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Immediate vs. delayed post-abortal copper T 380A IUD insertion in cases over 12 weeks of gestation.

Author(s): Cremer M, Bullard KA, Mosley RM, Weiselberg C, Molaei M, Lerner V, Alonzo TA

Affiliation(s): The Mount Sinai Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Box 1170, New York, NY 10029, USA. miriam.cremer@gmail.com

Publication date & source: 2011-06, Contraception., 83(6):522-7. Epub 2010 Dec 8.

Publication type: Comparative Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

BACKGROUND: The intrauterine device (IUD) is a safe, effective, well-tolerated form of contraception. Immediate placement after second-trimester abortion could increase high-tier contraception use in women who are at high risk for unintended pregnancy. STUDY DESIGN: This randomized controlled trial compared immediate vs. delayed placement of Copper T380A IUD insertion 2-4 weeks after second trimester abortion. The primary outcome analyzed was the percentage of women using a copper T380A IUD 6 months after surgery. Secondary outcomes were percentage of subjects using other high or middle tier contraception, expulsion, infection and repeat pregnancy rates as well as IUD satisfaction. In expectation of a high loss to follow-up at 6 months, 215 subjects were enrolled for a desired sample size of 158 subjects. RESULTS: Contraceptive and pregnancy status at 6 months was known for 159 of 215 subjects. Women randomized to immediate insertion were significantly more likely to have an IUD at 6 months compared to delayed (81.7% vs. 28.4%, p=.003). Relative risk was 11.2 (95% CI 5-26). There were 8 (5.1%) of 159 repeat unintended pregnancies. No women had a repeat pregnancy that had an IUD placed in the operating room. In the as-treated analysis, 64 women in the immediate group received the IUD and 0% had a repeat pregnancy. Of the remaining 95 women, 8 (8.4%) had a repeat pregnancy. This is a statistically significant difference (p=.022). CONCLUSION: Placing the IUD immediately after the procedure significantly increases the likelihood of use of effective contraception following a second-trimester procedure. Women who have an IUD placed immediately after their procedure may also be less likely to have a subsequent unplanned pregnancy. Copyright (c) 2011 Elsevier Inc. All rights reserved.

Page last updated: 2011-12-09

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