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Timing of copper intrauterine device insertion after medical abortion: a randomized controlled trial.

Author(s): Shimoni N, Davis A, Ramos ME, Rosario L, Westhoff C

Affiliation(s): Columbia University Department of Obstetrics and Gynecology and New York Presbyterian Hospital, New York, New York, USA. ns2476@columbia.edu

Publication date & source: 2011-09, Obstet Gynecol., 118(3):623-8.

Publication type: Research Support, Non-U.S. Gov't

OBJECTIVE: To compare intrauterine device (IUD) use at 6 months in women randomized to receive an intrauterine copper contraceptive 1 week compared with 1 month after medical abortion. METHODS: We recruited women undergoing medical abortion with mifepristone and misoprostol and choosing the copper IUD for contraception. We randomly assigned participants to "immediate" insertion 1 week after mifepristone or "delayed" insertion 4-6 weeks later. We followed rates of IUD insertion, 6-month utilization, expulsion, removal, and pregnancy. Participants recorded bleeding in a diary for 4 weeks. RESULTS: We randomized 156 participants. We inserted an IUD in 97% of participants in the immediate group and 76% in the delayed group (P<.001). At 6 months, 69% of participants in the immediate group used the IUD compared with 60% in the delayed group (P=.24). Expulsion rates were comparable; 12% (8 of 69) in the immediate group compared with 11% (7 of 65) in the delayed group. Removals occurred in 14% (10 of 69) of immediate and 8% (5 of 65) of delayed group participants (P=.21). Four pregnancies occurred in delayed group participants who did not return for IUD insertion (P=.09). The immediate and delayed groups reported a median of 20 and 19 bleeding or spotting days, respectively (P=.15). We detected no cases of serious infection, uterine perforation, or hemorrhage. CONCLUSION: Immediate insertion increased uptake of the IUD without increasing expulsions or bleeding. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinialtrials.gov, . LEVEL OF EVIDENCE: I.

Page last updated: 2011-12-09

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