IUD placement within 48 hours after second-trimester abortion non inferior to placement after 2 to 4 weeks: Study
Researchers have found that intrauterine device (IUD) placement within 48 hours of a second-trimester medical abortion is associated with increased expulsion rates and lower long-term use compared with placement at 2 to 4 weeks. A recent study was conducted by Sara H. and colleagues published in the American Journal of Obstetrics and Gynecology.
The aim of the research was to establish whether IUD placement within 48 hours would yield higher proportions of women using IUDs at six months post abortion without compromising safety and comfort compared with placement at 2 to 4 weeks postabortion. Eligible study participants were women aged 18 years or older who presented for a second-trimester medical abortion and consented to an IUD. Participants were randomly allocated to receive an IUD within 48 hours of abortion completion or at a later interval, 2 to 4 weeks postabortion. To assess the outcomes, the study made use of modified intention-to-treat and per-protocol analyses, using statistical tests to compare differences.
• Six months after placement, more women continued using the IUD in the delayed-placement group (48 of 67) compared with the early-placement group (34 of 67; P.02). The difference was 20.9% (95% CI, 4.4%–35.9%).
• The principal negative consequence of early placement was an expulsion rate that was markedly higher than that in the control group.
• Compared with the control group (2.9%, or 2 of 70), 30.1% of patients (22 of 73) in the intervention group had IUD expulsion within 48 hours, leading to premature study termination when rates exceeded the prespecified threshold of 20% (P<.001).
• While there was a difficulty experienced during expulsion, adverse events and complications were few, with good acceptability in participants across both groups.
• It indicates that though the danger of expulsion is more where it is placed early on, it can still remain a choice for women that intend to start on their contraceptives right away but after proper counseling for risk.
There was no six-month usage rate benefit for sixteenth-week abortion followed by the placement of an intrauterine device within 48 hours compared with 2 to 4 weeks after the placement. A postabortion contraceptive plan, therefore, must be individualized so that timing is both in accordance with medical recommendations and with the patient's needs.
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