A trial 1 included a total of 156 subjects undergoing medical abortion with mifepristone and misoprostol and choosing the copper IUD for contraception. Women were randomly assigned to "immediate" insertion 1 week after mifepristone or "delayed" insertion 4-6 weeks later. An IUD was inserted in 97% of participants in the immediate group and 76% in the delayed group. At 6 months, 69% of participants in the immediate group used the IUD compared with 60% in the delayed group. Expulsion rates were comparable; 12% (8/69) in the immediate group compared with 11% (7/65) in the delayed group. Removals occurred in 14% (10/69) of immediate and 8% (5/65) of delayed group participants. Four pregnancies occurred in delayed group participants who did not return for IUD insertion. The immediate and delayed groups reported a median of 20 and 19 bleeding or spotting days, respectively. No cases of serious infection, uterine perforation, or hemorrhage were detected.
In another trial 2, total of 129 women undergoing medical abortion with mifepristone and misoprostol up to 63 days gestation and opting for IUD were randomised to early insertion (day 5-9 after mifepristone) or delayed (routine) insertion (at 3-4 weeks after mifepristone). 116 women had a successful IUD insertion. There was no difference in expulsion rate between early (9.7%) vs. delayed (7.4%) insertion (risk difference -9.2 to13.4). Furthermore, 1.5% of women randomized to early and 11.5% to delayed insertion did not attend the follow up (proportion difference 10.0%, 95% CI 1.8 to 20.6%), and a higher proportion of women (41%) had had unprotected intercourse prior to returning for insertion in the delayed group compared with the early group (16%) (p = 0.015). Adverse events were rare and did not differ between the groups.
In a pilot trial 3 108 women were randomized at HASH(0x2fd0288)63 days' gestation to fast-track (n=55) or delayed (n=53) insertion of levonorgestrel 52-mg intrauterine system (LNG-IUS). Follow-up data at 3 months and 1 year for 41 (74.5%) and 37 (69.8%) women in the fast-track group and 31 (56.4%) and 28 (52.8%) women in the delayed group. By 3 months, expulsion occurred in 6 (12.5%) women after fast-track and 1 (2.3%) woman after delayed insertion (RR 5.50, 95% CI 0.69 to 43.90); most (n=5) of these were partial expulsions in the fast-track group. By 1 year, expulsion had occurred in 7 (14.6%) and 5 (11.5%) women in the fast-track and delayed groups, respectively (RR 1.28, 95% CI 0.44 to 3.75). We found no differences in rates of vacuum aspiration, residual tissue, infection and bleeding or bleeding patterns within 3 months of insertion.
A randomized trial 4 following the above pilot LNG-IUS insertion occurred immediately (same day) or 2-4 weeks following medical abortion. In the the group of gestational age 64-84 days (n=102), the expulsion rates by 3 months were 14 (27.5%) in the immediate-insertion group and 2 (4.0%) in the delayed-insertion group (RR 6.86; 95% CI 1.64 to 28.66). By 1 year the expulsion rates were 17 (33.3%) and 6 (12.0%) (RR 2.78, 95% CI 1.19 to 6.47). Following second-trimester abortion (gestational age 85-140 days, n=57) LNG-IUS expulsion rates by 3 months and 1 year were 5 (18.5%) in the immediate-insertion group and 1 (3.6%) in the delayed-insertion group (RR 5.19, 95% CI 0.65 to 41.54). No differences in adverse effects and bleeding profiles emerged between the groups.
In an open-label, randomized, controlled, multicenter, superiority trial 6 women (n=240) had an intrauterine device inserted within 48 hours of complete medical abortion (intervention group) or at 2 to 4 weeks after abortion (control group). In the intervention group, 82% participants used an intrauterine device at 6 months after the abortion vs 77.7% in the control group, with a difference in proportion of 4.3% (nonsignificant). Attendance rate and rate of successful insertion were similar between the groups. There was a trend towards lower pain scores at immediate insertion. Patients preferred their insertion time significantly more often in the intervention group (74.8%) than in the control group (61.4%). No difference was found in intrauterine device expulsion rates between the groups. There were no perforations or infections requiring antibiotic treatment.
A Cochrane review [Abstract] 5 included 12 studies with a total of 7 119 participants. Five studies examined immediate or delayed insertion of intrauterine devices (IUDs). The expulsion rate of IUD (levonorgestrel-releasing intrauterine system or CuT380A) was more likely for immediate compared to delayed insertion. On the other hand, with immediate compared to delayed insertion also use was more likely and pregnancy less likely. Immediate insertion of Copper 7 was associated with a higher risk of expulsion than was delayed insertion T1. Another trial randomized to the levonorgestrel IUD or Nova T; discontinuation rates due to pregnancy were likely to be higher for women in the Nova T group (MD 8.70, 95% CI 3.92 to 13.48;1 study; n=438; moderate quality evidence). There was no difference in upper genital tract infections between immediate or delayed insertion of IUD
| Outcome | Relative effect(95% CI) | Assumed risk - Control | Corresponding risk - Intervention=Immediate versus delayed insertion of IUD (95% CI) | Number of participants (studies) |
|---|---|---|---|---|
| Expulsion by 6 months | RR 2.9 (1.25 to 6.71) | 15 / 1000 | 43 / 1000(19 to 100) | 878(3) |
| Use at 6 months | RR 1.4 (1.24 to 1.58) | 464 / 1000 | 650 / 1000(575 to 733) | 878(3) |
| Pregnancy at six months | RR 0.37 (0.12 to 1.14) | 23 / 1000 | 9 / 1000(3 to 27) | 878(3) |
Date of latest search: 2024-01-23
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