Immediate placement of intrauterine devices after first and second trimester pregnancy termination.
BACKGROUND
We reviewed our experience with intrauterine device (IUD) placement after surgical abortion up to 20 weeks' gestation.


METHODS
Women presenting for elective abortion between January 2004 and March 2009 who requested an IUD were included in this retrospective review.


RESULTS
Of 308 women requesting postabortion IUD placement, 221 (72%) planned insertion at the time of abortion (immediate group) and 87 (28%) planned insertion at their postoperative visit (interval group). IUDs were placed in 96% of the immediate group and in 23% of the interval group (212/221 vs. 20/87; p<.0001). Failure to return for placement was the most common reason for noninsertion in the interval group (60/87=69%). Follow-up information was obtained for 56% of patients and was documented a median of 137 days postabortion (range 3-1594 days). There was no difference in complication rates between groups. Expulsion rates were 3% and 0% in the immediate and interval groups, respectively (6/212 vs. 0/20; p=.4). Considering only those with documented follow-up after immediate insertion (119), there was a nonsignificant trend towards increased expulsion with placement after second vs. first trimester abortion (4/54=7% vs. 2/65=2%; p=.3). When analyzing the 172 subjects with documented follow-up, those planning immediate insertion were more likely to have an IUD in situ at the last contact than those planning later insertion (84/124=68% vs. 20/48=42%; p=.002).


CONCLUSIONS
Immediate postabortion IUD insertion is safe and effective. Given the low rate of return for interval insertion, immediate placement may be preferable.
Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. mfox7@jhmi.edu
Michelle C
MC
Fox
Julia
J
Oat-Judge
Kathryn
K
Severson
Roxanne M
RM
Jamshidi
Rameet H
RH
Singh
Raegan
R
McDonald-Mosley
Anne E
AE
Burke
D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D055815:Young Adult