|
The Cochrane Collaboration
Cochrane Reviews |
| Explore | New + Updated | Other languages |
|
 |
Immediate postabortal insertion of intrauterine devicesGrimes DA, Lopez LM, Schulz KF, Stanwood NL.
Bookmark this:
     more ...
SummaryInserting an IUD right after abortion or miscarriage versus a later timeInserting an intrauterine device (IUD) right after an abortion or miscarriage can be good for many reasons. The woman is not pregnant and may be thinking about birth control. The time and place are convenient for the woman. If asked to delay IUD insertion, many women do not return to get the device. However, the IUD might be more likely to come out on its own if put in right away. This review looked how safe it was to insert an IUD right after abortion. We also looked at whether the IUD stayed in. We did computer searches for randomized trials of IUDs inserted right after abortion or miscarriage. We also wrote to researchers to find more studies. Trials could compare types of IUDs or times for insertion. Two large trials looked at inserting the IUD right away. The TCu 220C was better than the Lippes Loop and the Copper 7 for preventing pregnancy and staying in. The IUD was more likely to come out on its own when inserted after a mid-pregnancy abortion than after an earlier one. Only one trial compared inserting the IUD right away with a later time. The Copper 7 came out slightly more often on its own when inserted right after abortion. With copper arms added to the Lippes Loop, fewer women got pregnant and the IUD stayed in more often. Also, fewer women got pregnant with the levonorgestrel IUD than with the Nova T. Inserting an IUD right after an abortion or miscarriage is safe and practical.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 24. 2000 AbstractBackgroundInsertion 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. ObjectivesTo assess the safety and efficacy of IUD insertion immediately after spontaneous or induced abortion. Search strategyWe used MEDLINE, POPLINE, and EMBASE computer searches, supplemented by review articles and contacts with investigators. Selection criteriaWe 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 analysisWe 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 resultsFrom 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). Only one trial compared immediate versus delayed insertion. Performance of the Copper 7 inserted right after abortion was somewhat inferior to that after delayed insertion. With the addition of copper arms, the Lippes Loop was improved for preventing pregnancy (RR 3.82; 95% CI 1.41 to 10.36) and expulsion (RR 3.37; 95% CI 1.65 to 6.90). The levonorgestrel IUD prevented pregnancy better than the Nova T. Authors' conclusionsInsertion of an IUD immediately after abortion is both safe and practical. IUD expulsion rates appear higher than after interval insertions. |