The following is a summary of “Placement of an intrauterine device within 48 hours after early medical abortion—a randomized controlled trial,” published in the January 2023 issue of Obsterics and Gynecology by Hogmark, et al.

Intrauterine devices are known to lower the likelihood of unintended pregnancies and are safe and well-tolerated. Intrauterine devices are inserted at a follow-up appointment after a medical abortion. Patients who skip the appointment run the danger of being without contraception. For a study, researchers sought to determine if placing an intrauterine device within 48 hours of a successful medical abortion up to 63 days gestation resulted in greater usage rates 6 months later than insertion 2 to 4 weeks later. In addition, they compared patient satisfaction, safety, and ongoing intrauterine device usage between groups.

They conducted a multicenter, randomized, controlled, open-label superiority study (phase 3). A total of 240 patients who chose an intrauterine device and requested a medical abortion at up to 63 days’ gestation were randomly assigned to have it implanted either within 48 hours of the abortion (intervention group) or between two and four weeks later (control group). They considered an abortion to be finished when severe bleeding stopped after using misoprostol and the bleeding had stopped completely. At 3, 6, and 12 months, patients responded to surveys. The main result was the use of an intrauterine device six months after the abortion. The expulsion rate, discomfort during placement, adverse events and abortion-related complications, acceptance, and the success of pregnancies were considered secondary outcomes. The Mann-Whitney U test was used to compare differences in nonparametric continuous variables, while the chi-square or Fisher exact test was used to compare differences in nonparametric dichotomous variables. It was deemed statistically significant at a P value of <.05. 

At 6 months following the abortion, 91 of the 111 intervention group participants (82%) compared to 87 of the 112 control group participants (77.7%), representing a 4.3% difference (95% CI, -0.062 to 0.148; P=.51) in the proportion of patients using an intrauterine device. The groups had comparable attendance rates and success rates for implanting intrauterine devices. When the intrauterine device was implanted, patients in the intervention group experienced less pain than those in the control group (mean pain score [visual analogue scale], 32.3; standard deviation, 29; P=.002). In the intervention group (83/111, 74.8%), patients expressed a preference for their assigned time of placement substantially more often than in the control group (70/114, 61.4%; P=.03). In the intervention group (43/108, 39.8%), ultrasonography was used more frequently during intrauterine device implantation than in the control group (15/101, 14.9%; P<.001), and one patient in the control group had a retained gestational sac. It was due to concerns about a complete abortion. The intervention group included 3 patients with vacuum aspirations, compared to the control group’s two patients. In neither group were the rates of the expulsion of intrauterine devices different. 9 of the 97 patients (9.3%) in the intervention group and 4 of the 89 patients (4.5%; P=.25) in the control group both had expulsion in the first six months following abortion. No infections or perforations necessitating antibiotic therapy were seen.

When compared to intrauterine device placement two to four weeks following an abortion, placing an intrauterine device within 48 hours of a medical abortion at 63 days of gestation did not result in greater user rates six months later. Intrauterine device implantation within 48 hours of an early medical abortion looked safe, was favored by patients, and was connected to decreased pain levels when compared with insertion during a follow-up appointment after 2 to 4 weeks.

Reference: ajog.org/article/S0002-9378(22)00646-9/fulltext