Immediate postabortal insertion of intrauterine devices

Cochrane Review by Grimes DA, Lopez LM, Schulz KF, Stanwood N

This record should be cited as: Grimes DA, Lopez LM, Schulz KF, Stanwood N. Immediate postabortal insertion of intrauterine devices. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD001777. DOI: 10.1002/14651858.CD001777.pub2.

ABSTRACT

Title

Immediate postabortal insertion of intrauterine devices

Background

Insertion of an intrauterine device (IUD) immediately after an abortion has several potential advantages. The woman is known not to be pregnant, a major concern for clinicians. Many clinicians refuse to insert an IUD in a woman who is not menstruating. After induced abortion, a woman's motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries potential risks. For example, the risk of spontaneous expulsion may be increased due to recent cervical dilation.

Objectives

To assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion.

Search strategy

We used MEDLINE, POPLINE, and EMBASE computer searches, supplemented by review articles and contacts with investigators.

Selection criteria

We sought all randomized controlled trials with at least one treatment arm that involved IUD insertion immediately after an induced abortion or after curettage for spontaneous abortion. We identified 12 trials which described random assignment. We excluded three since two revealed unethical research conduct, and one used alternate assignment to treatments.

Data collection and analysis

We evaluated the methodological quality of each report and abstracted the data. We focused on discontinuation rates for accidental pregnancy, perforation, expulsion, and pelvic inflammatory disease. Using RevMan 4.2.8, we computed the weighted average of the rate ratios with the inverse variance method. We computed relative risks (RR) for individual studies.

Main results

From the meta-analysis of the multicenter trials, the TCu 220C proved superior to the Lippes Loop D and the Copper 7 IUDs for immediate postabortal insertion. For accidental (intrauterine) pregnancy, the rate ratio for the TCu 220C versus Lippes Loop was 0.38 (95% Confidence Interval (CI) 0.20 to 0.72). Compared to the Copper 7, the estimate for the TCu 220C was 0.52 (95% CI 0.36 to 0.77). For expulsions, the estimates were 0.51 (95% CI 0.30 to 0.88) and 0.58 (95% CI 0.39 to 0.87).

Authors' conclusions

Insertion of an IUD immediately after abortion is both safe and practical. IUD expulsion rates appear higher than after interval insertions.

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