Intrauterine contraception after medical abortion: factors affecting success of early insertion.
OBJECTIVE
To assess the success and factors affecting early intrauterine device (IUD) provision after first trimester medical termination of pregnancy (MTOP).


METHODS
Subgroup analysis of a randomized contraceptive trial assessing the long-term effects of early provision of intrauterine contraception following abortion. Altogether, 606 women undergoing MTOP were included and followed for 3 months. The intervention group (n=307) was offered an IUD (either the levonorgestrel-releasing intrauterine system or copper-IUD) at a follow-up visit 1-4 weeks after MTOP. The control group (n=299) contacted primary health care for follow-up and contraceptive provision. Adverse events (infections, bleeding, residual tissue and incomplete abortion) were analyzed on intention-to-treat basis and IUD expulsions on per-protocol (PP) basis.


RESULTS
In the intervention group, 234 women (76.2%) received the IUD as scheduled, 46 later (altogether 91.2%). In the control group, the corresponding figures were 8 (2.7%) and 64 [altogether 24.1%, Odds ratio (OR) (95% Confidence interval (CI))=32.7 (20.3-52.6)]. Eighty-five (27.7%) women in the intervention group and 38 (12.7%) in the control group received treatment (administration of antibiotics, misoprostol or surgical evacuation) because of presumed adverse event [2.63 (1.72-4.01)], mainly residual tissue. In the control group, 23 (60.5%) of these occurred during the first 2 weeks. IUD expulsion occurred in 12 (5.4%) of the 222 women in the intervention group (PP basis).


CONCLUSIONS
When provided as part of abortion service, most early insertions following MTOP were performed as planned. The main reason for postponement was overdiagnosis of adverse events suspected at follow-up. The rate of IUD expulsion was similar to that reported previously.


CONCLUSIONS
Early insertion following MTOP is safe, and the rate of IUD expulsion is low. Most adverse events possibly delaying IUD insertion occur early. Based on timing of adverse events in the control group, IUD insertion at approximately 2 weeks after completed MTOP seems optimal.
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Elina
E
Pohjoranta
Centralized Family Planning, Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland.
Satu
S
Suhonen
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Maarit
M
Mentula
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: oskari.heikinheimo@helsinki.fi.
Oskari
O
Heikinheimo
D000028:Abortion, Induced; D000328:Adult; D000359:Aftercare / Q000379:methods*; D003267:Contraception; D003270:Contraceptive Agents / Q000008:administration & dosage; D005260:Female; D005387:Finland; D006801:Humans; D007433:Intrauterine Device Expulsion; D007435:Intrauterine Devices, Copper; D016912:Levonorgestrel / Q000008:administration & dosage*; D016015:Logistic Models; D016595:Misoprostol / Q000008:administration & dosage; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D013997:Time Factors; D055815:Young Adult
D003270:Contraceptive Agents; D016595:Misoprostol; D016912:Levonorgestrel
Adverse event; Complication; IUD expulsion; Intrauterine contraception; Medical abortion