Immediate Postabortal IUD Placement Safe and Effective, Study Shows

   According to a paper presented at the American College of Obstetricians and Gynecologists' 58th Annual Clinical Meeting in San Francisco, postabortal intrauterine device (IUD)  placement is safe and more effective than usual contraception practices.

   Tania Basu, MD, and colleagues at the Department of Reproductive Medicine, University of California, San Diego, noted that the IUD is one of the most highly effective methods of contraception available today, yet it remains underused. Worldwide, 12% of women of reproductive age use an IUD, but only one percent of U.S. women of reproductive age choose the IUD as their method of contraception. Reasons for underutilization in the United States include misperceptions among both the public and providers regarding the risks associated with the method, especially with expulsion and infection.

   The researchers performed a retrospective cohort study of women from Kaiser Permanente San Diego who underwent a first-trimester abortion between May 2006 and December 2008. The 204 women who received immediate postabortal IUD were compared with a historic cohort of 407 who chose another postabortal contraception. Electronic medical records were reviewed for demographic, medical, perioperative, and postprocedure information. Primary outcomes included pregnancy within one year and repeat abortion rates. Descriptive analyses evaluated safety of postabortal IUD.

   Women who received postabortal IUD were older and more likely to be Latina, married, multiparous and had a previous abortion. Overall, one-year pregnancy (11% vs 23%, P <0.001) and repeat abortion (3% vs 15%, P<0.001) rates were significantly lower in the postabortal IUD group. In the postabortal IUD cohort no perforations occurred, seven (3%) had IUD expulsion, nine (4%) were diagnosed with pelvic inflammatory disease, and three (1%) required postabortal D&C. The IUD removal rate was 17%, primarily for bleeding.

   Dr. Basu and colleagues concluded that immediate postabortal IUD is safe and more effective than routine contraceptive practices in the population studied. It should be available to eligible IUD candidates at the time of abortion, they maintained.