Abstract
Objective
To assess the success and factors affecting early intrauterine device (IUD) provision
after first trimester medical termination of pregnancy (MTOP).
Study design
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.
Implications
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.
Keywords
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Article info
Publication history
Published online: November 08, 2016
Accepted:
October 31,
2016
Received in revised form:
October 28,
2016
Received:
July 8,
2016
Footnotes
☆Funding: This study was supported by Helsinki University Central Hospital Research funds and research grants provided by the Antti and Jenny Wihuri Foundation and the Yrjö Jahnsson Foundation. The sponsors had no role in the planning or carrying out of the study or in analyzing the study results.
☆☆Declaration of interests: OH has served on advisory boards for Bayer Healthcare, Gedeon Richter and MSD Finland (part of Merck & Co. Inc.) and designed and lectured at educational events of these companies. SS has served as an advisor for Exeltis and Gedeon Richter and lectured at educational events of Bayer and MSD Finland (part of Merck & Co. Inc.). The other authors have no conflicts of interests to declare.
★Clinical trial registration: Registered at www.clinicaltrials.gov (NCT01223521).
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
