J Midwifery Womens Health. 2016 Mar 11. doi: 10.1111/jmwh.12412.

Aspiration abortion with immediate intrauterine device insertion: comparing outcomes of advanced practice clinicians and physicians

Patil E, Darney B, Orme-Evans K, Beckley EH, Bergander L, Nichols M and Bednarek PH


Introduction: Immediate postabortion intrauterine device (IUD) insertion is a safe, effective strategy to prevent subsequent unplanned pregnancy. Oregon is one of 5 US states where advanced practice clinicians perform aspiration abortions. This study compares outcomes of first-trimester aspiration abortion with immediate IUD insertion between advanced practice clinicians and physicians.

Method: We conducted a historical cohort study of first-trimester aspiration abortions with immediate IUD insertion performed at our center from 2009 to 2011. We extracted demographic and clinical data from patient charts. Immediate complications including excessive blood loss, perforation, and reaspirations were recorded at the time of procedure. We used descriptive statistics and multivariable logistic regression to test for differences in outcomes by clinician type.

Results: Data were available on 669 of the 1134 combined procedures. Advanced practice clinicians performed 224 of these. There were no significant differences in immediate outcomes. The only immediate complications were reaspirations; 1.8% (4/224) in the advanced practice clinician group, and 2.0% (9/445) in the physician group (P = 0.83).

Discussion: We found no differences in outcomes between provider type for immediate IUD insertion after first-trimester aspiration abortion. This study helps reinforce that advanced practice clinicians can provide immediate postaspiration abortion IUD insertions with similar outcomes to those of physicians. Many countries do not allow advanced practice clinicians to perform this service, but a change in policy could help address family planning provider shortages.

Comment: It is good to see another article which makes it clear that advance practice clinicians, like midwives, can perform safe abortions and immediate post-abortion insertions as well as physicians. This task-shifting can really help women. (HMV)