Insertion of intrauterine contraceptives immediately following first- and second-trimester abortions

Drey, Eleanor A.; Reeves, Matthew F.; Ogawa, Dawn D.; Sokoloff, Abby; Darney, Philip D.; Steinauer, Jody E.

doi:10.1016/j.contraception.2008.11.019

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Volume 79, Issue 5 , Pages 397-402, May 2009

Insertion of intrauterine contraceptives immediately following first- and second-trimester abortions☆

Eleanor A. Drey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA
- Corresponding author. San Francisco General Hospital, San Francisco, CA 94110, USA. Tel.: +1 415 206 8358; fax: +1 415 206 3112.
Matthew F. Reeves
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and the Magee-Women's Research Institute, Pittsburgh, PA 15213, USA
Dawn D. Ogawa
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA
Abby Sokoloff
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA
Philip D. Darney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA
Jody E. Steinauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94110, USA

Received 18 January 2008; received in revised form 18 November 2008; accepted 21 November 2008. published online 19 January 2009.

Abstract

Background

The study was conducted to assess the continuation and patient satisfaction with intrauterine contraception (IUC) insertion immediately after elective abortion in the first and second trimesters in an urban, public hospital-based clinic.

Study Design

A cohort of 256 women who elected to have insertion of a copper-T IUC (CuT380a) or a levonorgestrel-releasing IUC (LNG-IUC) were followed postoperatively by phone calls or chart review to evaluate satisfaction and continuation with the method.

Results

Of our 256 subjects, 123 had first-trimester abortions and 133 had second-trimester abortions (14 or more weeks). Median time to follow-up was 8 weeks (range 7–544 days). Nineteen discontinuations occurred: eight (6.5%, 95% CI 2.8–12.4%) following first-trimester and 11 (8.3%, 95% CI 4.2–14.3%) following second-trimester abortion (p=.6). Five women reported expulsion; one (0.8%, 95% CI 0.0–4.4%) in the first-trimester group and four (3.0%, 95% CI 0.8–7.5%) in the second-trimester group. (p=.4) Seven infections resulting in discontinuation occurred (2.7%, 95% CI 1.1–5.6%); none were positive for gonorrhea or chlamydia at time of insertion. No perforations occurred. Nearly all (93.8%) of the women were satisfied with IUC. Rates of satisfaction between women after first- and second-trimester abortions were equal.

Conclusion

In an urban clinic, IUC has high initial continuation and high patient satisfaction when inserted immediately following either first- or second-trimester abortions.

Keywords: Post-abortion contraception, Intrauterine contraception, Intrauterine device, Immediate insertion, Continuation, Patient satisfaction