Separate STD Screening Unnecessary for Postpartum IUD Placement

WASHINGTON – It appears that only one postpartum visit is necessary for IUD placement, according to Dr. David R. Kattan.

A common protocol for placement of an IUD includes two postpartum visits: one for testing for STDs and a second to place the IUD, with the goal of preventing the development of pelvic inflammatory disease (PID). A retrospective study found that the rates of STDs were below 1% in women who requested an IUD, and that positivity for STDs in the postpartum period did not predict the development of pelvic inflammatory disease.

"Eliminating one of the two postpartum visits promises to increase the rate of IUD placement in women who seek a reliable contraceptive method post partum," said Dr. Kattan of the University of Colorado at Denver.

"Two postpartum visits for IUD insertion are unnecessary. Adopt what the American College of Obstetricians and Gynecologists already supports, which is a single-visit protocol for postpartum IUD insertion," he emphasized.

For women with no health insurance and little financial means, the postpartum visit may be the last time they see a doctor before proceeding with a second pregnancy. An IUD is an effective means of preventing unwanted pregnancy, yet many women who request an IUD fail to have one placed. Factors implicated in the failure to have an IUD placed include being counseled against using one, getting pregnant before having an IUD placed, and being lost to follow-up, Dr. Kattan explained.

Dr. Kattan and his colleagues hypothesized in their poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists that conflating testing for Chlamydia trachomatis and Neisseria gonorrhoeae with immediate IUD placement at one visit can improve the success rate of having an IUD implanted without increasing the rate of PID.

The study included 1,417 women receiving an IUD in the year 2008 at Denver Health Medical Center; of these, 629 (44%) met the inclusion criterion of having given birth within the previous 3 months. The average age was 25.3 years, and the average parity was 2.3.

At the preinsertion screening visit, five (0.8%) tested positive for chlamydia and one (0.16%) tested positive for gonorrhea. None of these six women developed PID. Three women did develop PID, and none of them tested positive for either of these organisms during pregnancy, the postpartum period, or at the time of PID diagnosis. None of these three women required hospitalization or removal of their IUD.

"Based on these data showing that a separate screening visit was unnecessary, practice at Denver Health Medical Center and the University of Colorado has changed. Residents at both sites are now taught one-visit IUD placement protocol," Dr. Kattan said. "One of the side benefits of adopting this protocol is the availability of a clinic appointment that would have otherwise been used for a second IUD placement visit. In a busy resident clinic, this means that women seeking gynecology care can be seen more quickly because an unnecessary clinic visit has been eliminated. One of the aims of my study is to reinforce a single-visit practice as the standard of care at other programs across the [United States]. Despite ACOG’s recommendations, practice is still sometimes slow to change."

Dr. Kattan said he had no relevant financial disclosures.

WASHINGTON – It appears that only one postpartum visit is necessary for IUD placement, according to Dr. David R. Kattan.

A common protocol for placement of an IUD includes two postpartum visits: one for testing for STDs and a second to place the IUD, with the goal of preventing the development of pelvic inflammatory disease (PID). A retrospective study found that the rates of STDs were below 1% in women who requested an IUD, and that positivity for STDs in the postpartum period did not predict the development of pelvic inflammatory disease.

"Eliminating one of the two postpartum visits promises to increase the rate of IUD placement in women who seek a reliable contraceptive method post partum," said Dr. Kattan of the University of Colorado at Denver.

"Two postpartum visits for IUD insertion are unnecessary. Adopt what the American College of Obstetricians and Gynecologists already supports, which is a single-visit protocol for postpartum IUD insertion," he emphasized.

For women with no health insurance and little financial means, the postpartum visit may be the last time they see a doctor before proceeding with a second pregnancy. An IUD is an effective means of preventing unwanted pregnancy, yet many women who request an IUD fail to have one placed. Factors implicated in the failure to have an IUD placed include being counseled against using one, getting pregnant before having an IUD placed, and being lost to follow-up, Dr. Kattan explained.

