Timing IUCD insertion post-abortion
QHow soon after a termination of pregnancy is it safe to fit an IUCD?
AThere has been concern that immediate post-abortal IUCD insertion may lead to higher rates of perforation, infection and expulsion. This has led some authors to suggest interval insertion two to six weeks post-abortion, but the potential advantages of immediate IUCD fitting include:
· Immediate contraceptive cover
· Avoids the inconvenience and discomfort of a second fitting procedure
· Provides an opportunity to offer contraceptive advice at a time when most women are highly motivated to sort out effective contraception
· Allows a unique opportunity to address contraceptive needs in users who may have difficulty accessing medical services and may default further follow-up.
Randomised controlled trials have compared the performance of different IUCDs inserted immediately post-abortion. In all these the rates of perforation, infection, expulsion and contraceptive failure have been low and comparable to figures quoted for interval or non-pregnant insertions of similar devices.
Only one randomised controlled trial looked specifically at immediate versus delayed IUCD insertion post-abortion. No statistically significant differences were found between the two groups.
There was a non-significant trend towards higher expulsion rates in the group who underwent immediate insertion. But inferences from this study are limited by its small size and high drop-out rate. Data for immediate IUCD insertion after medical termination of pregnancy is limited. Delaying insertion after second trimester abortion may be advisable.
In conclusion, immediate IUCD insertion after first trimester abortion is safe and effective; evidence suggests perforation and infection rates are not increased. There may be a slightly higher expulsion rate with immediate insertion after first trimester termination and the expulsion rates are increased with immediate insertion following later terminations.
The benefits of immediate insertion need to be balanced against the possibility of a slightly increased expulsion rate for each user. It is important to follow up these women to exclude asymptomatic expulsion.
Dr Jo Power is specialist registrar in community gynaecology and reproductive health at the
Margaret Pyke Centre, London