Avaliação dos desfechos clínicos relacionados à inserção de Dispositivo Intrauterino de Cobre (DIU) no pós-parto em hospital universitário

Abstract

Objective: To evaluate the clinical outcomes related to the insertion of a copper intrauterine device (IUD) in the postpartum period at a university hospital, with emphasis on expulsion rates, complications, method continuity, and adherence to outpatient follow-up. Methods: A descriptive and retrospective study was conducted through the analysis of medical records of women who underwent copper IUD insertion in the immediate or early postpartum period, after vaginal or cesarean delivery, at the University Hospital of the Federal University of Uberlândia, between January and December 2021. Sociodemographic, obstetric, and clinical data were collected, as well as information regarding IUD position, expulsion, complications, visualization of the strings, use of ultrasound, and method continuation. Associations between variables were analyzed using the chi-square test, adopting a significance level of 5%. Results: The study included 651 women, with a mean age of 26.4 years, predominantly single, of mixed race, and with low levels of education. The outpatient return rate was 37.6% at the first follow-up and 19.5% at the second. The overall IUD expulsion rate was 5.71%, and no statistically significant association was observed between the IUD expulsion rate and the type of delivery at the first return (p = 0.435). However, at the second return, there was a significant association between the IUD expulsion rate and the type of delivery, being higher after vaginal than cesarean delivery (16% vs. 2.6%, p = 0.0133). Changes in IUD position were identified in 18.36% of cases at the first return, with rotation being the most frequent alteration. There was an association between the type of delivery and the presence of a string, with a higher rate of strings visualized after vaginal delivery compared to cesarean section (87.8% vs. 33.9% with p <.0001). The method continuation rate was high, corresponding to 88.6% at the first follow-up and 71% after one year. Conclusion: Postpartum copper IUD insertion proved to be a safe, effective contraceptive method with a high continuation rate. Despite low adherence to outpatient follow-up, the results reinforce the importance of offering IUDs in the postpartum period and clinical and ultrasound monitoring for early identification of expulsion and changes in positioning.