Women's Health Issues 2014 Nov 26. pii: S1049-3867(14)00113-3. doi: 10 .1016/j.whi.2014.09.006.

Same-day intrauterine device placement is rarely complicated by pelvic infection

Papic M, Wang N, Parisi SM, Baldauf E, Updike G and Schwarz EB

Abstract

Purpose: To compare rates of pelvic inflammatory disease (PID) among women who did and did not receive an intrauterine device (IUD) the day they sought emergency contraception (EC) or pregnancy testing.

Methods: Women, 15 to 45 years of age, who sought EC or pregnancy testing from an urban family planning clinic completed surveys at the time of their clinic visit (August 22, 2011, to May 30, 2013) and 3 months after their clinic visit. The surveys assessed contraceptive use and symptoms, testing, and treatment for sexually transmitted infections (STI) and PID. We reviewed the medical records of participants who reported IUD placement within 3 months of enrollment and abstracted de-identified electronic medical record (EMR) data on all women who sought EC or pregnancy testing from the study clinic during the study period.

Findings: During the study period, 1060 women visited the study clinic; 272 completed both enrollment and follow-up surveys. Among survey completers with same-day IUD placement, PID in the 3 months after enrollment was not more common (1/28 [3.6%]; 95% CI, 0-10.4%) than among women who did not have a same-day IUD placed (11/225 [4.9%]; 95% CI, 2.7-8.6%; p = 0.71). Chart review and EMR data similarly showed that rates of PID within 3 months of seeking EC or pregnancy testing were low whether women opted for same-day or delayed IUD placement.

Conclusions: Same-day IUD placement was not associated with higher rates of PID. Concern for asymptomatic STI should not delay IUD placement, and efforts to increase the uptake of this highly effective reversible contraception should not be limited to populations at low risk of STI.

Comment:If a woman comes for pregnancy testing and/or to ask for emergency contraception, it is safe, effective, and a good idea to immediately place an IUD. This not only prevents current possible unplanned pregnancy, but also protects in the future. (HMV)