Immediate IUD insertion after uterine aspiration

January 01, 0001

Immediate IUD insertion after uterine aspiration

These US authors performed a randomized noninferiority trial involving women undergoing uterine aspiration for induced or spontaneous abortion at 5 to 12 weeks of gestation who desired an IUD. Subjects were randomly assigned (in a 5:6 ratio) to IUD insertion immediately after the procedure or 2 to 6 weeks afterward (delayed insertion). The primary outcome was the rate of IUD expulsion 6 months after IUD insertion; an expulsion rate 8 percentage points higher in the immediate-insertion group was defined as inferior.

They found: "Among 575 women who underwent randomization, an IUD was inserted in 100% (258 of 258) of the women in the immediate-insertion group and in 71.3% (226 of 317) of those in the delayed-insertion group. The 6-month expulsion risk was 5.0% (13 of 258 women) after immediate insertion and 2.7% (6 of 226) after delayed insertion, which was consistent with the predefined criterion for noninferiority. Six-month rates of IUD use were higher in the immediate-insertion group (92.3%, vs. 76.6% after delayed insertion). Adverse events were rare and did not differ significantly between groups. No pregnancies occurred in the immediate-insertion group; five occurred in the delayed-insertion group, all in women who never received an IUD."

The authors concluded: "The 6-month rate of expulsion of an IUD after immediate insertion was higher than but not inferior to that after delayed insertion. Immediate insertion resulted in higher rates of IUD use at 6 months, without an increased risk of complications."

On balance immediate insertion of IUD appears to be preferable.


For the full abstract, click here.

N Engl J Med 364:2208-2217, 9 June 2011 © 2011 to the American Medical Association
Immediate versus Delayed IUD Insertion after Uterine Aspiration. Paula H. Bednarek, Mitchell D. Creinin, Matthew F. Reeves, et al. Correspondence to Dr. Bednarek: [email protected]

Category: W. Pregnancy, Family Planning. Keywords: intrauterine device, 1st trimester abortion, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 28 June 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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