www.bmj.com/content/368/bmj.m149 No one wants to get pregnant two minutes after having a baby. And also agrees that an IUD is most effective form of conception. However placing IUD after delivering a child seems to be a point of debate as the risk of expulsion seems to be significantly higher immediately post pregnancy In this study titled Averbach SH, Ermias Y, Jeng G, et al. Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; They looked at the different rates of IUD expulsion postpartum. As you can imagine the rates vary based on if the IUD was placed within 3 minutes of child delivery or 3 weeks after child delivery. There also seemed to be a difference between hormonal IUD (LNG-IUD) compared with a copper T-shaped IUD. Finally there was a difference whether she had a C-section or a vaginal delivery as you can imagine the vaginal delivery was associated with significant less rates of expulsion which is the numbers we are going to talk about going forward as the rates of expulsion following C-section were significantly lower around 0-2%. Brand progesterone IUD are called Skyla, Liletta, Mirena -- but in this study they only included those papers which she used MIRANA. Copper IUD goes by paragard Ultimately the authors looked at 3 different timeframes for placement of the IUD. 1-immediate placement within 10 minutes postpartum, or IUD placement anywhere from 10 minutes postpartum to 72 hours postpartum or early outpatient placement somewhere between 72 hours to 4 weeks postpartum So let’s break them down by timeframe- Those individuals who had an IUD placed immediately following delivery had a 27% exposure rate with Mirena and a 12% exposure rate with ParaGard Those individuals who had an IUD placed not immediately but within the first 72 hours the exposure rate was 37% with the hormonal IUD and 7% for the copper IUD And finally for those women who had an IUD placed in the outpatient setting at some point between 72 hours in 4 weeks there was no expulsion that occurred for either the hormonal or copper IUD. I think the final answer here is for a woman who has a vaginal delivery and would like to have IUD placement following delivery there is almost no way we can justify placing hormonal IUDs within the first 72 hours as the expulsion rate of 30ish percent is way too high to justify. The ideal situation would be IUD placement in the outpatient setting at sometime point between 72 hours in 4 weeks however if you’re patient is insisting on IUD placement while still in the hospital then it appears the best option would be a copper IUD and this likely should be placed as close to discharge as possible because even those individuals who had a copper IUD placed prior to 72 hours still had a 7% exposure rate which seems a little high. If you’re going to use this paper and practice I think important thing to remember is that it was for woman with vaginal deliveries and not for women with C-sections as those individuals had near 0% expulsion rates. The next our article talks about one of the most irritating conditions to treat and of course that is irritable bowel syndrome. In this randomized double-blind placebo controlled trial titled Hamatani T, Fukudo S, Nakada Y, Inada H, Kazumori K, Miwa H. Randomised clinical trial: minesapride vs placebo for irritable bowel syndrome with predominant constipation. Aliment Pharmacol Ther 2020;52(3):430-441. Author still just over 400 patients with a history of severe irritable bowel syndrome predominant constipation who were having less than 3 spontaneous bowel movements per week and randomized them to placebo or minesapride 10 mg, 20 mg, or 40 mg daily for 3 months. The primary endpoint—an increase in one or more complete spontaneous bowel movements and in the end it didn’t matter what dose of mi(continued)