Obstet Gynecol 2014 May;123 Suppl 1:10S-1S. doi: 10.1097/01.AOG.0000447255.63996.53.

Comparison of intrauterine device expulsion rates after aspiration abortion or interval insertion

Jacob NS, Mahnert N, Livingston JB, Merchant M and Postlethwaite DA


Introduction: Twenty-two percent of all pregnancies in the United States result in termination, reflecting the need for more robust contraception. The intrauterine device (IUD) is highly effective and reversible although underused in the United States compared with other countries. Several institutions in the United States insert IUDs immediately after abortions with success despite international research that suggests a higher rate of expulsion.

Objective: To compare the rate of IUD expulsion in immediate postabortion insertion compared with interval insertion.

Methods: A retrospective cohort study was performed to ascertain complications after immediate compared with interval IUD placement after first-trimester aspiration abortions between April 1, 2006, and September 30, 2011, at all Kaiser Permanente Northern California facilities. The primary outcome was the rate of expulsion within 90 days of IUD insertion. Secondary outcomes included rates of uterine perforation, upper genital tract infection, and early removal of IUD. Statistical analysis used ? and t test comparisons. Logistic regression was performed for multiple variable analysis.

Results: Four hundred forty-seven women with same-day insertions were compared with 316 women with interval insertions. The overall rate of expulsion was low with no statistically significant differences seen between cohorts at 4.1% and 1.7%, respectively (P<0.073). Secondary outcome rates were all low. In multivariate analysis, African American race was noted to be an independent risk factor for expulsion with an odds ratio of 3.95.

Conclusion: In a diverse, American population, levonorgestrel or Cu-T IUD insertion immediately after first-trimester abortion appears to be safe with no significant increase in rates of expulsion or other complications when compared with interval insertion.

Comment: There is no need to be afraid of expulsion when an IUD is inserted immediately after first trimester abortion, so the woman can go home protected. (HMV)