Immediate IUD placement following abortion safe, preferred by patients

Placing an IUD within 48 hours of a complete abortion appeared safe and was associated with lower pain scores compared with placement 2 to 4 weeks after abortion, according to a study. This method was also preferred by patients.

“One hypothesis that has previously not been explored was that immediate IUD placement would be less painful than delayed placement due to dilation of the cervix after the abortion,” Sara Hogmark, MD, a PhD student at Karolinska Institutet’s Danderyd Hospital in Stockholm, and colleagues wrote in the American Journal of Obstetrics & Gynecology. “We measured pain scores momentarily on a visual analogue scale, and results clearly showed that patients in the intervention group had significantly lower pain scores during IUD placement compared to patients in the control group.”

The multicenter superiority trial included 240 patients who underwent medication abortion at 63 days’ gestation or earlier and chose to have an IUD placed. Hogmark and colleagues randomly assigned patients in a 1:1 ratio to the intervention group — IUD placement within 48 hours of complete abortion — and to a control group that had IUDs placed during follow-up 2 to 4 weeks after abortion. Complete abortion was defined as cessation of heavy bleeding and blood clots.

Patients answered questionnaires via phone call or email at 3, 6 and 12 months following abortion. The study’s primary outcome was IUD use at the 6-month mark. All other outcomes were evaluated using responses at 3, 6 and 12 months.

Overall, 82% of patients in the intervention group used an IUD at 6 months compared with 77.7% of patients in the control group. The rate of successful IUD placement was similar in both groups, researchers said. The intervention group had lower mean VAS pain scores at IUD placement compared with the control group (32.3 vs. 43.4; P = .002) and were more satisfied with their timing of placement (74.8% vs. 61.4%; P = .03).

Ultrasound was used more often to confirm complete abortion in the intervention group vs. the control group (39.8% vs. 14.9%; P < .001); however, only one patient in the control group had retained a gestational sac. Expulsion rates did not differ between groups.

Although placement of an IUD within 48 hours after a medical abortion did not lead to higher user rates at 6 months, the researchers concluded that the approach “appears safe, is preferred by patients and associated with lower pain scores.”