Dr. Kattan and his colleagues hypothesized in their poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists that conflating testing for Chlamydia trachomatis and Neisseria gonorrhoeae with immediate IUD placement at one visit can improve the success rate of having an IUD implanted without increasing the rate of PID.

The study included 1,417 women receiving an IUD in the year 2008 at Denver Health Medical Center; of these, 629 (44%) met the inclusion criterion of having given birth within the previous 3 months. The average age was 25.3 years, and the average parity was 2.3.

At the preinsertion screening visit, five (0.8%) tested positive for chlamydia and one (0.16%) tested positive for gonorrhea. None of these six women developed PID. Three women did develop PID, and none of them tested positive for either of these organisms during pregnancy, the postpartum period, or at the time of PID diagnosis. None of these three women required hospitalization or removal of their IUD.

"Based on these data showing that a separate screening visit was unnecessary, practice at Denver Health Medical Center and the University of Colorado has changed. Residents at both sites are now taught one-visit IUD placement protocol," Dr. Kattan said. "One of the side benefits of adopting this protocol is the availability of a clinic appointment that would have otherwise been used for a second IUD placement visit. In a busy resident clinic, this means that women seeking gynecology care can be seen more quickly because an unnecessary clinic visit has been eliminated. One of the aims of my study is to reinforce a single-visit practice as the standard of care at other programs across the [United States]. Despite ACOG’s recommendations, practice is still sometimes slow to change."

Dr. Kattan said he had no relevant financial disclosures.

WASHINGTON – It appears that only one postpartum visit is necessary for IUD placement, according to Dr. David R. Kattan.

A common protocol for placement of an IUD includes two postpartum visits: one for testing for STDs and a second to place the IUD, with the goal of preventing the development of pelvic inflammatory disease (PID). A retrospective study found that the rates of STDs were below 1% in women who requested an IUD, and that positivity for STDs in the postpartum period did not predict the development of pelvic inflammatory disease.

"Eliminating one of the two postpartum visits promises to increase the rate of IUD placement in women who seek a reliable contraceptive method post partum," said Dr. Kattan of the University of Colorado at Denver.

"Two postpartum visits for IUD insertion are unnecessary. Adopt what the American College of Obstetricians and Gynecologists already supports, which is a single-visit protocol for postpartum IUD insertion," he emphasized.

For women with no health insurance and little financial means, the postpartum visit may be the last time they see a doctor before proceeding with a second pregnancy. An IUD is an effective means of preventing unwanted pregnancy, yet many women who request an IUD fail to have one placed. Factors implicated in the failure to have an IUD placed include being counseled against using one, getting pregnant before having an IUD placed, and being lost to follow-up, Dr. Kattan explained.

Dr. Kattan and his colleagues hypothesized in their poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists that conflating testing for Chlamydia trachomatis and Neisseria gonorrhoeae with immediate IUD placement at one visit can improve the success rate of having an IUD implanted without increasing the rate of PID.

The study included 1,417 women receiving an IUD in the year 2008 at Denver Health Medical Center; of these, 629 (44%) met the inclusion criterion of having given birth within the previous 3 months. The average age was 25.3 years, and the average parity was 2.3.

At the preinsertion screening visit, five (0.8%) tested positive for chlamydia and one (0.16%) tested positive for gonorrhea. None of these six women developed PID. Three women did develop PID, and none of them tested positive for either of these organisms during pregnancy, the postpartum period, or at the time of PID diagnosis. None of these three women required hospitalization or removal of their IUD.

"Based on these data showing that a separate screening visit was unnecessary, practice at Denver Health Medical Center and the University of Colorado has changed. Residents at both sites are now taught one-visit IUD placement protocol," Dr. Kattan said. "One of the side benefits of adopting this protocol is the availability of a clinic appointment that would have otherwise been used for a second IUD placement visit. In a busy resident clinic, this means that women seeking gynecology care can be seen more quickly because an unnecessary clinic visit has been eliminated. One of the aims of my study is to reinforce a single-visit practice as the standard of care at other programs across the [United States]. Despite ACOG’s recommendations, practice is still sometimes slow to change."

Dr. Kattan said he had no relevant financial disclosures.