D Grimes1, K Schulz, N Stanwood. 1. Family Health International, P. O. Box 13950, Research Triangle Park, North Carolina 27709, USA. dgrimes@fhi.org
Abstract
BACKGROUND: Insertion of an intrauterine device (IUD) immediately after an abortion has several potential advantages. The woman is known not to be pregnant, a major concern for clinicians. For example, many clinicians refuse to insert an IUD in a woman who is not menstruating. After induced abortion, a woman's motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries potential risks as well. For example, the risk of spontaneous expulsion may be increased due to recent cervical dilation. OBJECTIVES: To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY: We used MEDLINE, Popline, and EMBASE computer searches, supplemented by review articles and contacts with investigators. SELECTION CRITERIA: We sought all randomized controlled trials that had at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 12 trials which described random assignment but excluded three from this review. Two of these revealed unethical research conduct, and one used alternate assignment to treatments. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and abstracted information onto a data collection form. We focused on gross discontinuation rates (single-decrement life table analysis) for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. We entered the data into RevMan 3.1 for analysis of Peto odds ratios. MAIN RESULTS: In large multicenter trials, the TCu 220C device proved superior to either the Lippes Loop D or the Copper 7 IUDs for immediate postabortal insertion. In single-center trials, the Nova T IUD had a significantly higher discontinuation rate for pregnancy than did the Multiload 250 (OR 4.5; 95% CI 1.0-19.8), while the Nova T had a significantly lower discontinuation rate for pregnancy than did the TCu 200 (OR 0.3; 95% CI 0.1-0.9). The levonorgestrel-releasing device was more effective in preventing pregnancy than was the Nova T. Only one trial compared immediate vs. delayed insertion. In this trial, the performance of the Copper 7 IUD inserted immediately after abortion was inferior to that after interval insertion (remote from pregnancy), although the differences were not statistically significant. REVIEWERS' CONCLUSIONS: Insertion of an IUD immediately after abortion is both safe and practical. IUD expulsion rates appear higher than after interval insertions.
BACKGROUND: Insertion of an intrauterine device (IUD) immediately after an abortion has several potential advantages. The woman is known not to be pregnant, a major concern for clinicians. For example, many clinicians refuse to insert an IUD in a woman who is not menstruating. After induced abortion, a woman's motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries potential risks as well. For example, the risk of spontaneous expulsion may be increased due to recent cervical dilation. OBJECTIVES: To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. SEARCH STRATEGY: We used MEDLINE, Popline, and EMBASE computer searches, supplemented by review articles and contacts with investigators. SELECTION CRITERIA: We sought all randomized controlled trials that had at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 12 trials which described random assignment but excluded three from this review. Two of these revealed unethical research conduct, and one used alternate assignment to treatments. DATA COLLECTION AND ANALYSIS: We evaluated the methodological quality of each report and abstracted information onto a data collection form. We focused on gross discontinuation rates (single-decrement life table analysis) for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. We entered the data into RevMan 3.1 for analysis of Peto odds ratios. MAIN RESULTS: In large multicenter trials, the TCu 220C device proved superior to either the Lippes Loop D or the Copper 7 IUDs for immediate postabortal insertion. In single-center trials, the Nova T IUD had a significantly higher discontinuation rate for pregnancy than did the Multiload 250 (OR 4.5; 95% CI 1.0-19.8), while the Nova T had a significantly lower discontinuation rate for pregnancy than did the TCu 200 (OR 0.3; 95% CI 0.1-0.9). The levonorgestrel-releasing device was more effective in preventing pregnancy than was the Nova T. Only one trial compared immediate vs. delayed insertion. In this trial, the performance of the Copper 7 IUD inserted immediately after abortion was inferior to that after interval insertion (remote from pregnancy), although the differences were not statistically significant. REVIEWERS' CONCLUSIONS: Insertion of an IUD immediately after abortion is both safe and practical. IUD expulsion rates appear higher than after interval insertions.
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