may be safely inserted at 4 or more weeks postpartum. The withdrawal technique for Copper T insertion presumably helps minimize perforations when inserting IUDs at the routine 4 or 6 week postpartum visit. Other IUDs that have a different profile or a push insertion technique might have different perforation rates. Given the relative lack of information on other IUDs at 4 to 6 weeks postpartum, it is prudent to wait until 6 weeks for the insertion of IUDs other than Copper Ts.
- Chi I, Farr G. Postpartum IUD contraception - a review of an international experience. Advances in Contraception 1989;5:127-146.
- O'Hanley K, Huber D. Postpartum IUDs: Keys for success. Contraception 1992;45:351-361.
- Mishell DR, Roy S. Copper intrauterine contraceptive device event rates following insertion 4 to 8 weeks postpartum. American Journal of Obstetrics and Gynecology 1982;143(1):29-33.
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d) In breastfeeding women.
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d) It has been shown that IUDs can be safely used in breastfeeding women.
- Farr G, Rivera R. Interactions between intrauterine contraceptive devices use and breastfeeding status at time of intrauterine contraceptive device insertion: Analysis of Tcu-380A acceptors in developing countries. Advances in Contraception 1992;167(1):144-151.
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