OBJECTIVE To investigate differences in health care utilization between immediate (within 10 minutes of placental delivery) and delayed (after 24 hours) intrauterine device (IUD) placement. METHODS This retrospective cohort study was conducted with data from Kaiser Permanente Northern California from 2017 to 2019 and included patients with an IUD placed between 0 and 63 days postpartum. The primary outcome for health care utilization was the number of obstetrician-gynecologist (ob-gyn) or women's health office visits within 1 year. Secondary outcomes included formal imaging studies, surgical intervention, and hospitalizations related to IUD complications within 1 year. An additional secondary outcome was live births at 120 days and 1 year. RESULTS Among 1,543 immediate and 10,332 delayed postpartum IUD placements, the number of visits to an ob-gyn or women's health office within 1 year was slightly increased with delayed placement (mean 2.30 vs 2.47, P<.001). Imaging was increased in the immediate compared with the delayed group (10.5% vs 4.1%, P<.001). Laparoscopy was decreased in the immediate compared with the delayed group (0.0% vs 0.4%, P=.005), with no significant difference in hysteroscopy (0.2% vs 0.1%, P=.413). Hospitalizations were rare and increased in the immediate group (0.4% vs 0.02%, P<.001). Lastly, there was no difference in repeat pregnancies between groups at 120 days (both 0.2%) or at 1 year (2.9% vs 2.5%, P=.342). CONCLUSION Compared with delayed placement, immediate postpartum IUD placement is not associated with increased office visits. Immediate placement is associated with an increase in imaging but a decrease in laparoscopic surgery to manage IUD-related complications. There was no difference in live birth rates at 6 months or 1 year between groups.

中文翻译：

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与延迟产后宫内节育器放置相比，即刻后的医疗保健利用率。


目的 探讨即刻 （胎盘娩出后 10 分钟内） 和延迟 （24 小时后） 宫内节育器 （IUD） 放置之间医疗保健利用的差异。方法 这项回顾性队列研究是使用 2017 年至 2019 年北加利福尼亚 Kaiser Permanente 的数据进行的，包括产后 0 至 63 天放置宫内节育器的患者。医疗保健利用的主要结局是 1 年内妇产科医生 （ob-gyn） 或妇女健康办公室就诊的次数。次要结局包括正式影像学检查、手术干预和 1 年内与 IUD 并发症相关的住院治疗。另一个次要结局是 120 天和 1 岁时的活产儿。结果 在 1,543 例即刻和 10,332 例延迟产后宫内节育器放置中，延迟放置后 1 年内去妇产科或妇女健康办公室就诊的次数略有增加（平均 2.30 对 2.47，P<.001）。与延迟组相比，即刻影像学检查增加 （10.5% vs 4.1%，P<.001）。与延迟组相比，腹腔镜检查立即减少 （0.0% vs 0.4%，P=.005），宫腔镜检查无显著差异 （0.2% vs 0.1%，P=.413）。住院率很少见，直接组增加 （0.4% vs 0.02%，P<.001）。最后，两组之间在 120 天 （均为 0.2%） 或 1 年 （2.9% vs 2.5%，P=.342） 的重复妊娠没有差异。结论 与延迟放置相比，产后立即放置 IUD 与门诊就诊次数增加无关。立即放置与影像学检查的增加有关，但与治疗 IUD 相关并发症的腹腔镜手术减少有关。 两组之间 6 个月或 1 岁的活产率没有差异。