An intrauterine device (IUD)
is a contraceptive device used in females preferably after an abortion or
childbirth. It is a safe and highly
effective method of contraception with a low failure rate. Once inserted, contraception lasts for 3 to
10 years depending on the type of IUD.
Post childbirth, the IUD is normally inserted after around 6 weeks since
the uterus has to return to its normal size.
Inserting the IUD soon after an abortion reduces the chances of an
unintended pregnancy reoccurring in the near future. The patient can also avoid an extra visit to the hospital. However, the disadvantages of early
insertion include expulsion of the device, perforation into the uterine wall,
infection as well as increased cost to the patient.
Dr. Paula Bednarek and her
colleagues conducted a study to determine the best time to insert an IUD post
first trimester abortion. The results
of the study were recently published in the New England Journal of
Medicine. Women of 18 years of age or
older were enrolled from four medical academic centers from May 2007 to June
2008. These women requested a
first-trimester abortion (between 5 and 12 weeks of pregnancy) and a
contraception post abortion. From a
total of 575 women participating in the study, 317 underwent delayed insertion
of the IUD (2 to 6 weeks following abortion) whereas 258 underwent immediate
insertion (soon after the abortion).
Expulsion of the IUD
occurred in 13 women in the immediate-insertion group and 6 women in the
delayed-insertion group at the end of 6 months after insertion. Most expulsions occurred during the first
two months following insertion. Women
with higher body-mass index had higher chances of expulsion.
Though the number of cases
of expulsion in the immediate-insertion group was slightly higher, the
difference was not significant between the two groups. In addition, there was no significant
difference in complications in the two groups.
The number of women using IUD at 6 months was also higher in the
immediate-insertion group, thus reducing the chances of future unwanted
pregnancies in this group.
The study thus concludes that immediate insertion of IUD post first
trimester abortion could result in a reduced rate of unintended pregnancies
with a similar rate of complications as compared to delayed insertion.
Bednarek PH, Creinin MD, Reeves MF, Cwiak, C, Espey E and Jensen JT for the Post-Aspiration IUD Randomization
(PAIR) Study Trial Group. Immediate
versus Delayed IUD Insertion after Uterine Aspiration. N Engl J Med 2011;