IUD placement within 48 hours nonsuperior vs 2 to 4 weeks after abortion
A study reveals no significant difference in 6-month intrauterine device use between placements within 48 hours or 2 to 4 weeks after a second-trimester abortion, though earlier placement carries a higher expulsion risk.
IUD placement within 48 hours nonsuperior vs 2 to 4 weeks after abortion | Image Credit: © New Africa - © New Africa - stock.adobe.com.
When evaluating the rate of intrauterine device (IUD) use after 6 months, placement within 48 hours of second-trimester medical abortion is nonsuperior to placement after 2 to 4 weeks, according to a recent study published in the American Journal of Obstetrics & Gynecology.1
Patients having an abortion will often choose IUD as their method of contraception. However, uptake may be reduced by delayed placement, indicating a need to increase contraception access among patients receiving a second-trimester abortion.2
There is little data about the timing of IUD placement after medical abortion despite this method being the most common for abortion in many countries.1 Currently, more information is needed about the placement of an IUD within 48 hours after second-trimester medical abortion.
To evaluate IUD use among patients receiving IUD placement within 48 hours after second-trimester medical abortion, investigators conducted a randomized, controlled, multicenter, superiority trial. Participants were aged at least 18 years and were requesting medical abortion for pregnancy with a gestation of 85 to 153 days confirmed by ultrasound.
Patients with contraindications for medical abortion or IUD use, abortion-related complications, or unable to provide consent were excluded from the analysis. Participants were randomized 1:1 to receive IUD placement within 48 hours or at 2 to 4 weeks after medical abortion, referred to as the intervention and control arms, respectively.
World Health Organization guidelines were followed during medical abortion, which was performed in-clinic. Screening and treatment for bacterial vaginosis and chlamydia occurred during the initial visit. IUD type was determined based on patient choice and placement was performed by a midwife.
Data was obtained during the initial visit and IUD placement visit using electronic case report forms. Follow-up data was collected through phone call or email at 3, 6, and 12 months, with rates of IUD use at 6 months after abortion reported as the primary outcome.
Secondary outcomes included IUD uptake, reasons for nonplacement, subsequent abortions, pain at placement, subsequent pregnancies and abortions, safety outcomes, and acceptability. Pain scores were measures using the visual analogue scale (VAS).
In the modified intention-to-treat (mITT) analysis, there were 67 patients in each group, with similar baseline characteristics reported between groups. Use of an IUD after 6 months was reported in 50.7% of the intervention group and 71.6% of the control group, indicating a difference of 20.9%.
The per-protocol analysis had 48 patients in the intervention group and 47 in the control group. IUD use at 6 months was reported in 27 and 42, respectively. These results were not changed in the sensitivity analysis.
Increased attendance of the IUD placement visit was reported in the intervention group. However, rates of ultrasound use at IUD placement, patient preference for time of placement, and health care providers’ ease of IUD placement did not differ between groups.
VAS pain scores at baseline were increased in the intervention group vs the control group, as 9.1 vs 3.8, respectively. Similarly, VAS pain scores at tenaculum placement were 35.2 vs 24.2, respectively. IUD expulsion within 6 months was reported in 30.1% and 2.9%, respectively, in the mITT analysis, indicating an absolute risk difference of 27.3%
These results indicated nonsuperiority from IUD placement within 48 hours of medical abortion vs 2 to 4 weeks in regards to IUD use after 6 months. Investigators noted higher expulsion rates but concluded it can be used in selected patients following counseling about expulsion risk.
Reference
- Hogmark S, Rydelius J, Envall N, Teleman P, Gemzell-Danielsson K, Kopp Kallner H. Placement of an intrauterine device within 48 hours after second-trimester medical abortion: a randomized controlled trial. American Journal of Obstetrics & Gynecology. 2024;231(5):530.E1-530.E8. doi:10.1016/j.ajog.2024.05.041
- Pohjoranta E, Mentula M, Suhonen SP, Heikinheimo O. Predicting poor compliance with follow-up and intrauterine contraception services after medical termination of pregnancy. BMJ Sex Reprod Health. 2018. doi:10.1136/bmjsrh-2018-200098
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