Incidence and risk factors for postplacental intrauterine device expulsion in a Brazilian hospital

OBJECTIVE: This study assessed the incidence of and risk factors associated with expulsion of copper intrauterine devices inserted in the immediate postpartum period at a public hospital in Brazil. METHODS: This retrospective cohort study included women who had a copper intrauterine device (IUD) inserted immediately after delivery at a teaching hospital and returned for follow-up within 12 months. The primary outcome was IUD expulsion (partial or complete) overall and by mode of delivery. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for expulsion. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: Among the 543 participants, the overall expulsion rate was 14.7%, with significantly higher rates for placement after vaginal delivery (22.8%) compared to cesarean section (5.2%). In bivariate analysis, maternal age, parity, gestational age, mode of delivery, and insertion by first-year residents were associated with device expulsion. In multivariate analysis, maternal age <20 years (aOR 5.03, 95% CI: 1.30-19.42), age 20-34 years (aOR 4.68, 95% CI: 1.40-15.63), and vaginal delivery (aOR 5.78, 95% CI: 2.17-15.42) remained independently associated with IUD expulsion. CONCLUSION: At a Brazilian teaching hospital, nearly 15% of the women who had a copper IUD inserted by residents in the immediate postpartum period expelled the device. Maternal age under 35 years and vaginal delivery were significant risk factors for expulsion. These findings highlight the importance of individualized counseling and close follow-up for higher-risk groups, as well as continuous training of providers.