RHL Commentary by Nguyen Thi Nhu Ngoc
EVIDENCE SUMMARY
The review included nine randomized controlled trials. All but one compared different intrauterine devices (IUDs) inserted immediately following an induced abortion. Only one trial evaluated the safety and efficacy of immediate versus interval (that is, few weeks after abortion) insertion. Overall, the review found immediate post abortion insertion of the IUDs to be safe and effective. Pregnancy rates observed in the trials that compared different IUDs for immediate insertion were about the same when compared with interval insertion (i.e. during or immediately after menses, usually few weeks after an abortion) as well as the occurrence of serious events such as perforation and pelvic inflammatory diseases. However, the expulsion rate of Copper 7 IUD was higher with immediate insertion when compared to interval insertion (Odds ratio: 2.9; 95% Confidence interval: 1.0 - 8.7). IUD insertion after abortion during the second trimester was shown to have higher expulsion rates than during first trimester abortion and therefore was not recommended.
In one recent trial the number of pregnancies were less with levonorgestrel-releasling IUD compared to Nova T.
Counselling is important when IUD insertion is done at the time of abortion.
The woman should be warned that there is a higher likelihood of expulsion when IUDs are inserted after abortion and after second trimester abortions compared to first.
When compared between various types of intrauterine contraceptive device (IUDs), the review has concluded that Copper T 220C is the most appropriate for immediate post abortion insertion because its continuation rate was longer and the expulsion rate was less when compared to other devices. Uterine perforation was a rare event for all types of IUD.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the intervention
Research
References
This document should be cited as: Nguyen Thi Nhu Ngoc. Immediate post abortion insertion of intrauterine devices: RHL commentary (last revised: 18 January 2005). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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