Immediate versus delayed insertion of the levonorgestrel-releasing intrauterine device following dilation and evacuation: a randomized controlled trial

Abstract

Background: The study was conducted to compare 6-month usage of the levonorgestrel-releasing intrauterine device (LNG-IUD) when placed immediately or 3 to 6 weeks after dilation and evacuation (D&E) procedure. Study Design: We enrolled women undergoing D&E at 15 to 23 weeks of gestation. After completion of the D&E, subjects without contraindications to immediate IUD insertion were randomized to immediate or delayed (3 to 6 weeks later) LNG-IUD insertion. Subjects in the immediate group had the LNG-IUD placed using ultrasound guidance. All subjects returned at 3 to 6 weeks and 8 to 10 weeks after D&E and were contacted by phone at 6 months. Results: Of the 93 subjects enrolled, 88 were randomized. All 44 subjects (100%) randomized to immediate insertion had successful IUD placement, while only 20 (45.5%) of the 44 subjects randomized to delayed insertion returned for IUD placement, all of which were successful [difference 54.5%, 95% confidence interval (CI) 39.8%-69.3%]. Seventeen (38.6%) participants in each group were lost to follow-up. Of subjects contacted at the 6-month follow-up phone call, 23 of 27 women (85.2%) and 17 of 27 women (62.9%) were utilizing the LNG-IUD in the immediate and delayed groups, respectively (difference 22.2%, 95% CI −0.4% to 44.8%). Intrauterine device expulsion occurred in three subjects (6.8%) and one subject (5.0%) in whom the IUD was placed in the immediate and delayed groups, respectively (p=1.0). No significant adverse events occurred. Conclusion: Significantly more participants had the LNG-IUD placed in the immediate insertion group compared with the delayed insertion group. Given the low risk of complications, immediate post-D&E insertion of the LNG-IUD should be offered, especially for populations that may have difficulty returning for follow-up.

Immediate versus delayed initiation of the contraceptive patch after abortion: a randomized trial

“…Baseline characteristics of those lost to follow-up differed by race, with Asians least likely to be lost and White women most likely to be lost. Other studies of contraceptive use in diverse, urban settings, including one in our own institution, have not reported differences in loss to follow-up by race/ethnicity [1,16,18,19]. While we cannot explain this finding, it did not differ by study arms, making an effect on our main results unlikely.…”

“…Studies of contraception in the postabortion setting in other institutions have had similar LTFU rates, such as 40% at 6 months in a study of women receiving IUDs after abortion and 46% at 6 weeks in another postabortion IUD study [16,17]. Baseline characteristics of those lost to follow-up differed by race, with Asians least likely to be lost and White women most likely to be lost.…”

Society of Family Planning clinical recommendations: contraception after surgical abortion

“…In this same retrospective analysis, the risk of IUD expulsion associated with second-trimester abortion was significantly higher than the risk associated with first-trimester abortion (7.0% vs. 1.6%, p=.02) [76]. In a small randomized controlled trial, 88 women undergoing second-trimester dilation and evacuation had an LNG-IUD expulsion rate of 6.8% after immediate postabortion insertion; this was not statistically significantly different from the 5.0% expulsion rate following delayed IUD insertion experienced by women in the same study [77]. Prospective studies of immediate postabortion IUD insertion suggest a trend toward greater risk of expulsion with increasing gestational age, although the differences were not statistically significant: 0.8%-2.0% after first-trimester abortion and 3%-7% after second-trimester abortion [78,79].…”

Immediate versus delayed initiation of the levonorgestrel‐releasing intrauterine system following medical termination of pregnancy – 1 year continuation rates: a randomised controlled trial

“…The continuation rate with IUD following immediate insertion at the time of surgical TOP has varied in randomised controlled trials: between 81–92% at 6 months and 68–71% at 1 year . In prospective cohort studies the proportions have been 78–82% at 6 months .…”