title: Immediate vs. delayed post-abortal copper T 380A IUD insertion in cases over 12 weeks of gestation.
abstract: BACKGROUND
  The intrauterine device (IUD) is a safe, effective, well-tolerated form of contraception. Immediate placement after second-trimester abortion could increase high-tier contraception use in women who are at high risk for unintended pregnancy.
  
  
  METHODS
  This randomized controlled trial compared immediate vs. delayed placement of Copper T380A IUD insertion 2-4 weeks after second trimester abortion. The primary outcome analyzed was the percentage of women using a copper T380A IUD 6 months after surgery. Secondary outcomes were percentage of subjects using other high or middle tier contraception, expulsion, infection and repeat pregnancy rates as well as IUD satisfaction. In expectation of a high loss to follow-up at 6 months, 215 subjects were enrolled for a desired sample size of 158 subjects.
  
  
  RESULTS
  Contraceptive and pregnancy status at 6 months was known for 159 of 215 subjects. Women randomized to immediate insertion were significantly more likely to have an IUD at 6 months compared to delayed (81.7% vs. 28.4%, p=.003). Relative risk was 11.2 (95% CI 5-26). There were 8 (5.1%) of 159 repeat unintended pregnancies. No women had a repeat pregnancy that had an IUD placed in the operating room. In the as-treated analysis, 64 women in the immediate group received the IUD and 0% had a repeat pregnancy. Of the remaining 95 women, 8 (8.4%) had a repeat pregnancy. This is a statistically significant difference (p=.022).
  
  
  CONCLUSIONS
  Placing the IUD immediately after the procedure significantly increases the likelihood of use of effective contraception following a second-trimester procedure. Women who have an IUD placed immediately after their procedure may also be less likely to have a subsequent unplanned pregnancy.
authors.affiliation: The Mount Sinai Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Box 1170, New York, NY 10029, USA. miriam.cremer@gmail.com
authors.forename: Miriam
authors.initials: M
authors.lastname: Cremer
authors.forename: Kimberley A
authors.initials: KA
authors.lastname: Bullard
authors.forename: Raegan McDonald
authors.initials: RM
authors.lastname: Mosley
authors.forename: Christine
authors.initials: C
authors.lastname: Weiselberg
authors.forename: Michael
authors.initials: M
authors.lastname: Molaei
authors.forename: Veronica
authors.initials: V
authors.lastname: Lerner
authors.forename: Todd A
authors.initials: TA
authors.lastname: Alonzo
mesh_terms: D000028:Abortion, Induced; D000293:Adolescent; D000328:Adult; D003268:Contraception Behavior; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D013997:Time Factors; D055815:Young Adult